Abstract:
A multipurpose aerosol medication delivery apparatus that includes a collapsible/expandable, or a fixed volume, or a combination of partially fixed volume and partially collapsible/expandable holding chamber for use with a metered dosed inhaler (MDI) and/or any standard small volume nebulizer. The holding chamber is designed to deliver-aerosol medication particles generated by an MDI; aerosol medication particles generated by a nebulizer; a single gas or a mixture of gases; a single gas or a mixture of gases that can yield a gas density that will enhance aerosol delivery of medication with both MDI and nebulizer; a single gas or a mixture of gases that will yield and deliver an oxygen concentration to a patient ranging from room air concentration to 100%. The device includes a reservoir that stores nebulized aerosol generated during exhalation to be inhaled during the next breath. The device also included a one way valve to prevent carbon dioxide generated during exhalation from rebreathing by not allowing the exhaled air from entering the holding chamber. The device includes an exit port with a second one way valve that allows the exhaled air to exit the device but closes during inhalation to prevent any entrainment of room air gas. The exit port may instead have a filter with one-way valve to trap the exhaled aerosol particles while allowing the exhaled gases to escape. The filter valve will similarly close during inhalation to prevent entrainment of room air gas. The holding chamber will allow a uniform mixture of aerosol medication and gases to flow together during inhalation to the patient via a mouthpiece or a facemask. The holding chamber is connected to a nebulizer chamber with a single or multiple connecting tubes that allow gas mixtures with varying density, viscosity, humidity and concentration of oxygen to flow into the holding chamber from the nebulizer chamber. The pattern of flow of the gas(es) does not disturb the flow of the nebulized medication from the nebulizer chamber to the holding chamber or interfere with the plume generated by an MDI. The device also serves as a facemask for delivering precise concentrations of oxygen or as a 100% non-rebreather mask. The device also serves to deliver precise concentrations of different density gases i.e. nitrogen, helium, oxygen, etc. This will allow varying fractions of inspired oxygen to deliver aerosol medication via MDI or a nebulizer. Thus, the device has the ability to deliver aerosol medication with an MDI or a nebulizer while retaining the ability to simultaneously deliver different density gas mixtures and varying fraction of inspired oxygen without interrupting one for the other.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
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                 US Pat. App. 
                 September, 2002 
                 Johnson 
               
               
                 #20020121275 
               
               
                   
               
             
          
         
       
     
       BACKGROUND OF THE INVENTION  
       [0002]     This invention relates to an improved aerosol inhalation device and particularly to an aerosol enhancement device which: 
        can be used as a facemask to deliver precise fraction of inspired oxygen     can be used as a 100% oxygen non-rebreather mask     can deliver a single gas or a mixture of gases to yield varying gas densities that can enhance aerosol delivery     can deliver an individual gas like nitrogen, oxygen, room air, helium, etc. or a single premixed gas or a mixture of individual gases to yield a final mixture which can deliver 100% oxygen or precise fraction of inspired oxygen or attain a mixture with a desired gas density and a desired concentration of oxygen that is physiologically compatible with life     can deliver aerosol medication with a metered dose inhaler     can deliver aerosol medication with standard small volume nebulizer     can deliver aerosol medication with an MDI and/or a standard small volume nebulizer simultaneously     can deliver aerosol medication with an MDI and/or a small volume nebulizer and simultaneously deliver a desired gas density to enhance aerosol delivery     can deliver aerosol medication with an MDI and/or a small volume nebulizer; can deliver a desired gas density to enhance aerosol delivery; and deliver a desired fraction of inspired oxygen to a hypoxemic patient     includes a reservoir in the form of a bag or an expandable/collapsible corrugated tubing for storage of aerosol generated by a nebulizer during exhalation.     includes a valve system to prevent waste of medication generated by a nebulizer chamber during exhalation and to prevent rebreathing of exhaled carbon dioxide     includes a valve system to prevent entrainment of room air during inhalation and for exit of carbon dioxide during exhalation     can be used with a Continuous Positive Airway Pressure (CPAP) or a Bi-level Positive Airway Pressure (BIPAP) system     can be introduced in a ventilatory circuit with the ability to deliver aerosol medication with a metered dose inhaler and/or a nebulizer     includes a filter system to trap exhaled aerosol particles while allowing the exhaled gas (es) to escape into room air     includes a filter system with a valve to prevent entrainment of room air during inhalation and to trap the exhaled aerosol particles while allowing exhaled gas (es) to escape into room air     includes a collapsible/expandable spacer device that can be fully collapsed and made compact when not in use for delivery of aerosol medications and be partially or fully expandable when in use for aerosol medication delivery via an MDI or a nebulizer     can serve as an ambu-bag for resuscitation     can be used to deliver anesthetic gas (es) 
 
 MDI drug canisters are typically sold by manufacturers with a boot that includes a nozzle, an actuator, and a mouthpiece. Patients can self-administer the MDI medication using the boot alone but the majority of patients have difficulty in synchronizing the actuation of the MDI canister and inhalation of the medication. Spacers or valved chambers have been used with MDI boot to obviate the problem associated with patient coordination by helping to synchronize the actuation of MDI canister and patient inhalation and improve the delivery of medication by decreasing oropharyngeal deposition of aerosol drug. Many valved chambers of this type are commercially available. Examples of such spacers are—AeroChamber, U.S. Pat. Nos. 4,470,412 and 5,012,803; Optichamber, U.S. Pat. No. 5,385,140; Collapsible Chamber, U.S. Pat. Nos. 4,637,528 and 4,641,644; Disposable Chamber U.S. Pat. No. 4,953,545; or Collapsible and Disposable Chamber U.S. Pat Application No. 20020129814. These devices are expensive and may be alright for chronic conditions that require frequent use of MDI inhalers provided the cost and labor involved in frequent delivery of medication is acceptable to the patient. However, under acute symptoms, such devices may fail to serve the purpose and lead to an inadequate delivery of medication. 
       
 
         [0022]     Aerosol delivery devices that use standard small volume nebulizers are commonly used in acute conditions as they are cheap and overcome the inhalation difficulties associated with actuation of MDI and synchronization of inhalation by the patient. Nebulizers are fraught with numerous problems as well. The medication dose used is about 10 times of that used with an MDI and hence the increased cost without any added proven clinical benefit. Secondly, the majority of the nebulized medication is wasted during exhalation. Thirdly, the time taken to deliver the medication is several times that of an MDI and the labor cost of respiratory therapist may outweigh the benefits of nebulizers compared with MDIs. Breath actuated nebulizer (s) with reservoir have been designed to overcome the medication waste. Example of one such device is U.S. Pat. No. 5,752,502. However, these devices are expensive and still have all the other problems associated with nebulizer use alone. Other examples of aerosol inhalation devices would be U.S. Pat. No. 4,210,155, in which there is a fixed volume mist accumulation chamber for use in combination with a nebulizer and a TEE connection. Problems with prior art devices such as described are a significant waste of medication, a non-uniform concentration of delivered medication, expensive, and difficult to use. Many such devices are commercially available in which the nebulizer is directly attached to a TEE connector without any mixing chamber. All the afore mentioned devices can be used with either an MDI or a nebulizer but not both, and hence, face the difficultly associated with either system alone. Other devices have tried to overcome the above problems by incorporating a mixing chamber in the device with adaptability to be used with an MDI or standard nebulizer. U.S. Pat. Application No. 20020121275 is an example of one such device. However, the device is plagued with problems typical of such devices. Just like other prior art devices, this device as well fails to incorporate some of the key the features necessary for enhanced aerosol delivery. A list of problems associated with this device and other similar devices are outlined below: 
    (1) The entrained airflow in this device interferes with the MDI plume as well as the plume generated by a nebulizer resulting in increased impaction losses of aerosol generated by either an MDI or nebulizer.     (2) The device does not have the ability to deliver a desired precise fraction of inspired oxygen to a hypoxic patient and simultaneously deliver aerosol medication with either a metered dose inhaler or a nebulizer.     (3) The device cannot deliver a gas with a desired density to improve aerosol delivery and a desired fraction of inspired oxygen to a hypoxemic patient     (4) The device does not have the ability to deliver different density gases with a desired fraction of inspired oxygen simultaneously while retaining the ability to deliver aerosol medication at the same time with either an MDI or a nebulizer     (5) the device does not have the ability to deliver a mixture of multiple gases to a patient and simultaneously maintain a desired fraction of inspired oxygen     (6) the device does not serve as a facemask for delivering varying concentrations of inspired oxygen from room air to 100% but serves solely as an aerosol delivery device     (7) the device does not have a reservoir chamber-either as a bag or as a large volume tubing t store nebulized medication that is otherwise wasted during exhalation. The holding chamber of this device varies from 90 cc to 140 cc and is not enough to serve as a reservoir for the volume of nebulized medication generated during exhalation and hence in a normal sized adult most of the medication generated during exhalation is wasted     (8) there is no mechanism in the device to prevent entrainment of room air which forms the bulk of volume during inhalation. The fraction of inspired oxygen and the density of gas mixture inhaled by the patient may vary with every breath with this device depending on the volume of entrained room air which may vary with each breath     (9) the device does not have any valve system to prevent exhaled carbon dioxide from entering the holding chamber. Rebreathing of carbon dioxide from the holding chamber on subsequent inhalation can be extremely detrimental to a patient and extremely dangerous under certain clinical conditions     (10) the device does not have the capability of delivering medication with an MDI and a nebulizer simultaneously     (11) the device has a fixed volume-holding chamber, which makes the device extremely large and cumbersome to deliver medication.    
