The pressurized metered-dose inhaler (pMDI) was introduced to deliver asthma medications in a convenient and reliable multi-dose presentation. The key components of the pMDI device (propellants, formulation, metering valve, and actuator) all play roles in the formation of the spray, and in determining drug delivery to the lungs. Hence the opportunity exists to design a pMDI product by adjusting the formulation, metering-valve size, and actuator nozzle diameter in order to obtain the required spray characteristics and fine-particle dose. Breath-actuated pMDIs, breath-coordinated pMDIs, spray-velocity modifiers, and spacer devices may be useful for patients who cannot use a conventional press-and-breathe pMDI correctly. Modern pMDI devices, which contain non-ozone-depleting propellants, should allow inhalation therapy via pMDI to extend well into the 21st century for a variety of treatment indications.