Inhaler
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Inhaler
For other uses, seeInhaler (disambiguation).
Aninhaler(orpuffer) is a medical device used for
Ametered-dose inhaler(MDI)
delivering medication into the body via the lungs. It is
mainly used in the treatment ofasthmaandChronic Ob-
structive Pulmonary Disease(COPD).Zanamivir (Re-
lenza), used to treatinfluenza, must be administered via
inhaler.
To reduce deposition in the mouth and throat, and to
reduce the need for precise synchronization of the start
of inhalation with actuation of the device,MDIsare
sometimes used with a complementaryspaceror holding
chamber device.
Decongestantinhalers are popularover-the-counter
remedies fornasal congestionin theupper respiratory
tract.
1 Types
1.1 Metered-dose (MDI)
The most common type of inhaler is the pressurized
metered-dose inhaler(MDI). In MDIs, medication is typ-
ically stored in solution in a pressurized canister that con-
tains a propellant, although it may also be a suspension.
[1]
Two MDIs displaying no. of doses remaining (house key for
scale)
The MDI canister is attached to a plastic, hand-operated
actuator. On activation, the metered-dose inhaler re-
leases a fixed dose of medication inaerosolform. The
correct procedure for using an MDI is to first fully exhale,
place the mouth-piece of the device into the mouth, and
having just started to inhale at a moderate rate, depress
the canister to release the medicine. The aerosolized
medication is drawn into the lungs by continuing to inhale
deeply before holding the breath for 10 seconds to allow
the aerosol to settle onto the walls of thebronchittusand
other airways of the lung. Some inhalers are made to act
instantly in case of an asthma attack, and others are made
to act later.
1.2 Dry powder (DPI)
Dry powder inhalersrelease a metered or device-
measured dose of powdered medication that is inhaled
through a DPI device.
1
For other uses, seeInhaler (disambiguation).
Aninhaler(orpuffer) is a medical device used for
Ametered-dose inhaler(MDI)
delivering medication into the body via the lungs. It is
mainly used in the treatment ofasthmaandChronic Ob-
structive Pulmonary Disease(COPD).Zanamivir (Re-
lenza), used to treatinfluenza, must be administered via
inhaler.
To reduce deposition in the mouth and throat, and to
reduce the need for precise synchronization of the start
of inhalation with actuation of the device,MDIsare
sometimes used with a complementaryspaceror holding
chamber device.
Decongestantinhalers are popularover-the-counter
remedies fornasal congestionin theupper respiratory
tract.
1 Types
1.1 Metered-dose (MDI)
The most common type of inhaler is the pressurized
metered-dose inhaler(MDI). In MDIs, medication is typ-
ically stored in solution in a pressurized canister that con-
tains a propellant, although it may also be a suspension.
[1]
Two MDIs displaying no. of doses remaining (house key for
scale)
The MDI canister is attached to a plastic, hand-operated
actuator. On activation, the metered-dose inhaler re-
leases a fixed dose of medication inaerosolform. The
correct procedure for using an MDI is to first fully exhale,
place the mouth-piece of the device into the mouth, and
having just started to inhale at a moderate rate, depress
the canister to release the medicine. The aerosolized
medication is drawn into the lungs by continuing to inhale
deeply before holding the breath for 10 seconds to allow
the aerosol to settle onto the walls of thebronchittusand
other airways of the lung. Some inhalers are made to act
instantly in case of an asthma attack, and others are made
to act later.
1.2 Dry powder (DPI)
Dry powder inhalersrelease a metered or device-
measured dose of powdered medication that is inhaled
through a DPI device.
1
2 3 HISTORY
1.3 Nebulizers
Nebulizers— supply the medication as an aerosol created
from an aqueous formulation.
1.4 Nasal
Nasal inhalers containdecongestantdrugs to relievenasal
congestionin theupper respiratory tract. The active in-
gredient in most decongestants is eitherpseudoephedrine
orphenylephrine. Many are soldover-the-counterwith-
out a prescription.
