Pulmonary mycoses are associated with high morbidity and mortality. The current standard treatment
by systemic administration is limited by inadequate local bioavailability and systemic toxic effects. Aerosolisation
of antifungals is an attractive approach to overcome these problems, but no inhaled antifungal formulation
is currently available for the treatment of pulmonary mycoses. Hence, the development of respirable antifungals
formulations is of interest and in high demand. In this review, the recent advances in the development of antifungal
formulations for pulmonary delivery are discussed, including both nebulised and dry powder formulations.
Although the clinical practices of nebulised parenteral amphotericin B and voriconazole formulations
(off-label use) are reported to show promising therapeutic effects with few adverse effects, there is no consensus
about the dosage regimen (e.g. the dose, frequency, and whether they are used as single or combination
therapy). To maximise the benefits of nebulised antifungal therapy, it is important to establish standardised protocol
that clearly defines the dose and specifies the device and the administration conditions. Dry powder formulations
of antifungal agents such as itraconazole and voriconazole with favourable physicochemical and aerosol
properties are developed using various powder engineering technologies, but it is important to consider
their suitability for use in patients with compromised lung functions. In addition, more biological studies on the
therapeutic efficacy and pharmacokinetic profile are needed to demonstrate their clinical potential.