In contrast, the Turbuhaler, a multidose (ie, requires no loading) breath actuated DPI, delivers only the active ingredient in powder form. Patients are usually unaware of inhaling anything but air. For this reason they need to be warned lest they think no medication is being delivered. This is of critical importance with budesonide, the inhaled steroid delivered via the Turbuhaler, because patients do not receive immediate feedback as to the efficacy of the therapy. In our practice, the Turbuhalerhas become the most popular inhaler device both from the patient’s point of view, with approximately half of new referrals started on or switched to this device, and by our educators who find the technique of use simple to teach. The device is both practical and portable, and does not require use of a spacer device. A further advantage is the formulation of terbutaline and budesonide as pure medication delivered by the Turbuhaler with no additives to be inhaled. This avoids the potential for adverse reactions seen occasionally in patients due the emulsifiers and preservatives contained in most pMDIs. The Diskus, a new multi-dose DPI, recently launched by Glaxo Wellcome will have many of the advantages of the Turbuhaler but with the addition of a dose counter.