Drug biodistribution is often secondary to drug action. However, drugs that have a topical action and are deposited into the airway by inhalation are dependent on effective deposition at the intended site of action. Measurement of the distribution of such drugs in the airway is a useful tool. Distribution data can help to interpret clinical results, to evaluate products relative to each other, to optimize a new drug formulation, and to choose effective drug delivery methods. Imaging of radiotracers is the only means available to measure drug deposition throughout the lungs, nasal passages, and sinuses. There are several approaches to imaging drug deposition. Planar imaging has been the most used method, but SPECT and PET imaging are beginning to be applied effectively. The properties of non-drug tracers, labeling of drugs, evaluation of distribution patterns, and quantification of deposited drugs are important issues that have been addressed. Imaging has been shown to be a powerful technique to evaluate and to speed development of inhaled drugs. This review explores the most recent advances and issues with an emphasis on drug development.