 
         [0034]     Our device overcomes all the difficulties and problems associated with this and all the prior art devices. Our device incorporates all the desired features to make it a compact, user friendly economical, and multipurpose aerosol device for both acute and chronic use with either an MDI or a nebulizer or with both MDI and nebulizer simultaneously as warranted by the patient&#39;s clinical circumstances. Our device also retains the ability to deliver a desired fraction of inspired oxygen and deliver a desired gas density to decrease the work of breathing and simultaneously deliver and enhance aerosol medication delivery.  
       SUMMARY OF THE INVENTION  
       [0035]     The present invention provides an aerosol medication delivery apparatus, which incorporates the aforementioned advantages. The inventive device includes a fixed volume or a collapsible/expandable MDI holding chamber, a fixed volume or a collapsible/expandable nebulizer chamber, a system of connecting the two chambers with 2 or more hollow collapsible/expandable or fixed volume cylindrical connecting tubes. The MDI holding chamber maybe a fixed volume chamber or a collapsible/expandable chamber or a combination of the two i.e., partly fixed and partly collapsible/expandable chamber. The collapsible feature of the device makes it compact when solely in use for delivery of single gas or different gas mixtures while the expandable feature can be utilized when delivering aerosol medication with an MDI and/or a nebulizer.  
         [0036]     The collapsible/expandable MDI chamber has a hollow cylindrical rigid inlet port at one end and a similar outlet port at the other end. When fully collapsed the outlet and the inlet port may be fused to each other to form a continuous hollow rigid cylindrical tube. When the holding chamber is fully expanded the outlet and inlet tubes stay disconnected. The holding chamber may be kept patent by internal support with a coiled metal or plastic wire. The rings of the coiled wire come together when the chamber is collapsed and stay separated when it is expanded. Alternatively, the MDI chamber may be constructed with a collapsible/expandable corrugated plastic tubing, which does not require any coiled metal or plastic wire support for maintaining patency of the chamber. The volume of the chamber may vary form 0.10 liters to 2.0 liters to accommodate both pediatric and adult patients. When partially or fully expanded, the chamber may also serve as a reservoir to prevent aerosol generated during exhalation from being wasted.  
         [0037]     The central rigid inlet port is connected to a universal boot adapter panel with an opening to accommodate the boot of any commercially available MDI such that medication can be delivered to the MDI chamber on actuation of the MDI canister. For aerosol delivery with nebuliser, the universal boot adapter is disconnected from the inlet port, which now fuses with the outlet port of the nebulizer chamber. The inlet of the MDI chamber is connected to the outlet to the nebulizer chamber with two additional peripheral hollow cylindrical connecting tubes; the two tubes have two outlet ports at 3 and 9 o&#39;clock positions in the nebulizer chamber and two inlet ports in similar locations in the MDI chamber. The distance between the connecting tubes and the length of the connecting tubes allows for any commercially available MDI boot to be accommodated easily between the MDI and the nebulizer chambers. At the inlet end of the MDI chamber, the peripheral hollow cylindrical connecting tubes split into multiple micrometric openings that are distributed at intervals along the entire circumference of the MDI chamber&#39;s inlet. This allows the flow of gas(es) from the two openings in the nebulizer chambers outlet to the multiple openings distributed all along the circumference of the MDI chamber&#39;s inlet. The pattern of flow of the gas(es) through multiple openings that are distributed along the circumference of the MDI chamber&#39;s inlet is such that it does not interfere with the plume of the MDI when it is actuated. Also this arrangement allows different desired density gas(es) with a desired fraction of inspired oxygen to flow into the MDI chamber to enhance aerosol delivery from MDI and to deliver oxygen to a patient if necessary. The flow pattern of the gas(es) in addition minimizes the impaction losses of aerosol generated by an MDI.  
         [0038]     The outlet rigid tube of the MDI chamber has an inhalation flap valve and a flap seat. The flap valve moves away from the flap valve seat on inhalation to allow the flow of medication from the MDI chamber to the patient. On exhalation the flap valve presses against the flap valve seat which prevents carbon dioxide exhaled during exhalation from entering into the MDI chamber. The outlet tube has an exhalation flap valve assembly with an exhalation flap valve and a valve seat on the superior or inferior surface. The flap valve moves away from the flap valve seat on exhalation to allow the exhaled gases to exit the outlet tube and presses against the valve seat on inhalation to prevent any entrainment of any room air gases on inhalation. The provision of a filter at this opening may be optional depending on the conditions under which aerosol is being delivered. The filter can trap all exhaled aerosol particles while allowing the gases to exit from this port. A flap valve may again be provided at the end of the filter to prevent entrainment of room air gas during inhalation and to allow exit of all exhaled gas(es).  
         [0039]     The nebulizer chamber has an inlet port with a central cylindrical hollow rigid tube for entry of one or more gases into the nebulizer chamber; an outlet port, a port for a nebulizer, and a port for a reservoir (a bag reservoir or a collapsible/expandable corrugated plastic tubing reservoir), the reservoir bag has one or more inlet ports for inflow of desired gases. There are two additional openings at 3 and 9 o&#39;clock positions for connection of peripheral tubes that connect the MDI chamber and the nebulizer chamber. The outlet of the nebulizer chamber has a rigid hollow cylindrical tube similar to that seen in the MDI chamber&#39;s inlet. The port of the nebulizer chamber remains plugged with a cap when MDI is in use. The cap is unplugged and the outlet port of the nebulizer fuses with the inlet port of the MDI chamber when nebulizer is to be used. When aerosol delivery is desired with a nebulizer, the nebulizer is connected to the nebulizer port, the nebulized medication flows through the peripheral connecting tubes between the MDI chamber and the nebulizer chamber through multiple openings distributed along the circumference of the MDI chamber&#39;s inlet. The universal boot adapter assembly may be disconnected from the central rigid tube of MDI the chamber, which could now be plugged with a cap. Alternatively, the central inlet tube of the MDI chamber and the central outlet tube of the nebulizer chamber can both uncapped and the two tubes fused to each other by moving the MDI chamber closer to the nebulizer chamber by collapsing the peripheral connecting tubes. The aerosol generated by the nebulizer can now flow from the nebulizer chamber to the MDI chamber via the central connection between the MDI chamber and the nebulizer chamber, as well as via the peripheral connections between the two chambers via the peripheral connecting tubes at 3 and 9 o&#39;clock positions. The connecting tubes between the MDI and nebulizer chambers are made collapsible/expandable in a manner identical to the principles of the expandable/collapsible MDI chamber itself. This will allow the MDI and the nebulizer chambers to be moved closer to each other to be fused during nebulizer operation or to be disconnected and moved apart to accommodate MDI in the space between the MDI and the nebulizer chambers during MDI operation.  
