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Prevalence is unknown. So far, nearly 10 cases have been reported worldwide.

Clinical manifestations are similar to other forms of botulism, with symmetrical cranial nerve palsies followed by descending, symmetric flaccid paralysis of voluntary muscles, which may progress to respiratory compromise and death.

The disease results from accidental or intentional release of aerosolized BoNTs. After inhalation, the toxin is absorbed into the blood stream and distributed throughout the body, causing the typical manifestations of botulism. The time to onset of inhalational botulism cannot be stated with certainty as few cases are known or because of repeated exposure. Accidental cases were initially reported in three laboratory workers and more recently in illicit drug users after intranasal use of cocaine, through sinusitis and possible sinus colonization and toxicogenesis, or through direct absorption by the nasal mucosa of preformed toxin in contaminated street cocaine. Deliberate dissemination of BoNTs by aerosol could produce an outbreak of inhalational botulism in a large number of simultaneous cases with a common geographic factor, but without common dietary exposure and, possibly, with an unusual BoNT type (e.g. type C, D, F, G). All cases of botulism should be reported to the appropriate government agency.