leaving space for the small holes on the side of the mouthpiece. 3. Slow inhalation is done while simultaneously pressing the button to release the medication. 4. Breath is held for 5–10 seconds. 5. Slow exhalation is done and steps 1-4 are repeated if another dose of medication is required after waiting for a few minutes. If inhaler is used everyday, the inhaler usually has to be primed the first time using a new cartridge, but it may need to be primed again if it has not been used in multiple days. After use If using inhaled corticosteroids, rinse mouth out directly after use of inhaler. This helps to prevent infection. Nebulizer 1. Mouth is placed over mouthpiece or face mask is placed over nose and mouth 2. The nebulizer machine is turned on. 3. Normal breathing is done for 10-20 min (or time allotted for treatment). 4. Machine is turned off and face mask/mouthpiece remove is removed. History The idea of directly delivering medication into the lungs was based on ancient traditional cures that involved the use of aromatic and medicinal vapors. These did not involve any special devices beyond the apparatus used for burning or heating to produce fumes. Early inhalation devices included one devised by John Mudge in 1778. It had a pewter mug with a hole allowing attachment of a flexible tube. Mudge used it for the treatment of coughs using opium. These devices evolved with modifications by Wolfe, Mackenzie (1872) and better mouth attachments such as by Beigel in 1866. Many of these early inhalers needed heat to vaporize the active chemical ingredient. The benefits of forced expiration and inspiration to treat asthma were noted by J. S. Monell in 1865. Chemicals used in inhalers included ammonia, chlorine, iodine, tar, balsams, turpentine camphor and numerous others in combinations. Julius Mount Bleyer used a variation in 1890 in New York. In 1968, Robert Wexler of Abbott Laboratories developed the Analgizer, a disposable inhaler that allowed the self-administration of methoxyflurane vapor in air for analgesia. The Analgizer consisted of a polyethylene cylinder 5 inches long and 1 inch in diameter with a 1 inch long mouthpiece. The device contained a rolled wick of polypropylene felt which held 15 milliliters of methoxyflurane. Because of the simplicity of the Analgizer and the pharmacological characteristics of methoxyflurane, it was easy for patients to self-administer the drug and rapidly achieve a