         [0040]     The aerosol reservoir may comprise of a collapsible/expandable bag made of plastic or neoprene, a fixed chamber, or a collapsible/expandable corrugated plastic tubing. The volume of the reservoir could vary from 0.1 liter to 2.0 liters to meet the needs of both pediatric and adult patients. The reservoir could be attached to a reservoir port in the nebulizer chamber or alternatively it could be attached to the inlet port of the nebulizer chamber to store the aerosol generated during exhalation which would otherwise, have been wasted as is the case with most TEE nebulizers. During the subsequent inhalation the aerosol stored in the reservoir bag during exhalation would flow from the nebulizer chamber into the MDI chamber via central and/or peripheral connections and then through the mouthpiece or facemask to the patient.  
         [0041]     Additional inlet ports may be available directly on the nebulizer chamber or on the reservoir bag or on the corrugated plastic tubing reservoir which will allow one of more, unmixed or premixed gases to flow into the nebulizer chamber and/or the reservoir at different flow rates to achieve a desired density, viscosity, humidity and fraction of inspired oxygen to simultaneously enhance medication delivery and deliver oxygen to a hypoxemic patient. The gases used may be oxygen, nitrogen, helium, heliox (premixed), room air, various anesthesia gases, various diagnostic gases, i.e. xenon, krypton etc. When not in use for aerosol delivery either via MDI or nebulizer the device could be used solely to deliver desired oxygen concentration or other aforementioned gases via a facemask which can be connected to outlet of the MDI chamber. The equipment in this case will be made extremely compact by fully collapsing the MDI chamber, fully collapsing the peripheral connecting tubes, and fully collapsing the corrugated plastic reservoir tubing connected to the nebulizer chamber. The nebulizer outlet port in the nebulizer chamber may be plugged with a cap when only delivering a gas without aerosolized medication or the inlet port of MDI chamber and the outlet port of the nebulizer chamber may be fused. The desired gas(es) can now flow to the patient from the reservoir bag/tubing to the MDI chamber via the central and/or peripheral connections between the two chambers and to the patient via a facemask.  
         [0042]     The device can also be incorporated into the inspiratory limb of the ventilatory circuit by making connections at two sites—between the inspiratory tubing and the outlet port of the MDI chamber at one end and between the inlet port of the nebulizer chamber and the inspiratory tubing at the other end. The device can now deliver aerosol medication with MDI or nebulizer to the patient on mechanical ventilation. This arrangement will have the distinct advantage of delivering the precise dose via MDI (ex-actuator) as specified by the manufacturer. This arrangement allows the MDI canister to be actuated using the MDI boot and actuator as specified by the manufacturers as opposed to commercially available custom designed universal actuators that are currently available to fit nozzles of various MDIs. Hence, this mode of delivery is different from all the prior art devices which have used custom designed universal actuators in ventilatory circuit to deliver aerosol by MDI as those devices fail to meet the ex-actuator delivery of dose as specified by the manufacturer. Hence, the ex-actuator dose output for each MDI will be different from that specified by the manufacturer. Our device obviates that problem.  
         [0043]     Alternatively, our device, like numerous prior art devices, can incorporate a custom designed universal actuator on the inlet port of the MDI chamber to accommodate the nozzles of all commercially available MDI canisters to deliver aerosol via MDI, as opposed to a universal MDI boot assembly to accommodate the boot of all commercially available MDIs. In this case all other features of the device would remain the same except that the MDI chamber and the nebulizer chamber may be fused at the center without any connecting tubes at the 3 and 9 o&#39;clock positions. Alternatively, the nebulizer and MDI chambers maybe connected only at peripheral 3 and 9 o&#39;clock positions with collapsible connecting tubes or fixed rigid tubes without intervening space between the MDI and the nebulizer chambers for MDI boot assembly which will no longer be required. Alternatively, nebulizer and MDI chambers maybe connected or fused at both central and peripheral locations.  
         [0044]     Alternatively, the collapsible/expandable MDI chamber and the collapsible/expandable MDI chamber may be fused to form a single chamber and the MDI boot assembly instead of now being fitted at the inlet of the MDI chamber fits at the inlet of the nebulizer chamber where an MDI boot can be attached to deliver aerosol medication via MDI. The boot assembly may also be designed to accommodate a nebulizer Tee piece which may generate aerosol particles via a nebulizer to deliver it into the collapsible/expandable MDI and nebulizer chambers. The Tee piece in this case will have one end of the horizontal limb completely closed so that no aerosol particles will escape out of the holding chamber during exhalation phase and there may be no need for a reservoir bag as the collapsible/expandable tubing of the MDI and nebulizer chambers when expanded will create a volume that will serve as a reservoir for storage of aerosol medication generated during the exhalation phase. Alternatively, the Tee piece may be open at both ends, one open end of which may be connected to the inlet of the nebulizer chamber and the other free end of which may be connected to a second Tee piece. The vertical limb of the second Tee piece may now serve as the inlet for the reservoir bag or the corrugated reservoir tubing and one end of the horizontal limb of the second Tee piece remaining closed.  
     
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING  
       [0045]     Further features of the present invention will become apparent in the accompanied drawings as well as the detailed description of the preferred embodiments.  
         [0046]      FIG. 1A  and  FIG. 1B  are plan views of the longitudinal length of aerosol delivery apparatus IV according to one embodiment of the present invention, incorporating the features described in the summary of the invention.  
         [0047]      FIG. 1C  and  FIG. 1D  are plan views of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention.  
         [0048]      FIG. 1E  and  FIG. 1F  are plan views of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention.  
         [0049]      FIG. 2A  and  FIG. 2B  are plan views of the longitudinal length of aerosol delivery apparatus IV according to the third alternative embodiment of the present invention.  
         [0050]      FIG. 2C  and  FIG. 2D  are plan views of the longitudinal length of aerosol delivery apparatus IV according to the fourth alternative embodiment of the present invention.  
         [0051]      FIG. 2E  and  FIG. 2F  are plan views of the longitudinal length of aerosol delivery apparatus IV according to the fifth alternative embodiment of the present invention.  
         [0052]      FIG. 3A  and  FIG. 3B  are expanded plan views of MDI chamber  1   a  according to the present invention as described in  FIG. 1A .  
         [0053]      FIG. 3C  is an expanded plan view of MDI chamber  1   a  according the first alternative embodiment of the present invention as described in  FIG. 3A  and  FIG. 3B .  
         [0054]      FIG. 3D  and  FIG. 3E  are expanded plan views of MDI chamber  1   a  according to the second alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  
         [0055]      FIG. 3F  is an expanded plan view of MDI chamber  1   a  according to the third alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  
         [0056]      FIG. 3G  and  FIG. 3H  are expanded plan views of MDI chamber  1   a  according to the fourth alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  
         [0057]      FIG. 3I  is an expanded plan view of MDI chamber  1   a  according to the fifth alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  
         [0058]      FIGS. 4A and 4B  are expanded plan views of tubes  50   a  or  51   a  according to the present invention as described in  FIG. 1A .  
         [0059]      FIGS. 4C and 4D  are expanded plan views of tubes  50   a  or  51   a  according to the first alternative embodiment of the present invention as described in  FIGS. 4A and 4B .  
         [0060]      FIGS. 4E and 4F  are expanded plan views of tubes  50   a  or  51   a  according to the second alternative embodiment of the present invention as described in  FIGS. 4A and 4B .  
         [0061]      FIG. 5A  is an expanded cross-sectional view of the inlet end  2   a  of the invention as described in  FIG. 1A .  
         [0062]      FIG. 5B  is an expanded cross-sectional view of the inlet end  2   a  according to the first alternative embodiment of the present invention as described in  FIG. 5A .  
         [0063]      FIG. 6A  is an expanded cross-sectional view of the inhalation/exhalation valve assemblies  32   a  or  35   a  of the invention as described in  FIG. 1A .  
