There are a number of driving forces behind the considerable development in this subject since the early 1990s. Environmental concerns caused a move from chlorofluorocarbon (CFC) propellants to newer hydrofluoroalkane (HFA) propellants for metered-dose inhalers (MDIs). These concerns were also partially responsible for the creation of newer dry powder inhalers (DPI). Such DPI devices were also a response to a need for less demanding hand-chest coordination, which some patients found difficult with conventional MDIs. Coordination was also responsible in part for a move to the use of spacer devices, as was also the need to improve lung delivery of inhaled drug. The latter need also provided an impetus to improve nebulizer devices and inhalation techniques for their use. Perhaps the greatest incentive for product advancement is the marketplace; and for these common diseases for which patients take many medications, the marketplace is huge. Without this potential, there would not be nearly so much advancement in devices to deliver aerosols and new drugs to be delivered.
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