Inhaler Usage and Aerosol Delivery Techniques in Pulmonary Disease

Inhaled therapy forms the cornerstone of management for asthma, chronic obstructive pulmonary disease (COPD) and other respiratory disorders. A range of devices—including pressurised metered-dose inhalers, dry powder inhalers, soft-mist inhalers and nebulisers—leverages aerosol physics to deposit medication directly in the airways. Optimal aerosol delivery depends on factors such as droplet size distribution, inspiratory flow profile and coordination between actuation and inhalation. Despite technological refinements, suboptimal technique remains a pervasive barrier to effective drug delivery, leading to poor symptom control, increased exacerbations and higher healthcare costs. Training in device handling, periodic reassessment and tailored patient education have emerged as pivotal strategies to sustain proficiency. In parallel, environmental considerations have driven interest in low-climate-impact formulations and device designs. Recent advances include user-friendly inhaler interfaces, smart sensor integration for adherence monitoring and novel spacers to enhance lung deposition. These innovations underscore the global imperative to harmonise clinical efficacy, patient usability and sustainability in aerosol therapy.

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Inhaler Usage and Aerosol Delivery Techniques in Pulmonary Disease publication trend

The graph below shows the total number of articles in inhaler usage and aerosol delivery techniques in pulmonary disease across all publications each year (not limited to Nature Index journals).

Technical terms

Pressurised metered-dose inhaler (pMDI): Device delivering aerosolised drug via propellant under pressure.

Dry powder inhaler (DPI): Breath-activated device releasing powdered medication through patient-generated airflow.

Aerosol: Suspension of fine liquid droplets or solid particles in a gas for inhalation delivery.

Spacer: Chamber attachment that holds inhaled medication to improve timing and lung deposition.

Inhaler technique decay: Progressive loss of proper device use accuracy in absence of reinforcement.

References

1. Recognizing and Tackling Inhaler Technique Decay in Asthma and Chronic Obstructive Pulmonary Disesase (COPD) Clinical Practice. The Journal of Allergy and Clinical Immunology In Practice (2023).
2. Inhalation technique-related errors after education among asthma and COPD patients using different types of inhalers – systematic review and meta-analysis. npj Primary Care Respiratory Medicine (2025).
3. Effect of low climate impact vs. high climate impact inhalers for patients with asthma and COPD-a nationwide cohort analysis. Respiratory Research (2024).
4. Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review. npj Primary Care Respiratory Medicine (2017).
5. Spacer devices for inhaled therapy: why use them, and how?. ERJ Open Research (2018).
6. The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries. BMC Health Services Research (2016).