The pulmonary route offers a non-invasive method of delivering drugs directly to the lungs, minimizing exposure to other organs, and is a promising alternative to intravenous administration for monoclonal antibodies (mAbs), which are poorly transferred from the blood to the lungs. Inhalation of mAbs has been proposed to improve their efficacy in the treatment of lung diseases. However, pulmonary delivery poses challenges in terms of aerosol technology and inhalation formulation. This chapter covers the pharmacological properties of antibody-based treatments for respiratory diseases and discusses the preclinical and clinical results of aerosolized mAbs. It outlines the advantages and disadvantages of aerosol devices and inhalation formulations, as well as strategies to overcome the associated barriers. Despite the difficulties in delivering mAbs by inhalation, this method remains attractive. Effective production of inhaled mAbs requires careful consideration of the disease, patient demographics, interactions of the therapeutic molecule with the lung barriers, formulation, excipients, and delivery systems. Addressing issues of instability and protein aggregation and developing new excipients and carriers are critical for stable and effective inhaled mAbs. Novel carriers could improve protein stability and pharmacokinetics. Overall, inhalation is a viable and appropriate method for therapeutic mAb delivery, with mesh nebulizers being the most suitable devices for safely delivering large amounts of active mAb to the lungs. Formulations must prevent mAb degradation and potential immunogenicity. While there are general guidelines for mAb aerosolization, formulations and device combinations should be tailored to specific therapeutic and clinical applications.