Abstract:
An inhaler device and a method of treating various symptoms associated with the airway and/or throat and/or respiratory system of a patient. The device is particularly designed to reduce swelling and inflammation of the larynx and or upper respiratory track, such as swelling and/or inflammation that result from croup, laryngitis&#39;s, laryngotracheobronchitis, and other diseases and conditions. In its method aspects, the present invention includes inhaling (or forcing manually or automatically) cool and/or moist air from the device to cause cool and/or moist air to enter the airways of the patient.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    The present invention relates to inhalation apparatus for the relief from symptoms of various respiratory illnesses, and to methods of treating such symptoms. 
         [0002]    There are a number of diseases and conditions that may cause upper respiratory tract symptoms that result in considerable discomfort. Exemplary diseases and conditions include the common cold, croup, laryngitis, Laryngotracheobronchitis, bronchitis, strep throat, mononucleosis, whooping cough (pertussis), respiratory tract infections, respiratory syncytial virus (RSV), flu, pneumonia, allergies, asthma, tonsillitis, etc. Exposure to severe environmental conditions, such as excessive heat during a fire or exposure to toxic gases may result in similar symptoms and cause similar discomfort. 
         [0003]    Various remedies that attempt to reduce or alleviate such discomfort are available, including vapor rubs, cough drops and lozenges, humidifiers, vaporizers, etc. These remedies, however, suffer from various disadvantages. For example, humidifiers, cool mist vaporizers or ultrasonic nebulizers require confining the patient to a relatively small area, as does the use of a hot shower, which confines the patient to a space that is relatively small and that can be very uncomfortable. Bacteria and fungi can grow in the filters and water tanks of portable and console humidifiers, and can be aerosolized and distributed throughout the room. Cough drops and lozenges can have high sugar content and can be high in calories. 
         [0004]    It would therefore be desirable to provide a device that is inexpensive and convenient to use, and that reduces or eliminates the foregoing discomforts without suffering from the drawbacks of the prior art. 
       SUMMARY OF THE INVENTION 
       [0005]    The problems of the prior art have been overcome by the present invention, which provides an inhaler device and a method of treating various symptoms associated with the airway and/or throat and/or respiratory system of a patient. The device is particularly designed to reduce swelling and inflammation of the larynx and or upper respiratory track, such as swelling and/or inflammation that result from croup, laryngitis&#39;s, laryngotracheobronchitis, and other diseases and conditions including those mentioned above. The device does not require that the user wear a mask. 
         [0006]    In certain embodiments, the device includes a housing containing a low temperature material and having an air flow passageway, such that when a patient inhales from the device, air travels into the air flow passageway and is cooled (and/or humidified) by the low temperature material as it travels through the device. The now cooled air exits the device and enters the airways of the patient. 
         [0007]    In its method aspects, the present invention includes inhaling (or forcing manually or automatically) cool and/or moist air from the device to cause cool and/or moist air to enter the airways of the patient. 
         [0008]    The device can be hand-held, or can be supported on a substrate such as the floor, a table or similar stand. 
     
    
     
       BRIEF DESCRIPTION OF THE INVENTION 
         [0009]      FIG. 1  is an exploded view of a device in accordance with certain embodiments; 
           [0010]      FIG. 2  is a cross-sectional view of the device in its assembled condition in accordance with certain embodiments; 
           [0011]      FIG. 3  is a cross-sectional view of an inner housing of the device in accordance with certain embodiments; 
           [0012]      FIG. 4  is a bottom view of the inner container of  FIG. 3 ; 
           [0013]      FIG. 5  is a cross-sectional view of an insert for the inner housing in accordance with certain embodiments; 
           [0014]      FIG. 6  is a side view of a center pipe in accordance with certain embodiments; 
           [0015]      FIG. 7  is a cross-sectional view of the cover of the device in accordance with certain embodiments; 
           [0016]      FIG. 8  is a top view of the cover of  FIG. 7 ; 
           [0017]      FIG. 9  is a side view of the cover of  FIG. 7 ; 
           [0018]      FIG. 10  is a bottom view of the cover of  FIG. 7 ; 
           [0019]      FIG. 11  is a top view of the twist cap in accordance with certain embodiments; 
           [0020]      FIG. 12  is a cross-sectional top view of a mouthpiece in accordance with certain embodiments; 
           [0021]      FIG. 13  is a cross-sectional side view of a mouthpiece in accordance with certain embodiments; 
           [0022]      FIG. 14  is a front view of the mouthpiece in accordance with certain embodiments; and 
           [0023]      FIG. 15  is a perspective view of an air bulb suitable for use with certain embodiments. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0024]    Turning first to  FIG. 1 , there is shown a device  10  in accordance with certain embodiments of the present invention. The device  10  includes an outer housing  12  that is shown in the shape of a truncated cone, tapering from the top end towards the bottom end. Those skilled in the art will appreciate that other shapes, including cylinders, rectangles, and irregular polygons are suitable and are within the scope of the invention. Preferably the outer housing is rigid, liquid impervious, and is durable. Suitable materials include plastics, polypropylene, polyvinyl chloride, polytetrafluoroethylene (TEFLON), polyethylene, polycarbonate, styrofoam, polystyrene, acrylic, metal, glass, etc. The most preferred material is FDA approved low density polyethylene. The outer housing  12  can be made to have antimicrobial and/or antibacterial properties, such as by coating or embedding an antimicrobial and/or antibacterial agent therein. The outer housing  12  is open at its top end and closed at its bottom end, and can include external threads  13  at or near the top end for mating with a cover as described in greater detail below. 