         [0064]      FIG. 6B  is an expanded cross-sectional view of the inhalation/exhalation valve assemblies  32   a  or  35   a  of the first alternative embodiment of the present invention as described in  FIG. 6A .  
         [0065]      FIG. 6C  is an expanded cross-sectional view of the inhalation/exhalation valve assemblies  32   a  or  35   a  of the second alternative embodiment of the present invention as described in  FIG. 6A .  
         [0066]      FIG. 7A  is a plan view of the longitudinal length of the mouthpiece according to one embodiment of the present invention.  
         [0067]      FIG. 7B  is a plan view of the longitudinal length of the facemask according to one embodiment of the present invention.  
         [0068]      FIG. 8A  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to alternative embodiment of the present invention as described in  FIG. 1E .  
         [0069]      FIG. 8B  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in  FIG. 8A .  
         [0070]      FIG. 8C  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in  FIG. 8A .  
         [0071]      FIG. 8D  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the alternative embodiment of the present invention as described in  FIG. 2E .  
         [0072]      FIG. 8E  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in  FIG. 8D .  
         [0073]      FIG. 8F  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in  FIG. 8D .  
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0074]     The present invention will now be described in detail by reference to the drawing figures, where as like parts as indicated by like reference numerals.  
         [0075]      FIG. 1A  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to one embodiment of the present invention, incorporating the features described in the summary of the invention.  FIG. 1A  is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber  1   a , and a nebulizer chamber  4   a . The MDI chamber  1   a  has an inlet end  2   a  and an outlet end  3   a . The nebulizer chamber  4   a  similarly has an inlet end  5   a  and an outlet end  6   a . The inlet end  2   a  has three hollow cylindrical inlet tubes, a central tube  7   a  and two peripheral tubes  10   a  and  13   a  located at three o&#39;clock to nine o&#39;clock positions, respectively. The central hollow cylindrical tube  7   a  has an inlet end  8   a  and an outlet end  9   a . The peripheral tube  10   a  has an inlet end  11   a  and an outlet end  12   a  and the peripheral tube  13   a  similarly has an inlet end  14   a  and an outlet ed  15   a . The outlet end  3   a  of the MDI chamber  1   a  has a hollow cylindrical tube  16   a  with an inlet end  17   a  and an outlet end  18   a . The MDI chamber  1   a  may be made of plastic, paper, or metal. The chamber  1   a  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  19   a  and grooves  20   a . Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   a  of the coil are demonstrated in the figure as dotted lines. The distance  22   a  and  23   a  between the two adjacent ridges, rings of the coil, or grooves may be equal. Alternatively, the chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. The figure demonstrates the expanded illustration of the MDI camber  1   a.    
         [0076]     The inlet end  8   a  of the central tube  7   a  is attached to the outlet end  27   a  of the boot  25   a  of a metered dose inhaler  24   a . The inhaler  24   a  has a boot  25   a  with an inlet end  26   a  and an outlet end  27   a . A canister  28   a  is introduced into the boot  25   a  through the inlet end  26   a  and the nozzle  29   a  of the MDI  24   a  is attached to an actuator  30   a . The actuator  30   a  has an opening or an aperture  31   a . On actuation of the MDI canister  28   a , the medication aerosol particles are generated through the opening  31   a  of the actuator  30   a , and enter into the chamber  1   a  through the outlet end  9   a  of the central tube  7   a.    
         [0077]     The outlet tube  16   a  of the MDI chamber  1   a  has two valve assemblies disposed between the inlet end  17   a  and the outlet end  18   a —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  32   a  that has a circular opening  33   a  and a flap valve  34   a  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  35   a  that has a circular opening  36   a  and a flap valve  37   a  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  34   a  moves away from the valve seat  32   a  for the aerosol particles to move from the MDI chamber  1   a  to the patient through the opening  33   a  in the valve seat  32   a  of the tube  16   a . On exhalation, the flap valve  34   a  moves towards the flap valve seat  32   a  and closes the opening  33   a  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   a  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  32   a  prevents any protrusion of the flap valve  34   a  through the opening  33   a . The exhalation flap valve assembly has a flap valve  37   a  that presses against the flap valve seat  35   a  on inhalation and completely occludes the opening  36   a  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  16   a  on inhalation. On exhalation the flap valve  37   a  moves away from the flap valve seat  35   a  for the air exhaled by the patient to escape into the atmosphere from tube  16   a  through the opening  36   a.    
         [0078]     The nebulizer chamber  4   a  has a hollow cylindrical inlet tube  38   a  with an inlet end  39   a  and an outlet end  40   a . The inlet and  39   a  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber  4   a  has a hollow cylindrical outlet tube  41   a  that has an inlet end  42   a  and an outlet end  43   a . The outlet end  43   a  may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes,  44   a  and  47   a , at three o&#39;clock and nine o&#39;clock positions. Tube  44   a  has an inlet end  45   a  and an outlet end  46   a , whereas the tube  47   a  has an inlet end  48   a  and an outlet end  49   a . The inlet end  1   a  of the tube  10   a  the inlet end  5   a  of the MDI chamber  1   a  is connected to the outlet end  46   a  of the tube  44   a  at the outlet end  6   a  of the nebulizer chamber  4   a  with a collapsible/expandable stiff corrugated plastic tubing  50   a  and similarly the inlet end  14   a  of tube  13   a  is connected to the outlet end  49   a  of tube  47   a  with a collapsible/expandable corrugated plastic tubing  51   a . The collapsible/expandable tubings  50   a  and  51   a  are demonstrated to be fully expanded in  FIG. 1A  to accommodate MDI boot  25   a  between the MDI chamber  1   a  and the nebulizer chamber  4   a.    
         [0079]     The nebulizer chamber has an inlet port  52   a  for connection with a standard small volume nebulizer  53   a . Chamber  4   a  also has another inlet  54   a  for connection to a reservoir bag  55   a . The reservoir bag  55   a  serves to store the aerosol particles generated by the nebulizer  53   a  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  55   a  has two small inlets  56   a  and  57   a  to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0080]      FIG. 1B  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to one embodiment of the present invention, incorporating the features described in the summary of the invention.  FIG. 1B  is a plan view of the invention just like the one described in  FIG. 1A  that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber  1   b , and a nebulizer chamber  4   b . The MDI chamber  1   b  has an inlet end  2   b  and an outlet end  3   b . The nebulizer chamber  4   b  similarly has an inlet end  5   b  and an outlet end  6   b . The inlet end  2   b  has three hollow cylindrical inlet tubes, a central tube  7   b  and two peripheral tubes  10   b  and  13   b  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  7   b  has an inlet end  8   b  and an outlet end  9   b . The peripheral tube  10   b  has an inlet end  11   b  and an outlet end  12   b  and the peripheral tube  13   b  similarly has an inlet end  14   b  and an outlet ed  15   b . The outlet end  3   b  of the MDI chamber  1   b  has a hollow cylindrical tube  16   b  with an inlet end  17   b  and an outlet end  18   b . The MDI chamber  1   b  may be made of plastic, paper, or metal just as described in  FIG. 1A . Chamber  1   b  is a collapsible/expandable cylindrical chamber with multiple ridges  19   b  and grooves  20   b . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   b  of the coil are demonstrated in the figure as dotted lines. The MDI chamber  1   b  in this figure is demonstrated to be fully or partially collapsed. The distance  22   b  and  23   b  between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end  17   b  of the tube  16   b  may be fused to the outlet end  9   b  of the tube  7   b.    
         [0081]     The inlet end  8   b  of the tube  7   b  is attached to the outlet end  27   b  of the boot  25   b  of a metered dose inhaler  24   b . The inhaler  24   b  has a boot  25   b  with an inlet end  26   b  and an outlet end  27   b . A canister  28   b  is introduced into the boot  25   b  through the inlet end  26   b  and the nozzle  29   b  of the MDI  24   b  is attached to an actuator  30   b . The actuator  30   b  has an opening or an aperture  31   b . On actuation of the MDI canister  28   b , the medication aerosol particles are generated through the opening  31   b  of the actuator  30   b , and enter into the chamber  1   b  through the outlet end  9   b  of the tube  7   b.    
