Abstract: A small form factor metered dose inhaler is disclosed. The inhaler includes a casing having a longitudinal axis and a transverse axis. The casing has a mouthpiece opening at one end along the longitudinal axis. The casing is configured to house a medicament canister along the longitudinal axis. The medicament canister contains a plurality of doses of a pulmonary medicament and a metered dose valve configured to release a metered dose of the pulmonary medicament through the mouthpiece opening along the longitudinal axis. A mechanical linkage translates an applied input force to the mechanical linkage into an output force along the longitudinal axis configured to actuate the metered dose valve and release the metered dose of the pulmonary medicament in a direction along the longitudinal axis. The aerosolized medicament exits the casing in a fluid flow which is symmetric in a vertical plane along the longitudinal axis.