         [0025]    A disc-shaped removable base  15  may be provided to help support and balance the assembly in an upright position. The base  15  is preferably circular, having a diameter larger than the diameter of the base of the outer housing  12 . A raised annular collar  16  having a diameter slightly larger than the diameter of the bottom of the outer housing can be provided on the base  15  and is used to receive or engage the outer housing  12  to support the same in the base  15 . A plurality of inner ribs  17  help secure the outer housing  12  in the annular collar  16 . To further secure the outer housing  12  in the base  15 , a second smaller raised annular collar  18  can be provided in the base  15  to mate with a smaller raised annular collar  19  formed in the bottom of the outer housing  12 . The outer diameter of the collar  19  is slightly smaller than the inner diameter of the second raised annular collar  18  so that it fits snuggly within the annular collar  18  by frictional engagement. Those skilled in the art will appreciate that the foregoing combination of annular collars are merely exemplary ways to secure the outer housing  12  to the base  15 , and that alternative mechanisms can be used and are within the scope of the invention. 
         [0026]    An air flow passageway is formed in the outer housing  12  such as with an inner housing  20  defining a perforated chamber, as best see in  FIGS. 1-3 . Preferably the inner housing  20  has a general shape substantially similar to that of the outer housing  10 , and most preferably it is shaped as a truncated cone, tapering from the top end towards the bottom end. Preferably the inner housing is rigid, liquid impervious, is durable, and can be made of the same materials suitable for the outer housing  12 . An FDA approved low density polyethylene is particular preferred. It also can be modified to have antimicrobial and/or antibacterial properties. The inner housing  20  is generally smaller in diameter than the outer housing  12 , such that the outer housing can contain the inner housing when the device  10  is assembled, and such that a gap  30  between the wall of the outer housing  12  and the wall of the inner housing  20  is formed defining the air flow passageway. The inner housing  20  includes a top annular collar or flange  21  that has a greater diameter than the remainder of the housing  20 . Preferably the diameter of the collar  21  is about equal to the diameter of the top rim of the outer housing  12 , such that when the inner housing  20  is placed in the outer housing  12 , the collar  21  sits on the top rim of the outer housing  12  and is supported thereby. The bottom of the collar  21  can include a radially inward annular ring  26  that is spaced from the circumferential outer end of the collar a sufficient distance such that when the inner housing  20  is positioned in the outer housing  12 , the annular ring  26  abuts against the inner wall of the outer housing  12 , just below the top rim thereof. Alternatively or in addition, the inner housing  20  can include an external support, such as one or more legs  22 , which extend below the base  23  of the inner housing  20  and are supported on the base of the outer housing  12 . In certain embodiments, four such legs  22  are provided, symmetrically about the inner housing  20 . The legs  23  can be integrally molded to the outside of the inner housing  20 , or can be attached by any suitable means, such as with an adhesive. 
         [0027]    Preferably the perforations or apertures  36  in the inner housing  20  are provided in the base  23  thereof, so that air entering the inner housing  20  through the apertures has the optimum residence time in the inner container  12  for contact with the low temperature material. Indeed, locating the apertures at the base  23  of the inner housing  20  also ensures that as the air travels down the air flow passageway defined by gap  30 , it contacts the outer surface of the inner housing. Since the outer surface of the inner housing may also be cooled by the low temperature material, the cooling of the air begins as the air flows downwardly to the base of the inner container, even before it enters the inner container and contacts the low temperature material. However, it is within the scope of the invention to provide the perforations elsewhere on the inner container, such as along the side wall of the inner container  20  instead of, or in addition to, perforations in the base  23  thereof. It is also within the scope of the invention to construct the inner housing  20  out of a thermally conductive material, such as stainless steel, so that the air traveling in the air flow passageway defined by gap  30  is even more effectively cooled by the low temperature material contained in the inner housing. 