         [0082]     The outlet tube  16   b  of the MDI chamber  1   b  has two valve assemblies disposed between the inlet end  17   b  and the outlet end  18   b —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  32   b  that has a circular opening  33   b  and a flap valve  34   b  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  35   b  that has a circular opening  36   b  and a flap valve  37   b  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  34   a  moves away from the valve seat  32   b  for the aerosol particles to move from the MDI chamber  1   b  to the patient through the opening  33   b  in the valve seat  32   b  of the tube  16   b . On exhalation, the flap valve  34   b  moves towards the flap valve seat  32   b  and closes the opening  33   b  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   a  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  32   b  prevents any protrusion of the flap valve  34   b  through the opening  33   b . The exhalation flap valve assembly has a flap valve  37   b  that presses against the flap valve seat  35   b  on inhalation and completely occludes the opening  36   b  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  16   b  on inhalation. On exhalation the flap valve  37   b  moves away from the flap valve seat  35   b  for the air exhaled by the patient to escape into the atmosphere from tube  16   b  through the opening  36   b.    
         [0083]     The nebulizer chamber  4   b  has a hollow cylindrical inlet tube  38   b  with an inlet end  39   b  and an outlet end  40   b . The inlet and  39   b  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber  4   b  has a hollow cylindrical outlet tube  41   b  that has an inlet end  42   b  and an outlet end  43   b . The outlet end  43   b  may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes,  44   b  and  47   b , at three o&#39;clock and nine o&#39;clock positions. Tube  44   b  has an inlet end  45   b  and an outlet end  46   b , whereas the tube  47   b  has an inlet end  48   b  and an outlet end  49   b . The inlet end  11   b  of the tube  10   b  is connected to the outlet end  46   b  of the tube  44   b  with a collapsible/expandable stiff corrugated plastic tubing  50   b  and similarly the inlet end  14   b  of tube  13   b  is connected to the outlet end  49   b  of tube  47   b  with a collapsible/expandable corrugated plastic tubing  51   b . The collapsible/expandable tubings  50   b  and  51   b  are demonstrated to be fully expanded in  FIG. 1B  to accommodate MDI boot  25   b  between the MDI chamber  1   b  and the nebulizer chamber  4   b.    
         [0084]     The nebulizer chamber has an inlet port  52   b  for connection with a standard small volume nebulizer  53   b . Chamber  4   b  also has another inlet  54   b  for connection to a reservoir bag  55   b . The reservoir bag  55   b  serves to store the aerosol particles generated by the nebulizer  53   b  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  55   b  has two small inlets  56   b  and  57   b  to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0085]      FIG. 1C  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention.  FIG. 1C  is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with a nebulizer. The device has two hollow chambers, a metered dose inhaler chamber  1   c , and a nebulizer chamber  4   c . The MDI chamber  1   a  has an inlet end  2   c  and an outlet end  3   c . The nebulizer chamber  4   c  similarly has an inlet end  5   c  and an outlet end  6   c . The inlet end  2   c  has three hollow cylindrical inlet tubes, a central tube  7   c  and two peripheral tubes  10   c  and  13   c  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  7   c  has an inlet end  8   c  and an outlet end  9   c . The peripheral tube  10   c  has an inlet end  11   c  and an outlet end  12   c  and the peripheral tube  13   c  similarly has an inlet end  14   c  and an outlet ed  15   c . The outlet end  3   c  of the MDI chamber  1   c  has a hollow cylindrical tube  16   c  with an inlet end  17   c  and an outlet end  18   c . The MDI chamber  1   c  may be made of plastic, paper, or metal. The chamber  1   c  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  19   c  and grooves  20   c . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   c  of the coil are demonstrated in the figure as dotted lines. The distance  22   c  and  23   c  between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber  1   c  in this figure is illustrated as fully expanded. The inlet end  8   c  of the tube  7   c  is not attached to the MDI  24   c  as demonstrated in  FIG. 1A . The MDI  24   c  is demonstrated separately in this figure The inhaler  24   c  has a boot  25   c  with an inlet end  26   c  and an outlet end  27   c . A canister  28   c  is introduced into the boot  25   c  through the inlet end  26   c  and the nozzle  29   c  of the MDI  24   c  is attached to an actuator  30   c . The actuator  30   c  has an opening or an aperture  31   c . On actuation of the MDI canister  28   c , the medication aerosol particles are generated through the opening  31   c  of the actuator  30   c.    
         [0086]     The outlet tube  16   c  of the MDI chamber  1   c  has two valve assemblies disposed between the inlet end  17   c  and the outlet end  18   c —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  32   c  that has a circular opening  33   c  and a flap valve  34   c  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  35   c  that has a circular opening  36   c  and a flap valve  37   c  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  34   c  moves away from the valve seat  32   c  for the aerosol particles to move from the MDI chamber  1   c  to the patient through the opening  33   c  in the valve seat  32   c  of the tube  16   c . On exhalation, the flap valve  34   c  moves towards the flap valve seat  32   c  and closes the opening  33   c  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   c  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  32   c  prevents any protrusion of the flap valve  34   c  through the opening  33   c . The exhalation flap valve assembly has a flap valve  37   c  that presses against the flap valve seat  35   c  on inhalation and completely occludes the opening  36   c  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  16   c  on inhalation. On exhalation the flap valve  37   c  moves away from the flap valve seat  35   c  for the air exhaled by the patient to escape into the atmosphere from tube  16   c  through the opening  36   c.    
         [0087]     The nebulizer chamber  4   c  has a hollow cylindrical inlet tube  38   c  with an inlet end  39   c  and an outlet end  40   c . The inlet and  39   c  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber  4   c  has a hollow cylindrical outlet tube  41   c  that has an inlet end  42   c  and an outlet end  43   c . The nebulizer chamber also has two hollow cylindrical tubes,  44   c  and  47   c , at three o&#39;clock and nine o&#39;clock positions. Tube  44   c  has an inlet end  45   c  and an outlet end  46   c , whereas the tube  47   a  has an inlet end  48   c  and an outlet end  49   c . The inlet end  11   c  of the tube  10   c  is connected to the outlet end  46   c  of the tube  4   c  with a collapsible/expandable stiff corrugated plastic tubing  50   c  and similarly the inlet end  14   c  of tube  13   c  is connected to the outlet end  49   c  of tube  47   c  with a collapsible/expandable corrugated plastic tubing  51   c . Quite unlike  FIG. 1A  the collapsible/expandable tubings  50   c  and  51   c  are now demonstrated to be collapsed but still fully patent. The inlet end  9   c  of the tube  7   c  is now fused to the outlet end  43   c  of the tube  41   c . The inlet ends  11   c  and  14   c  may be fused to the outlet ends  46   c  and  49   c  respectively or may stay separated.  
         [0088]     The nebulizer chamber has an inlet port  52   c  for connection with a standard small volume nebulizer  53   c . The aerosol medication generated with the nebulizer  53   c  can enter the MDI chamber via a central connection between the tubes  7   c  and  41   c  or through the peripheral connections between the tubes  10   c  and  44   c , and  13   c  and  47   c . Chamber  4   c  also has another inlet  54   c  for connection to a reservoir bag  55   c . The reservoir bag  55   c  serves to store the aerosol particles generated by the nebulizer  53   c  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  55   c  has two small inlets  56   c  and  57   c  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The MDI  24   c  can be connected to the inlet  40   c  and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  4   c  to the MDI chamber  1   c  via the central and two peripheral connections between the two chambers as described before.  
