Patient compliance and techniques used with inhalation devices can strongly influence the effectiveness of inhaled medications but these issues are often poorly recognized and may be neglected when these products are prescribed. The extent of these problems and the success of differing education and training programs designed to improve inhaler technique have been evaluated by a review of the literature using Medline, EMBASE and Biosis Database from 1985 to date.Drug delivery to the airways to optimize clinical response and improve compliance is dependent on correct technique, which requires educational and motivational programs aimed at patients and healthcare providers. Written instructions alone are often insufficient; practical demonstration is also required. Frequent reassessments and re-education for patients and healthcare professionals are necessary, as correct technique usually deteriorates over time. This all necessitates dedicated resources, which may be a problem in the current cost-containment climate. Treating acute symptoms immediately provides feedback on technique, but the intensive learning needed to reinforce correct inhaler technique may make the use of inhalers problematic for short treatment courses of acute diseases. To maximize therapeutic benefit from inhaled medications, long term educational programs involving verbal and practical demonstrations must accompany inhaler use, and techniques should be frequently reassessed, particularly in children and the elderly.