2 Propellants
In 2009, the FDA banned the use of inhalers that
utilizechlorofluorocarbons(CFC) as propellants for
hydrofluorocarbons(HFA) inhalers; HFA is not environ-
mentally inert as agreenhouse gasbut does not affect the
ozone layer.
[2]
While some asthma sufferers and advo-
cacy groups contend that the latter are not as effective,
[3]
published clinical studies indicate equivalent control of
asthma is achieved with use of HFA inhalers.
[4]
Inhalers
used to treat asthma contains dry powder spin inhalers
and aerosoles containing suspending liquid medicament,
but in both the cases the size of suspended particles or
powder particles must be less than 5 micrometres so as to
increase the surface area and deliver the drug to the inner
most areas. Such a sufficiently small size of particles is
necessary for dispersion and also for rapid action.
While the impact of CFC of inhalers on the ozone layer
had been minuscule, the FDA in its interpretation of the
Montreal Protocolmandated the switch in propellants.
[2]
Patients expressed concern about the high price of the
HFA inhalers as there is no generic version, which had
been available in the CFC inhalers for many years.
[3]
The
elimination of generics from the market led to a price in-
crease in inhalers that is expected to cost American con-
sumers, insurances and the government about $8 billion
by 2017.
[2]
3 History
The idea of directly delivering medication into the lungs
was based on ancient traditional cures that involved the
use of aromatic and medicinal vapours. These did not in-
volve 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 attach-
ments such as by Beigel in 1866. Many of these early in-
Penetro brand inhaler from mid 20th century Mexico, part of the
permanent collection of theMuseo del Objeto del Objeto.
Inhaler designed by John Mudge in 1778.
halers needed heat to vapourize the active chemical ingre-
dient. The benefits of forced expiration and inspiration to
treat asthma were noted by J. S. Monell in 1865. Chemi-
cals used in inhalers included ammonia, chlorine, iodine,
tar, balsams, turpentine camphor and numerous others in
combinations.
[5]
Julius Mount Bleyerused a variation in
1890 in New York.
[6]
A mouthpiece for an inhaler designed by Dr Beigel (1867).
1.3 Nebulizers
Nebulizers— supply the medication as an aerosol created
from an aqueous formulation.
1.4 Nasal
Nasal inhalers containdecongestantdrugs to relievenasal
congestionin theupper respiratory tract. The active in-
gredient in most decongestants is eitherpseudoephedrine
orphenylephrine. Many are soldover-the-counterwith-
out a prescription.
2 Propellants
In 2009, the FDA banned the use of inhalers that
utilizechlorofluorocarbons(CFC) as propellants for
hydrofluorocarbons(HFA) inhalers; HFA is not environ-
mentally inert as agreenhouse gasbut does not affect the
ozone layer.
[2]
While some asthma sufferers and advo-
cacy groups contend that the latter are not as effective,
[3]
published clinical studies indicate equivalent control of
asthma is achieved with use of HFA inhalers.
[4]
Inhalers
used to treat asthma contains dry powder spin inhalers
and aerosoles containing suspending liquid medicament,
but in both the cases the size of suspended particles or
powder particles must be less than 5 micrometres so as to
increase the surface area and deliver the drug to the inner
most areas. Such a sufficiently small size of particles is
necessary for dispersion and also for rapid action.
While the impact of CFC of inhalers on the ozone layer
had been minuscule, the FDA in its interpretation of the
Montreal Protocolmandated the switch in propellants.
[2]
Patients expressed concern about the high price of the
HFA inhalers as there is no generic version, which had
been available in the CFC inhalers for many years.
[3]
The
elimination of generics from the market led to a price in-
crease in inhalers that is expected to cost American con-
sumers, insurances and the government about $8 billion
by 2017.