         [0028]    It is important for proper operation of this embodiment of the device that the inner housing  20  be positioned in the outer housing  12  such that a sufficient volume  31  is provided between the base  23  of the inner housing  20  and the base of the outer housing  12 , to allow air to flow from the gap  30  to the volume  31  and then into the inner housing  20  through apertures  36  in the base  23 , and providing a melt chamber for melted ice to collect while still ensuring air flow into the inner housing through the apertures  36 . For example, the legs  23 , when provided, should extend below the base  23  of the inner housing a sufficient amount, and that the height of the inner housing be such that, a sufficient volume  31  is provided between the base  23  of the inner housing  20  and the base of the outer housing  12  as seen in  FIG. 2 . The interior volume of the inner housing  20  is configured to hold a low temperature material or coolant (i.e., a material having a lower temperature than the ambient air, preferably at least 10-20° lower, more preferably at least about 30° lower), such as ice, cold packs (e.g., ammonium nitrate based packs), gel packs, etc., preferably ice. The ice may be in the form of cubes, crushed ice or a single block of ice, and is preferably supported on the base  23  of the inner housing  20 . The volume  31  should be sufficient to hold any water that results from the melting of the low temperature material, while still maintaining sufficient space to allow air flow into the inner container without causing the water to be carried along with the air flow, which can cause the user to gurgle. 
         [0029]    Although the inner housing  20  is preferably removable from the outer housing  12 , it is within the scope of the invention to provide a single or integral housing that includes interior walls that define the gap  30  and volume  31  and thus performs the same function as two separate housings  12  and  20  as described above. 
         [0030]    Turning now to  FIG. 4 , the collar  21  is shown having a plurality of spaced apertures  35  positioned annularly around the collar  21 . In the embodiment shown, there are three concentric rings of circular apertures  35 , with a first outer ring radially inwardly of the ring  26  near the outer circumferential end of the collar  21 , a second middle ring radially inwardly of the first outer ring, and a third inner ring radially inwardly of the second middle ring. Preferably the apertures  35  in each ring are substantially evenly spaced, and have diameters of about 2.5 mm. Preferably each ring of apertures is also substantially evenly spaced from an adjacent ring. Those skilled in the art will appreciate that additional or fewer apertures and/or rings of apertures can be provided without departing from the spirit and scope of the invention, and that the shape of the apertures is not particularly limited. It also will be readily appreciated that the invention is not to be limited to any particular pattern of apertures; other patterns or randomly oriented apertures also may be used, keeping in mind that it is important that a sufficient number and size of the apertures should be provided to allow for sufficient air flow through the apertures as discussed in greater detail below. 
         [0031]    Since the collar  21  extends radially outwardly from the interior of the inner container  20 , when the inner container  20  is properly positioned in the outer container  12 , the collar, via apertures  35 , allows air flow into the gap  30  from either intake opening aperture  63 A in cover  60 , or port  74  in cover  60  (discussed in greater detail below). 
         [0032]      FIG. 4  also shows that the base  23  of the inner housing  20  includes a plurality of spaced apertures  36 . The number and size of the apertures  36  also should be sufficient to ensure sufficient air flow through the apertures as discussed in greater detail below. Preferably the apertures  36  are circular and are located substantially over the entire base  23  surface, and are 2.88 mm in diameter. Other suitably shaped apertures can be used. The numbers and sizes of the apertures  35  and apertures  36  are preferably chosen so that the air flow through the apertures  35  is substantially the same as the air flow through the apertures  36 . 
