Metered dose inhalers (MDIs) play a crucial role in managing respiratory diseases, but their effectiveness depends on whether the intended dose is delivered to the target, which can be influenced by various factors. Accurate assessment of MDI performance is crucial for optimizing MDI delivery and ensuring drug efficacy. This study numerically examined the role of evaporation dynamics and dosimetry methods in assessing the efficiency of MDI delivery to different regions in a mouth–lung model extending to the eleventh generation (G11) of lung bifurcations. The experimentally determined spray exit speed, applied dose, and droplet size distribution were implemented as the initial/boundary conditions. Large eddy simulations (LES) were used to resolve the transient inhalation flows, and a chemical species model was applied to simulate vapor and temperature variations in the airflow. A multi-component model was used to consider the heat and mass transfer between the droplets and the airflow. The model was validated against literature data and applied to evaluate the impact of evaporation on pulmonary drug delivery using MDI, in comparison to inert particles. Three methods were used to quantify deposition, which were based on the droplet count, the droplet mass, and the drug carried by the droplets. The results demonstrate that evaporation notably alters the spray droplet size distribution and subsequent deposition patterns. Compared to inert particles, evaporation led to significantly more droplets ranging from 1–5 µm entering the pulmonary region. For a given region, large discrepancies were observed in the deposition fraction (DF) using different dosimetry methods. In the lower lung, the count-based DF (33.9%) and mass-based DF (2.4%) differed by more than one order of magnitude, while the drug-based DF fell between them (20.5%). This large difference highlights the need to include evaporation in predictive dosimetry, as well as to use the appropriate method to quantify the delivery efficiency of evaporating droplets.