[2]
3 History
The idea of directly delivering medication into the lungs
was based on ancient traditional cures that involved the
use of aromatic and medicinal vapours. These did not in-
volve 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 attach-
ments such as by Beigel in 1866. Many of these early in-
Penetro brand inhaler from mid 20th century Mexico, part of the
permanent collection of theMuseo del Objeto del Objeto.
Inhaler designed by John Mudge in 1778.
halers needed heat to vapourize the active chemical ingre-
dient. The benefits of forced expiration and inspiration to
treat asthma were noted by J. S. Monell in 1865. Chemi-
cals used in inhalers included ammonia, chlorine, iodine,
tar, balsams, turpentine camphor and numerous others in
combinations.
[5]
Julius Mount Bleyerused a variation in
1890 in New York.
[6]
A mouthpiece for an inhaler designed by Dr Beigel (1867).
3
In 1968, Robert Wexler ofAbbott Laboratoriesdevel-
oped the Analgizer, a disposable inhaler that allowed the
self-administration ofmethoxyfluranevaporin air for
analgesia.
[7]
The Analgizer consisted of apolyethylene
cylinder 5 inches long and 1 inch in diameter with a 1
inch long mouthpiece. The device contained a rolled
wickofpolypropylenefeltwhich held 15millilitersof
methoxyflurane.
Because of the simplicity of the Analgizer and the
pharmacologicalcharacteristics of methoxyflurane, it was
easy for patients to self-administer the drug and rapidly
achieve a level ofconscious analgesiawhich could be
maintained and adjusted as necessary over a period of
time lasting from a few minutes to several hours. The 15
milliliter supply of methoxyflurane would typically last
for two to three hours, during which time the user would
often be partlyamnesicto the sense of pain; the device
could be refilled if necessary.
[8]
The Analgizer was found to be safe, effective, and sim-
ple to administer inobstetricpatients during childbirth,
as well as for patients withbone fracturesandjoint dis-
locations,
[8]
and for dressing changes onburnpatients.
[9]
When used for labor analgesia, the Analgizer allows la-
bor to progress normally and with no apparentadverse
effectonApgar scores.
[8]
Allvital signsremain normal
in obstetric patients, newborns, and injured patients.
[8]
The Analgizer was widely utilized for analgesia and
sedationuntil the early 1970s, in a manner that foreshad-
owed thepatient-controlled analgesiainfusion pumpsof
today.
[10][11][12][13]
The Analgizer inhaler was withdrawn
in 1974, but use of methoxyflurane as a sedative and anal-
gesic continues in Australia and New Zealand in the form
of thePenthrox inhaler.
[14][15][16][17][18][19]
4 Manufacturers
The largest manufacturers of inhalers areCipla,
GlaxoSmithKline(makers of the Advair Discus, a
DPI),Midascare Pharmaceuticals Pvt Ltd,Merck,
AstraZeneca(makers of Pulmicort and Symbicort) and
Boehringer-Ingelheim(makers of Atrovent, Combivent,
and Spiriva). BI, GSK, Merck, and AstraZeneca man-
ufacture the medication being delivered via inhaler.
However,3MDrug Delivery Systems does some of the
finished product manufacturing, as they are one of the
leaders of MDI canisters, metering valves and other
components.
5 See also
-List of medical inhalants
-Decongestant
6 References
[1]Hickey, A.J., ed. (2004).Pharmaceutical Inhalation
Aerosol Technology(2nd ed.). NY: Marcel Dekker.
[2]Nick Baumann(July–August 2011).“Why You're Paying
More to Breathe”.Mother Jones.
[3]“Asthma Group Concerned “Green” Inhalers May Not be
as Effective | ksdk.com | St. Louis, MO”. ksdk.com. Re-
trieved 2010-11-21.
[4]Hendeles L, Colice GL, Meyer RJ (March 2007).
“Withdrawal of albuterol inhalers containing chloroflu-
orocarbon propellants”(PDF).N. Engl. J. Med.356
(13): 1344–51.doi:10.1056/NEJMra050380.PMID
17392304.
