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Background Small airways dysfunction is associated with worse disease control. Hence optimizing peripheral airways deposition using extra fine particles is considered desirable for achieving optimal disease control in asthma and COPD. This in vitro study compared the aerosol performance of BDP/FF/GB pMDI vs BUD/FF/GB pMDI and FLU/VIL/UMEC DPI, focusing on extra-fine particle delivery.Methods The Next Generation Impactor was used to assess aerodynamic particle size distribution at 30 L/min for pMDI’s and 60 L/min for DPI’s. Extra-Fine Particle Fraction (eFPF, ≤1.36 µm) expressed as% of Delivered Dose (DD), and Mass Median Aerodynamic Diameter (MMAD) were compared across all active components.Results BDP/FF/GB pMDI demonstrated substantially greater eFPF vs either BUD/FF/GB pMDI or FLU/VIL/UMEC DPI across all components ( table 1). For the ICS moiety, the eFPF was 7.8-fold higher with BDP/FF/GB pMDI vs BUD/FF/GB pMDI and 14.8-fold vs FLU/VIL/UMEC DPI. For the LAMA moiety BDP/FF/GB pMDI was 6.6-fold higher vs BUD/FF/GB pMDI and 4.0-fold higher vs FLU/VIL/UMEC DPI. Concerning the LABA component, BDP/FF/GB pMDI was 4.2-fold higher vs BUD/FF/GB pMDI and 3.4-fold vs FLU/VIL/UMEC DPI.Moreover, the MMAD was consistently smaller for BDP/FF/GB pMDI vs BUD/FF/GB pMDI or FLU/VIL/UMEC DPI across all moieties, in keeping with homogeneity of the extra fine solution formulation.Abstract P268 Table 11 within the BDP/FF/GB pMDI formulation; 2 within the BUD/FF/GB pMDI formulation; 3 within the FLU/VIL/UMEC DPI formulationConclusions The extra-fine formulation of BDP/FF/GB pMDI delivers a substantially higher proportion of extra-fine particles compared to both BUD/FF/GB pMDI and FLU/VIL/UMEC DPI. These findings suggest greater potential to target small airways, which in turn may be clinically relevant in optimising disease control in asthma and COPD.