According to an article published in the Journal of Aerosol Medicine and Pulmonary Drug Delivery, people have inhaled substances to treat asthma symptoms for at least 3,500 years, from smoking opium in ancient China to breathing in the fumes of burning herbs in ancient Greece. (1) The first known reference to this type of respiratory treatment goes back to an ancient Egyptian papyrus scroll. The papyrus describes people inhaling the vapor of the black henbane plant, or stinking nightshade. The plant was placed on hot bricks, then covered with a jar with a hole in it. People breathed in the vapor through the hole using a reed stalk. It wasn’t until the scientific and technological advancement of the English industrial revolution that the first inhaler was invented. New manufacturing capacities spurred the creation of nebulizers, dry-powder inhalers, and ceramic pot inhalers. The early 20th century also saw the commercialization of asthma cigarettes, ranging in ingredients from stramonium to tea leaves. The major breakthrough came in the 1950s, when the metered dose inhaler (MDI) was invented. The first device to effectively deliver medicine to the lungs, the MDI set the stage for asthma technology to come, including breath-actuated MDIs, spacer devices, and dosage counters. During the 1960s, asthma was recognized as a chronic inflammatory disease. Before this point, many scientists considered it to be a psychological condition — a child’s wheeze was thought to be the suppressed cry for its mother. (2) However, with new medical understanding, effective medication like albuterol (Proventil) became available in the late 20th century. Today, as treatment continues to advance, there is a wide range of asthma inhalers and medications out there. You can now even purchase inhaler sensors to track your treatment electronically. Read on to find out how inhalers have evolved over the years.
The First Inhaler Was Called the Mudge Inhaler
English physician and astronomer John Mudge created the first inhaler in 1778. Based on a pewter tankard, the inhaler allowed people to breathe in an opium vapor to treat what was called a “catarrhous cough,” a cough with a lot of mucus. To operate the inhaler, users would pour water into the tankard, close the lid, and breathe in the steam through a flexible tube inserted into an opening in the cover. Thanks to the new manufacturing and technological capacities brought about by the English industrial revolution, this treatment device became popular in homes and hospitals. It wasn’t used only for alleviating asthma symptoms either but also for administering surgical anesthetic. (3)
From Portable Nebulizers to Dry-Powder Inhalers
The 1800s saw the invention of the first portable nebulizer, named the “Pulverisateur.” The pump handle forced a liquid solution through an atomiser to turn it into a vapor. (4) This treatment was recommended for conditions like pharyngitis, tuberculosis, and asthma. (5) Ceramic pot inhalers were also invented for people to directly inhale the steam of boiling plant or chemical substances that were thought to help their symptoms. Dry-powder inhalers (DPIs), which deliver medicine as a powder, became popular around this time, too. One curious DPI was the carbolic smoke ball, which promised to cure asthma in 10 minutes. Users squeezed a rubber ball, forcing a powder through a sieve to convert it into an inhalable spray. (1)
A 13-Year-Old Girl Inspired the Metered Dose Inhaler
The major breakthrough came in 1956, when George Maison, the president of Riker Laboratories, invented the metered dose inhaler (MDI) using glass vials and valves designed for perfume bottles. (5) It was Maison’s daughter who inspired this invention. Suffering from severe asthma and tired of her ineffective, unwieldy squeeze-bulb glass nebulizer, the 13-year-old asked her father why they couldn’t put her medication in a spray can, like perfume. (1) Spurred by her question, Maison created the first convenient, portable device that effectively delivered medicine to the lungs. This launched the development of MDIs, now the most common device used for treating asthma.
Built-In Spacers and Breath-Actuated Technology
After the invention of the MDI, physicians noticed that for many people, coordinating the motion of pressing the canister down and breathing in was tricky. This resulted in medication staying in the mouth. Medicine was more likely to reach the lungs with a spacer device. This tube holds the released medication between the canister and the mouthpiece of the inhaler, so you can inhale at your own pace. Until the first commercialized spacer was developed in the 1970s, physicians and people with asthma experimented with toilet paper tubes, plastic cups, and empty vinegar bottles. Fortunately, you can now purchase MDIs with built-in spacers. The 1970s also saw the development of breath-actuated MDIs for people finding it difficult to synchronize this motion. With this technology, all you need to do is breathe normally to activate the medication’s release. (1)
Knowing When to Refill With Dose Counters
If you have asthma, it’s essential to monitor your medication to take care of your health. In an effort to help patients know when their inhaler has exceeded or is nearing the last available dose, GlaxoSmithKline Pharmaceuticals developed the first MDI with an integrated dose counter in 2004. All new MDIs are now recommended to have dose counters or dose indicators. Counters show how many sprays the inhaler has left, while indicators turn a different color when the medication’s running low. This means you know exactly when you need to refill, so you’re not caught short when your symptoms flare.