[5]Cohen, J. Solis (1876).Inhalation in the treatment of dis-
ease: its therapeutics and practice. Philadelphia: Lindsay
& Blakiston.
[6]Bleyer, J. Mount (1890). “A new method of larygeal
and bronchial medication by means of a spray and
tube during the act of deep inspiration. Read in
the Section of Laryngology and Otology at the Forty-
first Annual Meeting of the American Medical Asso-
ciation, Nashville, Tenn., May, 1890.”.Journal of
the American Medical Association15(18): 634–636.
doi:10.1001/jama.1890.02410440006001a.
[7]Wexler RE (1968).“Analgizer: Inhaler for supervised
self-administration of inhalation anesthesia”. Abbott
Park, Illinois: Abbott Laboratories. Retrieved 2010-11-
21.
[8]Romagnoli A, Busque L, Power DJ (1970).“The
“analgizer” in a general hospital: a preliminary report”
(PDF).Canadian Journal of Anesthesia17(3): 275–8.
doi:10.1007/BF03004607.PMID5512851.
[9]Packer KJ, Titel JH (1969). “Methoxyflurane analge-
sia for burns dressings: experience with the Analgizer
(subscription required)".British Journal of Anaesthesia
41(12): 1080–5.doi:10.1093/bja/41.12.1080.PMID
4903969.
[10]Major V, Rosen M, Mushin WW (1966).
“Methoxyflurane as an obstetric analgesic: a com-
parison with trichloroethylene”.BMJ2(5529): 1554–61.
doi:10.1136/bmj.2.5529.1554.PMC1944957.PMID
5926260.
[11]Dragon A, Goldstein I (1967). “Methoxyflurane: prelimi-
nary report on analgesic and mood modifying properties in
dentistry (subscription required)".Journal of the Ameri-
can Dental Association75(5): 1176–81.PMID5233333.
[12]Firn S (1972). “Methoxyflurane analgesia for burns dress-
ings and other painful ward procedures in children (sub-
scription required)".British Journal of Anaesthesia44(5):
517–22.doi:10.1093/bja/44.5.517.PMID5044082.
[13]Josephson CA, Schwartz W (1974). “The Cardiff Inhaler
and Penthrane. A method of sedation analgesia in rou-
tine dentistry”.Journal of the Dental Association of South
Africa29(2): 77–80.PMID4534883.
In 1968, Robert Wexler ofAbbott Laboratoriesdevel-
oped the Analgizer, a disposable inhaler that allowed the
self-administration ofmethoxyfluranevaporin air for
analgesia.
[7]
The Analgizer consisted of apolyethylene
cylinder 5 inches long and 1 inch in diameter with a 1
inch long mouthpiece. The device contained a rolled
wickofpolypropylenefeltwhich held 15millilitersof
methoxyflurane.
Because of the simplicity of the Analgizer and the
pharmacologicalcharacteristics of methoxyflurane, it was
easy for patients to self-administer the drug and rapidly
achieve a level ofconscious analgesiawhich could be
maintained and adjusted as necessary over a period of
time lasting from a few minutes to several hours. The 15
milliliter supply of methoxyflurane would typically last
for two to three hours, during which time the user would
often be partlyamnesicto the sense of pain; the device
could be refilled if necessary.
[8]
The Analgizer was found to be safe, effective, and sim-
ple to administer inobstetricpatients during childbirth,
as well as for patients withbone fracturesandjoint dis-
locations,
[8]
and for dressing changes onburnpatients.
[9]
When used for labor analgesia, the Analgizer allows la-
bor to progress normally and with no apparentadverse
effectonApgar scores.
[8]
Allvital signsremain normal
in obstetric patients, newborns, and injured patients.
[8]
The Analgizer was widely utilized for analgesia and
sedationuntil the early 1970s, in a manner that foreshad-
owed thepatient-controlled analgesiainfusion pumpsof
today.
