Soft mist, dry powder, and smart inhalers: comparative technologies and clinical impact on asthma and COPD management

Abstract Asthma and chronic obstructive pulmonary disease (COPD) continue to pose significant global health burdens, with optimal inhalation therapy being central to effective disease control. Despite advancements in pharmacotherapy, suboptimal inhaler technique and poor adherence hinder therapeutic outcomes. This review offers a comprehensive comparison of soft mist inhalers (SMIs), dry powder inhalers (DPIs), and smart inhalers, with a focus on their technological design, clinical efficacy, and applicability in diverse patient populations. SMIs, such as Respimat®, deliver slow-moving aerosols independent of patient inhalation effort, ensuring efficient lung deposition with minimal coordination. DPIs rely on inspiratory flow to aerosolize dry powders, offering breath-actuated delivery but requiring sufficient pulmonary effort. Smart inhalers integrate sensors, mobile connectivity, and AI to monitor adherence, optimize technique, and enhance disease monitoring through telemedicine platforms. Key factors such as particle size, plume velocity, and deposition dynamics are discussed in detail, highlighting how each device performs in varying clinical scenarios. Comparative data reveal differences in drug delivery efficiency, patient satisfaction, and adherence across device types. Special considerations for pediatric, geriatric, and comorbid populations are explored, alongside emerging trends like AI-driven analytics and nanoparticle-assisted pulmonary delivery. This review also addresses cost-effectiveness, regulatory concerns, and implementation strategies within clinical workflows. Best-practice recommendations are presented to guide device selection, patient training, and personalized respiratory care. Bridging current gaps in inhaler technology and clinical practice is crucial in realizing the full potential of inhalation therapy in the management of chronic respiratory diseases.