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Is there a perfect inhaler? All have their advantages and disadvantages, but the proper technique and compliance can assure that one inhaler is just right for your patient.

Aerosol therapy, while a very old method of drug delivery, has become the mainstay of therapy for patients with respiratory disease. Inhalers have been used for more than 80 years, but it was not until the mid 50s that both the hand-held jet nebulizer and the metered-dose inhaler (MDI) were approved for clinical use. The last device added to the list was the dry-powder inhaler (DPI) in 1971.1 While performance of almost every available device is far from providing consistent drug delivery, available evidence has demonstrated that inhalation is the route of choice for the treatment of respiratory diseases.

Over the last few years, newly designed inhaler devices have dramatically improved lung deposition. Their technology and mode of operation may vary considerably, however. The proliferation of inhaler devices has provided the clinician with a wide selection to optimize aerosol therapy; nevertheless, it has also made it more challenging and at times confusing for both clinicians and patients. New guidelines call for evaluation of adherence not only to medical advice but also to inhalation technique when the patient's disease is poorly controlled.2 In this article we attempt to review general features of the inhaler devices, their advantages, and their limitations, and provide some guidance in making the right selection of inhalers for patients with respiratory disease.

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