[10][11][12][13]
The Analgizer inhaler was withdrawn
in 1974, but use of methoxyflurane as a sedative and anal-
gesic continues in Australia and New Zealand in the form
of thePenthrox inhaler.
[14][15][16][17][18][19]
4 Manufacturers
The largest manufacturers of inhalers areCipla,
GlaxoSmithKline(makers of the Advair Discus, a
DPI),Midascare Pharmaceuticals Pvt Ltd,Merck,
AstraZeneca(makers of Pulmicort and Symbicort) and
Boehringer-Ingelheim(makers of Atrovent, Combivent,
and Spiriva). BI, GSK, Merck, and AstraZeneca man-
ufacture the medication being delivered via inhaler.
However,3MDrug Delivery Systems does some of the
finished product manufacturing, as they are one of the
leaders of MDI canisters, metering valves and other
components.
5 See also
-List of medical inhalants
-Decongestant
6 References
[1]Hickey, A.J., ed. (2004).Pharmaceutical Inhalation
Aerosol Technology(2nd ed.). NY: Marcel Dekker.
[2]Nick Baumann(July–August 2011).“Why You're Paying
More to Breathe”.Mother Jones.
[3]“Asthma Group Concerned “Green” Inhalers May Not be
as Effective | ksdk.com | St. Louis, MO”. ksdk.com. Re-
trieved 2010-11-21.
[4]Hendeles L, Colice GL, Meyer RJ (March 2007).
“Withdrawal of albuterol inhalers containing chloroflu-
orocarbon propellants”(PDF).N. Engl. J. Med.356
(13): 1344–51.doi:10.1056/NEJMra050380.PMID
17392304.
[5]Cohen, J. Solis (1876).Inhalation in the treatment of dis-
ease: its therapeutics and practice. Philadelphia: Lindsay
& Blakiston.
[6]Bleyer, J. Mount (1890). “A new method of larygeal
and bronchial medication by means of a spray and
tube during the act of deep inspiration. Read in
the Section of Laryngology and Otology at the Forty-
first Annual Meeting of the American Medical Asso-
ciation, Nashville, Tenn., May, 1890.”.Journal of
the American Medical Association15(18): 634–636.
doi:10.1001/jama.1890.02410440006001a.
[7]Wexler RE (1968).“Analgizer: Inhaler for supervised
self-administration of inhalation anesthesia”. Abbott
Park, Illinois: Abbott Laboratories. Retrieved 2010-11-
21.
[8]Romagnoli A, Busque L, Power DJ (1970).“The
“analgizer” in a general hospital: a preliminary report”
(PDF).Canadian Journal of Anesthesia17(3): 275–8.
doi:10.1007/BF03004607.PMID5512851.
[9]Packer KJ, Titel JH (1969). “Methoxyflurane analge-
sia for burns dressings: experience with the Analgizer
(subscription required)".British Journal of Anaesthesia
41(12): 1080–5.doi:10.1093/bja/41.12.1080.PMID
4903969.
[10]Major V, Rosen M, Mushin WW (1966).
“Methoxyflurane as an obstetric analgesic: a com-
parison with trichloroethylene”.BMJ2(5529): 1554–61.
doi:10.1136/bmj.2.5529.1554.PMC1944957.PMID
5926260.
[11]Dragon A, Goldstein I (1967). “Methoxyflurane: prelimi-
nary report on analgesic and mood modifying properties in
dentistry (subscription required)".Journal of the Ameri-
can Dental Association75(5): 1176–81.PMID5233333.
[12]Firn S (1972). “Methoxyflurane analgesia for burns dress-
ings and other painful ward procedures in children (sub-
scription required)".British Journal of Anaesthesia44(5):
517–22.doi:10.1093/bja/44.5.517.PMID5044082.