         [0033]      FIG. 5  shows a center insert  40  for the inner housing  20 . The insert  40  is preferably made of the same materials used to make the outer housing  12 . It includes a base  41  and an annular side wall  42  that extends upwardly from the base  41  and terminates in a circumferential top flange  43  that extends radially outwardly as shown. The outer diameter of the annular side wall  42  is slightly smaller than the inner diameter at or near the top of the inner container  20 , such that the insert  40  fits snuggly inside the inner container  12  by frictional engagement when in the assembled condition. It is readily removable from the container  20  so as to provide access to the inside of the container  20  such as to position low temperature material (e.g., ice) in the container  20 . The diameter of the circumferential top flange  43  is greater than the inner diameter at or near the top of the inner container  20 , such that the flange  43  acts as a stop, seating on the top surface of the collar  21  (without blocking any of the apertures  35 ) and preventing the insert from descending further into the inner housing  20 . The insert  40  may include one or more ribs  44  (e.g., four symmetrically spaced) to add structural integrity thereto. The insert  40  also includes an aperture  47 , preferably centrally located in the insert, and an annular upwardly extending wall  45  circumscribing the aperture  47 . The insert  40  includes a blocking portion that serves to block air flow from entering the interior of the inner container  20  other than through aperture  47  (i.e., prevents air from entering the interior of the inner container  20  without first passing through the air passageway defined by the gap  30 ). 
         [0034]    The annular wall  45  of insert  40  is configured to receive center pipe  50  ( FIG. 6 ) in frictional engagement. Center pipe  50  includes a central pipe  51 , including a base portion  52  having an open end at  53  and a top portion  54  having an open end at  55 . The base portion  52  mates with the annular wall  45  of insert  40 , such as by configuring the inner diameter of the base portion  52  to be slightly greater than the outer diameter of the wall  45 , so that the base portion  52  can receive the wall  45  and allow fluid communication between the inner housing  20  and the center pipe  51  via aperture  47  in the insert  40 . Extending radially from the center pipe  50  is radial arm  56 , which can be integrally molded to the center pipe or affixed thereto such as with an adhesive. The radial arm  48  is configured to be received in conduit  67 , providing fluid communication between the outtake of the device and the inner container  20  as discussed in greater detail below. 
         [0035]      FIGS. 7-10  illustrate the removable cover  60  of the device  10 . Preferably the cover  60  includes an annular side wall  62  having internal threads  61  for cooperating with external threads  13  on the outer housing  12  such that the cover can be secured, by screwing, to the outer housing  12 . Other means of attachment of the cover  60  to the outer housing  12 , such as by snapping, can be used. As best seen in  FIG. 9 , preferably the cover  60  includes a central raised portion  64 , that as two spaced side apertures  63 A,  63 B  FIG. 8 ) and central apertures  72 A,  72 B. Conduit member  66  is secured in intake aperture  63 A, such as by gluing, or can be integrally formed as part of the cover. Similarly, conduit member  67  is secured in outtake aperture  63 B. An optional port  74  may be provided in the cover  60 , and in the embodiment shown, extends radially outwardly from the central raised portion  64 . A cap (not shown) or the like can be provided to close off the open end of the port  74  depending upon the mode of use. 
         [0036]    As seen in  FIGS. 8 and 9 , extending upwardly from the central raised portion  64  is a disk member  69 , having a central upwardly extending pin  70 . The disk  69  includes a pair of oppositely spaced pie shaped solid members  71 A,  71 B that co-join at the location of central pin  70 . The oppositely spaced pie shaped solid members  71 A and  71 B define between them the oppositely spaced pie shaped central apertures  72 A,  72 B that together define an exhaust port. Other configurations of the exhaust port can be used. 
         [0037]    As best seen in  FIG. 10  viewing the cover  60  from the underside, central aperture  63 C is defined by a ring  68  that has an annular side wall that extends downwardly from the top of the disk  69 . The ring  68  is dimensioned to be received by the top portion  54  of the central pipe  50 . Thus, the ring  68  has an external diameter slightly smaller than the internal diameter of the top portion  54  of the central pipe  50  for frictional engagement therewith. 
         [0038]    Ring  68  (and thus top portion  54 ) is also dimensioned to receive a one-way valve  75 . One suitable one-way valve is an AirLife™ one-way valve commercially available from Cardinal Health Respiratory Care. The one-way valve includes a cylindrical support, supporting a donut-shaped membrane that allows air flow through it only one direction. The valve is snuggly disposed in ring  68  by frictional engagement such that the membrane is positioned just beneath the apertures  72 A,  72 B, allowing air flow through it and out the apertures  72 A,  72 B. A. similar one-way valve  75 A ( FIG. 1 ) is positioned in conduit member  66  to allow air flow into the device  10  and thus provides an air intake. 
