Accurate diagnosis is crucial to improve the treatment and prognosis of respiratory disease, especially lung cancer. Tumors and lesions located deep in the lung are directly accessible via dendritic tracheal bronchus, thereby opening a new way to tackle respiratory disease. Intratracheal delivery is an innovative, noninvasive approach for imaging and treating respiratory disease efficiently, when compared with other delivery methods. Intratracheal delivery of nanoand microparticles and hyperpolarized gases offers valuable clinical advantages, such as assessing lung function, monitoring ventilation and perfusion, controlling disease progression, and inhibiting tumor growth. Especially, versatile nanosized particles have enormous potential to benefit precision imaging and therapy at the molecular level. Here we discuss advances of intratracheal delivery of nano-and microparticles and hyperpolarized gases for respiratory disease imaging and treatment, with an emphasis on intratracheal nanoparticles delivery for pulmonary imaging, which has extremely valuable clinical applications in precise theranostics for respiratory disease.