[13]Josephson CA, Schwartz W (1974). “The Cardiff Inhaler
and Penthrane. A method of sedation analgesia in rou-
tine dentistry”.Journal of the Dental Association of South
Africa29(2): 77–80.PMID4534883.
4 8 EXTERNAL LINKS
[14]Babl F, Barnett P, Palmer G, Oakley E, Davidson A
(2007). “A pilot study of inhaled methoxyflurane for pro-
cedural analgesia in children (subscription required)".Pe-
diatric Anesthesia17(2): 148–53.doi:10.1111/j.1460-
9592.2006.02037.x.PMID17238886.
[15]Grindlay J, Babl FE (2009). “Efficacy and safety of
methoxyflurane analgesia in the emergency department
and prehospital setting”.Emergency Medicine Australasia
21(1): 4–11.doi:10.1111/j.1742-6723.2009.01153.x.
PMID19254307.
[16]Babl FE, Jamison SR, Spicer M, Bernard S (2006).
“Inhaled methoxyflurane as a prehospital analgesic in
children (subscription required)".Emergency Medicine
Australasia18(4): 404–10.doi:10.1111/j.1742-
6723.2006.00874.x.PMID16842312.
[17]McLennan JV (2007).“Is methoxyflurane a suitable bat-
tlefield analgesic?"(PDF).Journal of the Royal Army
Medical Corps153(2): 111–3.doi:10.1136/jramc-153-
02-08.PMID17896540.
[18]Medical Developments International Pty. Ltd. (2009).
“PENTHROX (methoxyflurane) Inhalation: Product In-
formation”(PDF). Springvale, Victoria, Australia: Medi-
cal Developments International Limited. Retrieved 2010-
11-21.
[19]National Prescribing Service(2010).“Methoxyflurane
(Penthrox) for analgesia (doctor’s bag listing)"(PDF).
NPS RADAR. Canberra, Australia: National Prescribing
Service,Department of Health and Ageing. Retrieved
2010-11-21.
7 Further reading
-Patton J (February 1998). “Breathing life into
protein drugs — Inhalation of therapeutic macro-
molecules is a feasible, natural, more people-
friendly, delivery system”.Nat. Biotechnol.16
(2): 141–3.doi:10.1038/nbt0198-141.PMID
9487516.
8 External links
-Basics aspects of inhaled pharmaceutical aerosols
-Recent advances in spray medication technology
-Discrete simulation of powder dispersion in phar-
maceutical aerosol inhalers
[14]Babl F, Barnett P, Palmer G, Oakley E, Davidson A
(2007). “A pilot study of inhaled methoxyflurane for pro-
cedural analgesia in children (subscription required)".Pe-
diatric Anesthesia17(2): 148–53.doi:10.1111/j.1460-
9592.2006.02037.x.PMID17238886.
[15]Grindlay J, Babl FE (2009). “Efficacy and safety of
methoxyflurane analgesia in the emergency department
and prehospital setting”.Emergency Medicine Australasia
21(1): 4–11.doi:10.1111/j.1742-6723.2009.01153.x.
PMID19254307.
[16]Babl FE, Jamison SR, Spicer M, Bernard S (2006).
“Inhaled methoxyflurane as a prehospital analgesic in
children (subscription required)".Emergency Medicine
Australasia18(4): 404–10.doi:10.1111/j.1742-
6723.2006.00874.x.PMID16842312.
[17]McLennan JV (2007).“Is methoxyflurane a suitable bat-
tlefield analgesic?"(PDF).Journal of the Royal Army
Medical Corps153(2): 111–3.doi:10.1136/jramc-153-
02-08.PMID17896540.
[18]Medical Developments International Pty. Ltd. (2009).
“PENTHROX (methoxyflurane) Inhalation: Product In-
formation”(PDF). Springvale, Victoria, Australia: Medi-
cal Developments International Limited. Retrieved 2010-
11-21.