         [0039]      FIG. 11  illustrates twist cap  80  that is rotatably disposed on disk member  69 , forming a valve assembly to open and close the exhaust port. The top surface  81  of the cap  80  includes a central aperture  82  for receiving central pin  70  to properly position the cap  80  on the disk member  69  and help secure it thereto. The top surface  81  also includes a pair of spaced arc-shaped apertures  83 A,  83 B, each positioned to respectively align with one of apertures  72 A,  72 B when the cap  80  is in a first position with respect to the disk member  69  (thereby allowing air flow (e.g., air exhaled by the user) out of the exhaust port), and to respectively align with one of pie-shaped members  71 A,  71 B when the cap  80  is in a second position with respect to disk member  69  (thereby preventing air flow out of the exhaust port). The cap  80  may include one or more knurls  84  formed on the outer perimeter thereof to facilitate manual rotation of the cap  80  about disk member  69 . Those skilled in the art will appreciate that other valve assemblies can be used to control the opening and closing the exhaust port. The one-way valve  75  allows air to travel only out of the exhaust port; air cannot travel into the device through the exhaust port. 
         [0040]    Turning now to  FIGS. 12 and 13 , a mouthpiece  90  suitable for use with the device of the invention is shown. Preferably the mouthpiece  90  is made out of a polyolefin, most preferably polypropylene. A suitable mouthpiece is commercially available from Teleflex Incorporated. The mouthpiece  90  has a cylindrical portion  91  having an open end  92 . The outside diameter of the cylindrical portion  91  is preferably slightly smaller than the inside diameter of conduit  67 , so that mouthpiece  90  can be inserted into conduit  67  and fits snuggly within conduit  67  and remains in the conduit by frictional engagement unless it is forceably (such as by manually pulling on the mouthpiece) removed therefrom. The mouthpiece is removable from the conduit  67  and can be disposed of, and then replaced by a new mouthpiece so that a different user may use the device without risking contamination from other users. It is noted that the inside diameter of conduit  67  is preferably different from the inside diameter of conduit  66 , so that the mouthpiece fits in only conduit  67  and cannot mistakenly be placed in conduit  66 . In the embodiment shown, the inside diameter of the conduit  67  is larger than that of conduit  66 . 
         [0041]    The distal end  93  of the mouthpiece  90  has an oval shaped opening  94  shaped to the average general contour of a person&#39;s mouth ( FIG. 14 ), defined by an outwardly extending flange portion  95  adapted to fit into the patient&#39;s mouth and around which the lips of the patient can be positioned so comfortably position and maintain the mouthpiece in the patient&#39;s mouth. 
         [0042]    Mouthpiece  90  preferably has an internal filter assembly  96 , integrally molded therein. In the embodiment shown, the filter assembly  96  includes a front checkerboard grate  97 , and opposite side filters  98  tapering outwardly as they extend towards the end  92  of the mouthpiece  90 . The filter assembly  96  helps ensure that no particular matter enters the patient&#39;s mouth during use of the device, and is shaped to direct the air flow towards the center of the mouthpiece. Those skilled in the art will appreciate that other filter assemblies could be used without departing from the spirit and scope of the invention. 
         [0043]    In an alternative embodiment, the mouthpiece  90  can be attached to suitable flex medical tubing (not shown), which tubing is then attached to the device via conduit  67 . This allows the device  10  to be positioned further away from the patient&#39;s mouth if desired. In yet a further alternative embodiment, a facemask can be placed in fluid communication with the device and can be worn by the user to cover the user&#39;s mouth, nose or both. Alternatively still, a nasal cannula can be positioned in fluid communication with the conduit  67  to direct air into the nose of the patient. 
         [0044]    The device can be assembled by inserting the one-way valves in the appropriate locations, and attaching the center pipe  50  to the cover by inserting radial arm  56  in conduit  67  and top portion  54  about ring  68 . Inner housing  20  is placed inside outer housing  12 , and cover  60  is attached to the outer housing. Attachment of the cover  60  to the outer housing  12  causes the base portion  52  of the center pipe  50  to engage the annular upwardly extending wall  45  of insert  40 , thereby establishing fluid communication between the interior of the inner housing  20  and the center pipe  50 . 
