Atomization has been widely applied in pulmonary drug delivery as a promising technology to transport drug formulations directly to the respiratory tract in the form of inhaled particles or droplets. Because of the targeted treatment, the drug can be delivered directly to the site of inflammation, thus the need for systemic exposure and the possibility of side effects are both reduced. Therefore pulmonary drug delivery has significant advantages over other methods in the treatment of respiratory diseases such as asthma. The most common atomization methods employed in pulmonary drug delivery are jet atomization and ultrasonic atomization. However, the difficulty is in producing monodispersed particles/droplets in a size range of 1–5 micron meter in diameter, necessary for deposition in the targeted lung area or lower respiratory airways, within a controllable fashion. In this paper, we demonstrate surface acoustic wave (SAW) atomization as an efficient technique to generate monodispersed aerosol to produce the required size distribution. The SAW atomizer is made of a 127.86 Y-X rotated single-crystal lithium niobate piezoelectric substrate, which is patterned with chromium-aluminum interdigital transducer (IDT) electrodes via UV lithography. When an alternating electric field is applied onto lithium niobate substrate through the IDT, a SAW, propagating across substrate surface with ten nanometer order amplitudes, is generated. When the SAW meets the liquid which is placed upon substrate, the acoustic energy carried by the wave induces atomization of the working fluid, which contains salbutamol as a model drug. In order to measure the size distribution of the atomized droplets, two methods are used. One is the laser diffraction based Spraytec technique and the other is an in-vitro lung modelthe one stage glass twin impinger. The former revealed that the mean diameter of the aerosol atomized was around 3 um which were confirmed by the lung model that demonstrated that nearly 80% of atomized drug aerosol was deposited in the simulated lung area. Moreover, the SAW atomizer only requires 1–3 W driving power, suggesting that it can be miniaturized for portable consumer use.