[19]National Prescribing Service(2010).“Methoxyflurane
(Penthrox) for analgesia (doctor’s bag listing)"(PDF).
NPS RADAR. Canberra, Australia: National Prescribing
Service,Department of Health and Ageing. Retrieved
2010-11-21.
7 Further reading
-Patton J (February 1998). “Breathing life into
protein drugs — Inhalation of therapeutic macro-
molecules is a feasible, natural, more people-
friendly, delivery system”.Nat. Biotechnol.16
(2): 141–3.doi:10.1038/nbt0198-141.PMID
9487516.
8 External links
-Basics aspects of inhaled pharmaceutical aerosols
-Recent advances in spray medication technology
-Discrete simulation of powder dispersion in phar-
maceutical aerosol inhalers
5
9 Text and image sources, contributors, and licenses
9.1 Text
-InhalerSource:https://en.wikipedia.org/wiki/Inhaler?oldid=717360510Contributors:Shyamal, Fuzheado, Raul654, Zandperl, Bkell, Jfd-
wolff, Chowbok, Sonjaaa, Discospinster, Bobo192, Davidruben, Brim, Themindset, Hooperbloob, Zerofoks, RJFJR, Alai, Ceyockey,
PoccilScript, Ekem, Mandarax, Rjwilmsi, Maurog, FlaBot, Nlu, Encephalon, Thrustinj, Veinor, SmackBot, Yamaguchi , Bluebot, RD-
Brown, Thumperward, Roscelese, JonHarder, Psellis, Radagast83, Dcamp314, Joseph Solis in Australia, LadyofShalott, Rsteif, Thatbox,
CmdrObot, Skittleys, Epbr123, CowardX10, Rcej, Jeff Dahl, Careless hx, Dep. Garcia, Tins128, Aetkin, Ijustam, Omniconnexus Liber-
atis, CWii, Sweetness46, Qxz, Jackecko, Doc James, RonEJ, GirasoleDE, Lightmouse, Thelmadatter, ClueBot, The Thing That Should Not
Be, Sebkaerger, Gregmcc, Excirial, Dank, DumZiBoT, Wikiuser100, MystBot, Thatguyflint, Addbot, Tongzhenbo, Sillyfolkboy, Luckas-
bot, Amirobot, Quantumclimber, DiverDave, Daniele Pugliesi, Piano non troppo, Jmarchn, ArthurBot, TechBot, Nitrxgen, Twirligig,
Nikhilpatel25132, Steven.huffer, FrescoBot, Suenica, I dream of horses, HRoestBot, World wide wilson, Tinton5, Gladheart, Whisky
drinker, Danish Expert, Wham Bam Rock II, ChuispastonBot, ClueBot NG, Peter James, Gilderien, Djhinds, Mark Arsten, Silvrous, Je.rrt,
CitationCleanerBot, BattyBot, Rajasathishkumar, YFdyh-bot, Johnscotaus, Monkbot, Filedelinkerbot, Kekki1978 and Anonymous: 64
9.2 Images
-File:Action_photo_of_nasal_spray_on_a_black_background.jpgSource:https://upload.wikimedia.org/wikipedia/commons/a/a7/
Action_photo_of_nasal_spray_on_a_black_background.jpgLicense:CC BY 2.0Contributors:http://www.flickr.com/photos/robin24/
5222119114/in/photostreamOriginal artist:robin_24
-File:Beigel_mouthpiece.jpgSource:https://upload.wikimedia.org/wikipedia/commons/b/b2/Beigel_mouthpiece.jpgLicense:Public do-
mainContributors:Cohen, J. Solis (1876)Inhalation in the treatment of disease: its therapeutics and practice, invalid ID: Lindsay & Blakiston
Original artist:J. Solis Cohen
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Contributors:Cohen, J. Solis (1876)Inhalation in the treatment of disease: its therapeutics and practice, invalid ID: Lindsay & Blakiston
Original artist:J. Solis Cohen
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