         [0045]    In use in a first mode of operation, a low temperature material such as ice is placed in the inner container  20 , and the device is assembled. The amount of low temperature material is not particularly limited, although it is preferred that when ice is used, the container  20  be filled in order to maximize the length of time the ice remains solid. The cap  80  is positioned so that the exhaust port is open, allowing one-way flow out the exhaust port through one-way valve  75 . The air port  74  is closed. The patient then places his mouth about the mouthpiece  90 , and inhales. The inhalation is a driving force that draws ambient air into the device  10  through the intake opening in conduit  66 , through one-way valve  75 A positioned therein, down through apertures  35  and through the gap  30  between the inner housing  20  and the outer housing  12 , into the volume  31 , up through apertures  36  in the base  23  of the inner housing  20  and into the inner housing  20 , where the air contacts the low temperature material which effectively lowers the temperature of and adds humidity to the air. The now cool, moist air exits the inner housing  20 , flows into central pipe  51  of center pipe  50 , into radial arm  56  thereof, and then through the outtake opening  63 B and into the mouthpiece  90 , from which it enters the mouth of the patient, where it cools the throat, larynx, upper respiratory tract, etc. of the patient, providing soothing relief thereto. The intake opening and outtake opening, although in fluid communication via the gap  30  and the inner housing  20 , are segregated; intake air must flow through the inner housing  20  (and thus be cooled by the low temperature material) prior to reaching the outtake. The patient may then exhale into the mouthpiece, and the flow of exhaled air travels through conduit  67 , up through center pipe  50 , through one-way valve  75 , and then through the exhaust port to ambient (the one-way valve  75 A prevents exhaled air from exiting through the conduit  66 . In this mode, the patient does not have to remove his mouth from the mouthpiece  90  to exhale; the patient can breath (inhale and exhale) normally while maintaining the mouthpiece inside the mouth. A closed system is thus established. Alternatively, the patient may remove the mouthpiece from the mouth and exhale into the ambient environment rather than into the device  10 . As the ice melts, the resulting liquid drips into and collects in the volume  31  between the inner container  20  and outer container  12 , which can be periodically emptied. The inner container  20  can be periodically replenished with ice and/or other low temperature material as needed simply by removing the cover  60  and insert  40 . 
         [0046]    In an alternative mode of operation, particularly applicable for use with small children (e.g., under 3 years of age), infants or the elderly, an air assist can be provided. In this mode, the exhaust port is closed by moving disk member  80  so that its pie-shaped apertures  83 A,  83 B are out of alignment with apertures  72 A,  72 B, thereby blocking flow through apertures  72 A,  72 B. The air port  74  is also closed. A driving force, such as a manually operated air bulb  99  ( FIG. 15 ), pump or fan, is then placed in fluid communication with the conduit  66  (such as through suitable tubing (not shown)), and is actuated such that air is forced into the conduit  66  and through one-way valve  75 A in the intake aperture  63 A. The air then flows down through apertures  35  and through the air passageway defined by gap  30  between the inner housing  20  and the outer housing  12 , up through apertures  36  in the base  23  of the inner housing  20  and into the inner housing  20 , where the air contacts the low temperature material which effectively lowers the temperature of and adds humidity to the air. The now cool, moist air exits the inner housing  20 , flowing into central pipe  51  of center pipe  50 , into radial arm  56  thereof, and then through the mouthpiece  90  and into the mouth of the patient. It should be noted that the mouthpiece need not be positioned inside the mouth of the patient; it is sufficient to place the mouthpiece (or, for example, the outlet of conduit  67 ) in proximity to the mouth and/or nose of the patient (e.g., within about 3 inches thereof) to effectively cool the air that the patient is breathing. Indeed, this allows the patient to breath normally without forcing too much cool air into the respiratory system of the patient. It should be noted that the mouthpiece can be omitted entirely in this mode. Alternatively still, a nosepiece such as a nasal cannula (not shown) can be used and can be inserted into the nose of the patient or placed in proximity thereto. The air assist as the driving force for air circulation through the device can be provided alone or in addition to inhalation by the patient. 
         [0047]    In yet a further alternative mode of operation, the exhaust port is closed by moving disk member  80  so that its pie-shaped apertures  83 A,  83 B are out of alignment with apertures  72 A,  72 B, thereby blocking flow through apertures  72 A,  72 B. The air port  74  is opened, and an air or oxygen feed source, such as a typical oxygen feed available in hospitals, is placed in fluid communication with the port  74 . In the hospital, oxygen conventionally is supplied to each patient room and is available via an outlet in the wall, and a flow meter and valve regulate the oxygen flow. Attachments may be connected to moisturize the oxygen flow. In the home, the oxygen source is usually an oxygen canister or an air compressor. This mode allows for a constant flow of oxygen to enter the device and be cooled by flowing through the device as discussed above. 
         [0048]    The inhaler could also be used to warm air by substituting a high temperature material, such as a pouch containing iron powder that when exposed to air, causes an oxidation reaction producing heat, for the low temperature material.