A combination spray containing two bronchodilators (Combivent), albuterol and ipratropium bromide, has already been marketed in the United States. Battery-Powered DPI One of the disadvantages of current DPls is that they are "breath activated." A patient who is unable to inhale vigorously may not receive a full dose of medication. A battery-driven, multiple dose DPI should be available in the near future. A device known as Spiros has been developed by Dura and is awaiting FDA approval. This device has a battery operated motor that provides the energy necessary to whip the powdered drug into an aerosol that can be inhaled. Recent studies of the Spiros device have shown consistent levels of drug delivery to human subjects. Albuterol, beclomethasone, and ipratropium bromide are expected to be made available in a Spiros delivery system within the next two years. "Soft Mist" Inhaler A novel alternative to both CFC-containing MDls and DPls is the RESPIMAT device (Boehringer Ingelheim), which is currently under study. This handheld, multidose device uses mechanical power from a spring rather than gas propellants to release doses of solutions for inhalation through a system of nozzles. Studies of this "soft mist" inhaler have revealed that it delivers greater lung deposition of medication compared to propellant MDls and most DPls. This greater delivery of medication may allow asthmatics to be treated with lower daily dosages of medication. The Next GenerationThe next generation of asthma medications will most likely provide more sustained relief of symptoms with fewer puffs of medication. This should allow patients to use medication once or twice a day and still maintain control over their asthma. These new drugs will also be more specific antagonists of the chemicals that produce inflammation and bronchoconstriction. Future treatment of asthma will also likely include an anti-IgE vaccine that prevents allergic reactions and reduces the frequency of asthmatic attacks.