         [0089]      FIG. 1D  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention.  FIG. 1D  is a perspective view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with a nebulizer. The device has two hollow chambers, a metered dose inhaler chamber  1   d , and a nebulizer chamber  4   d . The MDI chamber  1   d  has an inlet end  2   d  and an outlet end  3   d . The nebulizer chamber  4   d  similarly has an inlet end  5   d  and an outlet end  6   d . The inlet end  2   d  has three hollow cylindrical inlet tubes, a central tube  7   d  and two peripheral tubes  10   d  and  13   d  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  7   d  has an inlet end  8   d  and an outlet end  9   d . The peripheral tube  10   d  has an inlet end  11   d  and an outlet end  12   d  and the peripheral tube  13   d  similarly has an inlet end  14   d  and an outlet  15   d . The outlet end  3   d  of the MDI chamber  1   d  has a hollow cylindrical tube  16   d  with an inlet end  17   d  and an outlet end  18   d . The MDI chamber  1   a  may be made of plastic, paper, or metal. The chamber  1   a  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  19   d  and grooves  20   d . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   d  of the coil are demonstrated in the figure as dotted lines. The chamber  1   d  in this figure is demonstrated to be fully or partially collapsed The distance  22   d  and  23   d  between the two adjacent ridges; rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end  17   d  of the tube  16   d  may be fused to the outlet end  9   d  of the tube  7   d . The distance  22   d  and  23   d  between the two adjacent ridges, rings of the coil, or grooves may be equal. The inlet end  8   d  of the tube  7   d  is not attached to the MDI  24   d  as demonstrated in  FIG. 1A . The MDI  24   d  is demonstrated separately in this figure. The inhaler  24   d  has a boot  25   d  with an inlet end  26   d  and an outlet end  27   d . A canister  28   d  is introduced into the boot  25   d  through the inlet end  26   d  and the nozzle  29   d  of the MDI  24   d  is attached to an actuator  30   d . The actuator  30   d  has an opening or an aperture  31   d . On actuation of the MDI canister  28   d , the medication aerosol particles are generated through the opening  31   d  of the actuator  30   d.    
         [0090]     The outlet tube  16   d  of the MDI chamber  1   d  has two valve assemblies disposed between the inlet end  17   d  and the outlet end  18   d —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  32   d  that has a circular opening  33   d  and a flap valve  34   d  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  35   d  that has a circular opening  36   d  and a flap valve  37   d  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  34   d  moves away from the valve seat  32   d  for the aerosol particles to move from the MDI chamber  1   d  to the patient through the opening  33   d  in the valve seat  32   d  of the tube  16   d . On exhalation, the flap valve  34   d  moves towards the flap valve seat  32   d  and closes the opening  33   d  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   d  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  32   d  prevents any protrusion of the flap valve  34   d  through the opening  33   d . The exhalation flap valve assembly has a flap valve  37   d  that presses against the flap valve seat  35   d  on inhalation and completely occludes the opening  36   d  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  16   d  on inhalation. On exhalation the flap valve  37   d  moves away from the flap valve seat  35   d  for the air exhaled by the patient to escape into the atmosphere from tube  16   d  through the opening  36   d.    
         [0091]     The nebulizer chamber  4   d  has a hollow cylindrical inlet tube  38   d  with an inlet end  39   d  and an outlet end  40   d . The inlet and  39   d  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber  4   d  has a hollow cylindrical outlet tube  41   d  that has an inlet end  42   d  and an outlet end  43   d . The nebulizer chamber also has two hollow cylindrical tubes,  44   d  and  47   d , at three o&#39;clock and nine o&#39;clock positions. Tube  44   d  has an inlet end  45   d  and an outlet end  46   d , whereas the tube  47   d  has an inlet end  48   d  and an outlet end  49   d . The inlet end  1   d  of the tube  10   d  is connected to the outlet end  46   d  of the tube  44   d  with a collapsible/expandable stiff corrugated plastic tubing  50   d  and similarly the inlet end  14   d  of tube  13   d  is connected to the outlet end  49   d  of tube  47   d  with a collapsible/expandable corrugated plastic tubing  51   d . Quite unlike  FIG. 1A  the collapsible/expandable tubings  50   d  and  51   d  are now demonstrated to be collapsed but still fully patent. The inlet end  9   d  of the tube  7   d  is now fused to the outlet end  43   d  of the tube  41   d . The inlet ends  11   d  and  14   d  may be fused to the outlet ends  46   d  and  49   d  respectively or may stay separated.  
         [0092]     The nebulizer chamber has an inlet port  52   d  for connection with a standard small volume nebulizer  53   d . The aerosol medication generated with the nebulizer  53   d  can enter the MDI chamber via a central connection between the tubes  7   d  and  41   d  or through the peripheral connections between the tubes  10   d  and  44   d , and  13   d  and  47   d . Chamber  4   d  also has another inlet  54   d  for connection to a reservoir bag  55   d . The reservoir bag  55   d  serves to store the aerosol particles generated by the nebulizer  53   d  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  55   d  has two small inlets  56   d  and  57   d  to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0093]      FIG. 1E  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention.  FIG. 1E  is a perspective view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber  1   e  has an outlet end  3   e . The nebulizer chamber  4   e  has an inlet end  5   e . The inlet end of the MDI chamber  1   e  and the outlet end of the nebulizer chamber  4   e  are fused together, the point of fusion is labeled as  2   e   6   e . The outlet end  3   e  of the MDI chamber  1   e  has a hollow cylindrical tube  16   e  with an inlet end  17   e  and an outlet end  18   e . The MDI chamber  1   e  may be made of plastic, paper, or metal. The chamber  1   e  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  19   e  and grooves  20   e . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   e  of the coil are demonstrated in the figure as dotted lines. The distance  22   e  and  23   e  between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber le in this figure is illustrated as fully expanded.  
         [0094]     The outlet tube  16   e  of the MDI chamber  1   e  has two valve assemblies disposed between the inlet end  17   e  and the outlet end  18   e —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  32   e  that has a circular opening  33   e  and a flap valve  34   e  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  35   e  that has a circular opening  36   e  and a flap valve  37   e  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  34   e  moves away from the valve seat  32   e  for the aerosol particles to move from the MDI chamber  1   e  to the patient through the opening  33   e  in the valve seat  32   e  of the tube  16   e . On exhalation, the flap valve  34   e  moves towards the flap valve seat  32   e  and closes the opening  33   e  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   e  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  32   e  prevents any protrusion of the flap valve  34   e  through the opening  33   e . The exhalation flap valve assembly has a flap valve  37   e  that presses against the flap valve seat  35   e  on inhalation and completely occludes the opening  36   e  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  16   e  on inhalation. On exhalation the flap valve  37   e  moves away from the flap valve seat  35   e  for the air exhaled by the patient to escape into the atmosphere from tube  16   e  through the opening  36   e.    
         [0095]     The nebulizer chamber  4   e  has a hollow cylindrical inlet tube  38   e  with an inlet end  39   e  and an outlet end  40   e . The inlet and  39   e  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end  39   e  may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI  24   e  maybe alternatively be connected to the inlet end  39   e  of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  4   e  to the MDI chamber. The inhaler  24   e  has a boot  25   e  with an inlet end  26   e  and an outlet end  27   e . A canister  28   e  is introduced into the boot  25   e  through the inlet end  26   e  and the nozzle  29   e  of the MDI  24   e  is attached to an actuator  30   e . The actuator  30   e  has an opening or an aperture  31   e . On actuation of the MDI canister  28   e , the medication aerosol particles are generated through the opening  31   e  of the actuator  30   e.    
