Inhaled therapy has a central role in both asthma and COPD management. There are many advantages of inhaled therapy compared to systemic therapy. The principal types of devices used to generate therapeutic aerosols are pressurized metered dose inhalers (pMDIs), dry powder inhalers (DPIs), soft mist inhalers (SMIs) and nebulizers. There is a wide range of inhaler devices on the market, among which the clinician chooses the one most suitable for their patient. Correct inhaler technique and adherence to therapy are of major importance for effective treatment of asthma and COPD. Asthma and COPD patients commonly make critical mistakes while using their inhalers, as well as show poor adherence to their therapy. Possible solutions to aforementioned problems are proper clinician and patient education and a personalized approach to inhaler choice. It is very important to include patients‘ preferences while making decisions about their inhaled therapy. Inhaled medications in COPD management include long- and short-acting bronchodilators (SABA, SAMA, LABA, LAMA), inhaled corticosteroids (ICS), and a number of their combinations (LAMA/LABA, ICS/LABA, ICS/LABA/LAMA). According to the GOLD guidelines, initial management of COPD is based on the symptom severity, the level of dyspnea, and the risk of exacerbations. In the follow up management, therapy regime can be modified according to the patient‘s leading problem – persistent dyspnea or exacerbations. The goal of asthma treatment is to achieve disease control, which means both symptom control and control of exacerbations and other adverse events. Two basic groups of medications are used to achieve that: reliever (ICS/formoterol or SABA) and controller medications. The latest GINA guidelines recommend two tracks in the choice of controller medication, which differ in the chosen reliever. The recommended track is the one where ICS/formoterol is used as a reliever, due to its more effective exacerbation prevention and a lack of safety with SABAs. Initial choice of controller medication is based on first presentation symptom severity. In the follow up management the treatment can be stepped up or down, depending on whether complete disease control was achieved. Asthma severity is assessed retrospectively according to the controller medication that was necessary to achieve the control of the disease.