Introduction: Proper device selection is crucial in clinical results of inhalation therapy, but none of the available devices fully conforms to the requirements for delivering drug with increased patient adherence, and we are still looking for the ideal inhaler. Consequently, there are several ongoing technical innovations to improve inhaler devices. Areas covered: Progress in pulmonary drug delivery device technology is examined, focusing on innovations in pressurized metered dose inhalers, dry powder inhalers, nebulizers, and soft mist inhalers. Expert opinion: Both formulation improvements and new device technologies have been developed over the last couple of decades through an improved understanding of the mechanisms of aerosolization and lung deposition. Digital health is offering the potential to produce inhalers with a wider range of monitoring capabilities, but further studies are needed, in particular as regards the analysis of cost-effectiveness. Furthermore, there are still substantial issues that must be overcome in order to continually innovate and improve targeted inhaled drug delivery to the lungs. In any case, there are other potential therapeutic possibilities for COPD in development that may be administered by inhalation, whose clinical use requires advances and improvements in the devices used for administration.

In idiopathic pulmonary fibrosis (IPF), lung accumulation of excessive extracellular iron and macrophage haemosiderin may suggest disordered iron homeostasis leading to recurring microscopic injury and fibrosing damage.The current study population comprised 89 consistent IPF patients and 107 controls. 54 patients and 11 controls underwent bronchoalveolar lavage (BAL). Haemosiderin was assessed by Perls' stain, BAL fluid malondialdehyde (MDA) by high-performance liquid chromatography, BAL cell iron-dependent oxygen radical generation by fluorimetry and the frequency of hereditary haemochromatosis HFE gene variants by reverse dot blot hybridisation.Macrophage haemosiderin, BAL fluid MDA and BAL cell unstimulated iron-dependent oxygen radical generation were all significantly increased above controls (p<0.05). The frequency of C282Y, S65C and H63D HFE allelic variants was markedly higher in IPF compared with controls (40.4%versus22.4%, OR 2.35, p=0.008) and was associated with higher iron-dependent oxygen radical generation (HFE variant 107.4±56.0, HFE wild type (wt) 59.4±36.4 and controls 16.7±11.8 fluorescence units per 10⁵BAL cells; p=0.028 HFE variantversusHFE wt, p=0.006 HFE wtversuscontrols).The data suggest iron dysregulation associated with HFE allelic variants may play an important role in increasing susceptibility to environmental exposures, leading to recurring injury and fibrosis in IPF.