呼吸系统疾病是一个全球性的健康问题。最近爆发的Sars-CoV-2疫情，肺癌和炎症性呼吸系统疾病的负担迫切要求发展创新的治疗解决方案。在这种情况下，治疗性抗体（Ab）为呼吸系统疾病患者带来了巨大的机会。通过呼吸道输送抗体已被证明可以改善其治疗指数。然而，市场上仅有少量的吸入抗体产品。本综述描述了可能影响吸入治疗性抗体在肺中命运的不同屏障。它涉及物理和生物屏障，并讨论了考虑呼吸系统疾病期间的病理变化对这些屏障的重要性。肺部途径仍然很少用于传递治疗性抗体，尽管有有希望的证据，但批准的吸入分子很少。努力应集中于与肺部疾病相关的相互关联的屏障，以开发适当的抗体-制剂-设备组合，确保在呼吸道中最佳的抗体沉积。最后，应进行随机对照临床试验，以确立吸入治疗性抗体疗法在呼吸系统疾病中的重要性。

Respiratory diseases represent a worldwide health issue. The recent Sars-CoV-2 pandemic, the burden of lung cancer and inflammatory respiratory diseases urge for the development of innovative therapeutic solutions. In this context, therapeutic antibodies (Ab) offer a tremendous opportunity to benefit to patients with respiratory diseases. Delivering Ab through the airways has been demonstrated relevant to improve their therapeutic index. However, few inhaled Abs are on the market.This review describes the different barriers that may alter the fate of inhaled therapeutic Abs in the lungs at steady state. It addresses both physical and biological barriers and discusses the importance of taking into consideration the pathological changes occurring during respiratory disease, which may reinforce these barriers.The pulmonary route remains rare for delivering therapeutic Abs, with few approved inhaled molecules, despite promising evidence. Efforts must focus on the intertwined barriers associated to lung diseases to develop appropriate Ab-formulation-device combo ensuring optimal Ab deposition in the respiratory tract. Finally randomized controlled clinical trials should be carried out to establish inhaled Ab therapy as prominent against respiratory diseases.