         [0096]     The nebulizer chamber has an inlet port  52   e  for connection with a standard small volume nebulizer  53   e . The aerosol medication generated with the nebulizer  53   e  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  2   e   6   e . Chamber  4   e  also has another inlet  54   e  for connection to a reservoir bag  55   e . The reservoir bag  55   e  serves to store the aerosol particles generated by the nebulizer  53   e  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  55   e  has two small inlets  56   e  and  57   e  to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0097]      FIG. 1F  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention.  FIG. 1F  is a perspective view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber  1   a  has an outlet end  3   f . The nebulizer chamber  4   f  has an inlet end  5   f . The inlet end of the MDI chamber  1   f  and the outlet end of the nebulizer chamber  4   f  are fused together, the point of fusion is labeled as  2   f   6   f . The outlet end  3   f  of the MDI chamber  1   f  has a hollow cylindrical tube  16   f  with an inlet end  17   f  and an outlet end  18   f . The MDI chamber  1   f  may be made of plastic, paper, or metal. The chamber  1   f  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  19   f  and grooves  20   f . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   f  of the coil are demonstrated in the figure as dotted lines. The chamber  1   f  in this figure is demonstrated to be fully or partially collapsed. The distance  22   f  and  23   f  between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end  17   f  of the tube  16   f  may be fused to the outlet end  9   f  of the tube  7   f . The distance  22   f  and  23   f  between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0098]     The outlet tube  16   f  of the MDI chamber  1   f  has two valve assemblies disposed between the inlet end  17   f  and the outlet end  18   f —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  32   f  that has a circular opening  33   f  and a flap valve  34   f  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  35   f  that has a circular opening  36   f  and a flap valve  37   f  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  34   f  moves away from the valve seat  32   f  for the aerosol particles to move from the MDI chamber  1   f  to the patient through the opening  33   f  in the valve seat  32   f  of the tube  16   f . On exhalation, the flap valve  34   f  moves towards the flap valve seat  32   f  and closes the opening  33   f  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   f  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  32   f  prevents any protrusion of the flap valve  34   f  through the opening  33   f . The exhalation flap valve assembly has a flap valve  37   f  that presses against the flap valve seat  35   f  on inhalation and completely occludes the opening  36   f  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  16   f  on inhalation. On exhalation the flap valve  37   f  moves away from the flap valve seat  35   f  for the air exhaled by the patient to escape into the atmosphere from tube  16   f  through the opening  36   f.    
         [0099]     The nebulizer chamber  4   f  has a hollow cylindrical inlet tube  38   f  with an inlet end  39   f  and an outlet end  40   f . The inlet and  39   f  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end  39   f  may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI  24   f  maybe alternatively be connected to the inlet end  39   f  of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  4   f  to the MDI chamber. The inhaler  24   f  has a boot  25   f  with an inlet end  26   f  and an outlet end  27   f . A canister  28   f  is introduced into the boot  25   f  through the inlet end  26   f  and the nozzle  29   f  of the MDI  24   f  is attached to an actuator  30   f . The actuator  30   f  has an opening or an aperture  31   f . On actuation of the MDI canister  28   f , the medication aerosol particles are generated through the opening  31   f  of the actuator  30   f.    
         [0100]     The nebulizer chamber has an inlet port  52   f  for connection with a standard small volume nebulizer  53   f . The aerosol medication generated with the nebulizer  53   f  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  2   f   6   f . Chamber  4   f  also has another inlet  54   f  for connection a reservoir bag  55   f . The reservoir bag  55   f  serves to store the aerosol particles generated by the nebulizer  53   f  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  55   f  has two small inlets  56   f  and  57   f  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0101]      FIG. 2A  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the third alternative embodiment of the present invention.  FIG. 2A  is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber  58   a , and a nebulizer chamber  61   a . The MDI chamber  58   a  has an inlet end  59   a  and an outlet end  60   a . The nebulizer chamber  61   a  similarly has an inlet end  62   a  and an outlet end  63   a . The inlet end  59   a  has three hollow cylindrical inlet tubes, a central tube  64   a  and two peripheral tubes  67   a  and  70   a  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  64   a  has an inlet end  65   a  and an outlet end  66   a . The peripheral tube  67   a  has an inlet end  68   a  and an outlet end  69   a  and the peripheral tube  70   a  similarly has an inlet end  71   a  and an outlet ed  72   a . The outlet end  60   a  of the MDI chamber  58   a  has a hollow cylindrical tube  73   a  with an inlet end  74   a  and an outlet end  75   a . The MDI chamber  58   a  may be made of plastic, paper, or metal. The chamber  58   a  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  76   a  and grooves  77   a . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  21   a  of the coil are demonstrated in the figure as dotted lines. The distance  79   a  and  80   a  between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber  58   a  and the nebulizer chamber  61   a  in this figure are illustrated as fully expanded. The inlet end  65   a  of the tube  64   a  is attached to the outlet end  84   a  of the boot  82   a  of a metered dose inhaler  81   a . The inhaler  81   a  has a boot  82   a  with an inlet end  83   a  and an outlet end  84   a . A canister  85   a  is introduced into the boot  82   a  through the inlet end  83   a  and the nozzle  86   a  of the MDI  81   a  is attached to an actuator  87   a . The actuator  87   a  has an opening or an aperture  88   a . On actuation of the MDI canister  85   a , the medication aerosol particles are generated through the opening  88   a  of the actuator  87   a , and enter into the chamber  58  through the outlet end  66   a  of the tube  64   a.    
         [0102]     The outlet tube  73   a  of the MDI chamber  58   a  has two valve assemblies disposed between the inlet end  74   a  and the outlet end  75   a —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  89   a  that has a circular opening  90   a  and a flap valve  91   a  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  92   a  that has a circular opening  93   a  and a flap valve  94   a  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  91   a  moves away from the valve seat  89   a  for the aerosol particles to move from the MDI chamber  58   a  to the patient through the opening  90   a  in the valve seat  89   a  of the tube  73   a . On exhalation, the flap valve  91   a  moves towards the flap valve seat  89   a  and closes the opening  90   a  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  58   a  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  89   a  prevents any protrusion of the flap valve  91   a  through the opening  90   a . The exhalation flap valve assembly has a flap valve  94   a  that presses against the flap valve seat  92   a  on inhalation and completely occludes the opening  93   a  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  73   a  on inhalation. On exhalation the flap valve  94   a  moves away from the flap valve seat  92   a  for the air exhaled by the patient to escape into the atmosphere from tube  73   a  through the opening  93   a.    
         [0103]     The nebulizer chamber  61   a  has a hollow cylindrical outlet tube  98   a  that has an inlet end  99   a  and an outlet end  100   a . The outlet end  100   a  may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes,  101   a  and  104   a , at three o&#39;clock and nine o&#39;clock positions. Tube  101   a  has an inlet end  102   a  and an outlet end  103   a , whereas the tube  104   a  has an inlet end  105   a  and an outlet end  106   a . The inlet end  68   a  of the tube  67   a  is connected to the outlet end  103   a  of the tube  101   a  with a collapsible/expandable stiff corrugated plastic tubing  107   a  and similarly the inlet end  71   a  of tube  70   a  is connected to the outlet end  106   a  of tube  104   a  with a collapsible/expandable corrugated plastic tubing  108   a . The collapsible/expandable tubings  107   a  and  108   a  are demonstrated to be fully expanded in  FIG. 1A  to accommodate MDI boot  82   a  between the MDI chamber  1   a  and the nebulizer chamber  61   a . The nebulizer chamber has an inlet port  109   a  for connection with a standard small volume nebulizer  110   a.    
         [0104]     Nebulizer chamber  61   a  may have another inlet  11   a  for connection to a reservoir bag  112   a . The bag  112   a  may have two small inlets  113   a  and  114   a  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  112   a  may be replaced by a corrugated plastic reservoir tubing or chamber  115   a  that may be connected to inlet  111   a  or to the inlet end  62   a  of the nebulizer chamber  61   a . The reservoir tubing/chamber  115   a  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  116   a  and grooves  117   a . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  118   a  of the coil are demonstrated in the figure as dotted lines. The distance  119   a  and  120   a  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  112   a  or reservoir tubing  115   a  serves to store the aerosol particles generated by the nebulizer  110   a  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  121   a  that may have a hollow cylindrical inlet tube  95   a  with an inlet end  96   a  and an outlet end  97   a . The inlet and  96   a  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0105]      FIG. 2B  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the third alternative embodiment of the present invention.  FIG. 2B  is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber  58   b , and a nebulizer chamber  61   b . The MDI chamber  58   b  has an inlet end  59   b  and an outlet end  60   b . The nebulizer chamber  61   b  similarly has an inlet end  62   b  and an outlet end  63   b . The inlet end  59   b  has three hollow cylindrical inlet tubes, a central tube  64   b  and two peripheral tubes  67   b  and  70   b  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  64   b  has an inlet end  65   b  and an outlet end  66   b  The peripheral tube  67   b  has an inlet end  68   b  and an outlet end  69   b  and the peripheral tube  70   b  similarly has an inlet end  71   b  and an outlet ed  72   b . The outlet end  60   b  of the MDI chamber  58   b  has a hollow cylindrical tube  73   b  with an inlet end  74   b  and an outlet end  75   b . The MDI chamber  58   b  may be made of plastic, paper, or metal. The chamber  58   b  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  76   b  and grooves  77   b . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  78   b  of the coil are demonstrated in the figure as dotted lines. The chamber in this figure is demonstrated to be fully or partially collapsed. The distance  79   b  and  80   b  between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. When fully collapsed, the inlet end  74   b  of the tube  73   b  may be fused to the outlet end  66   b  of the tube  64   b . The distance  79   a  and  80   a  between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber  58   b  and the nebulizer chamber  61   b  in this figure are illustrated as fully or partially collapsed. The inlet end  65   b  of the tube  64   b  is attached to the outlet end  84   b  of the boot  82   b  of a metered dose inhaler  81   b . The inhaler  81   b  has a boot  82   b  with an inlet end  83   b  and an outlet end  84   b . A canister  85   b  is introduced into the boot  82   b  through the inlet end  83   b  and the nozzle  86   b  of the MDI  81   b  is attached to an actuator  87   b . The actuator  87   b  has an opening or an aperture  88   b . On actuation of the MDI canister  85   b , the medication aerosol particles are generated through the opening  88   b  of the actuator  87   b , and enter into the chamber  58  through the outlet end  66   b  of the tube  64   b.    
         [0106]     The outlet tube  73   b  of the MDI chamber  58   b  has two valve assemblies disposed between the inlet end  74   b  and the outlet end  75   b —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  89   b  that has a circular opening  90   b  and a flap valve  91   b  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  92   b  that has a circular opening  93   b  and a flap valve  94   b  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  91   b  moves away from the valve seat  89   b  for the aerosol particles to move from the MDI chamber  58   b  to the patient through the opening  90   b  in the valve seat  89   b  of the tube  73   b . On exhalation, the flap valve  91   b  moves towards the flap valve seat  89   b  and closes the opening  90   b  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  58   b  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  89   b  prevents any protrusion of the flap valve  91   b  through the opening  90   b . The exhalation flap valve assembly has a flap valve  94   b  that presses against the flap valve seat  92   b  on inhalation and completely occludes the opening  93   b  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  73   b  on inhalation. On exhalation the flap valve  94   b  moves away from the flap valve seat  92   b  for the air exhaled by the patient to escape into the atmosphere from tube  73   b  through the opening  93   b . The nebulizer chamber  61   b  has a hollow cylindrical inlet tube  95   b  with an inlet end  96   b  and an outlet end  97   b . The inlet and  96   b  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0107]     The nebulizer chamber  61   b  has a hollow cylindrical outlet tube  98   b  that has an inlet end  99   b  and an outlet end  100   b . The outlet end  100   b  may remain plugged with a cap when the device is in use with a metered dose inhaler. The nebulizer chamber also has two hollow cylindrical tubes,  101   b  and  104   b , at three o&#39;clock and nine o&#39;clock positions. Tube  101   b  has an inlet end  102   b  and an outlet end  103   b , whereas the tube  104   b  has an inlet end  105   b  and an outlet end  106   b . The inlet end  68   b  of the tube  67   b  is connected to the outlet end  103   b  of the tube  101   b  with a collapsible/expandable stiff corrugated plastic tubing  107   b  and similarly the inlet end  71   b  of tube  70   b  is connected to the outlet end  106   b  of tube  104   b  with a collapsible/expandable corrugated plastic tubing  108   b . The collapsible/expandable tubings  107   b  and  108   b  are demonstrated to be fully expanded in  FIG. 1A  to accommodate MDI boot  82   b  between the MDI chamber  1   b  and the nebulizer chamber  61   b . The nebulizer chamber has an inlet port  109   a  for connection with a standard small volume nebulizer  110   b.    
         [0108]     Nebulizer chamber  61   b  may have another inlet  111   b  for connection to a reservoir bag  112   b . The bag  112   b  may have two small inlets  113   b  and  114   b  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  112   b  may be replaced by a corrugated plastic reservoir tubing/chamber  115   b  that may be connected to inlet  111   b  or to the inlet end  62   b  of the nebulizer chamber  61   b . The reservoir tubing/chamber  115   b  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  116   b  and grooves  117   b . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  118   b  of the coil are demonstrated in the figure as dotted lines. The distance  119   b  and  120   b  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  112   b  or reservoir tubing  115   b  serves to store the aerosol particles generated by the nebulizer  110   b  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  121   b  that may have a hollow cylindrical inlet tube  95   b  with an inlet end  96   b  and an outlet end  97   b . The inlet and  96   b  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0109]      FIG. 2C  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fourth alternative embodiment of the present invention.  FIG. 2C  is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber  58   c , and a nebulizer chamber  61   c . The MDI chamber  58   c  has an inlet end  59   c  and an outlet end  60   c . The nebulizer chamber  61   c  similarly has an inlet end  62   c  and an outlet end  63   c . The inlet end  59   c  has three hollow cylindrical inlet tubes, a central tube  64   c  and two peripheral tubes  67   c  and  70   c  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  64   c  has an inlet end  65   c  and an outlet end  66   c  The peripheral tube  67   c  has an inlet end  68   c  and an outlet end  69   c  and the peripheral tube  70   c  similarly has an inlet end  71   c  and an outlet ed  72   c . The outlet end  60   c  of the MDI chamber  58   c  has a hollow cylindrical tube  73   c  with an inlet end  74   c  and an outlet end  75   c . The MDI chamber  58   c  may be made of plastic, paper, or metal. The chamber  58   c  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  76   c  and grooves  77   c . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  78   c  of the coil are demonstrated in the figure as dotted lines. The distance  79   c  and  80   c  between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber  58   c  and the nebulizer chamber  61   c  in this figure are illustrated as fully expanded. The inlet end  65   c  of the tube  64   c  is not attached to the MDI  81   c  as demonstrated in  FIG. 1A . The MDI  81   c  is demonstrated separately in this figure. The inhaler  81   c  has a boot  82   c  with an inlet end  83   c  and an outlet end  84   c . A canister  85   c  is introduced into the boot  82   c  through the inlet end  83   c  and the nozzle  86   c  of the MDI  81   c  is attached to an actuator  87   c . The actuator  87   c  has an opening or an aperture  88   c . On actuation of the MDI canister  85   c , the medication aerosol particles are generated through the opening  88   c  of the actuator  87   c.    
         [0110]     The outlet tube  73   c  of the MDI chamber  58   a  has two valve assemblies disposed between the inlet end  74   c  and the outlet end  75   c —the inhalation valve assembly and an exhalation valve assembly The inhalation flap valve assembly has a circular flap valve seat  89   c  that has a circular opening  90   c  and a flap valve  91   c  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  92   c  that has a circular opening  93   c  and a flap valve  94   c  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  91   c  moves away from the valve seat  89   c  for the aerosol particles to move from the MDI chamber  58   c  to the patient through the opening  90   c  in the valve seat  89   c  of the tube  73   c . On exhalation, the flap valve  91   c  moves towards the flap valve seat  89   c  and closes the opening  90   c  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  58   c  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  89   c  prevents any protrusion of the flap valve  91   c  through the opening  90   c . The exhalation flap valve assembly has a flap valve  94   c  that presses against the flap valve seat  92   c  on inhalation and completely occludes the opening  93   c  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  73   c  on inhalation. On exhalation the flap valve  94   c  moves away from the flap valve seat  92   c  for the air exhaled by the patient to escape into the atmosphere from tube  73   c  through the opening  93   c . The nebulizer chamber  61   c  has a hollow cylindrical inlet tube  95   c  with an inlet end  96   c  and an outlet end  97   c . The inlet and  96   c  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0111]     The nebulizer chamber  61   c  has a hollow cylindrical outlet tube  98   c  that has an inlet end  99   c  and an outlet end  100   c . The nebulizer chamber also has two hollow cylindrical tubes,  101   c  and  104   c , at three o&#39;clock and nine o&#39;clock positions. Tube  101   c  has an inlet end  102   c  and an outlet end  103   c , whereas the tube  104   c  has an inlet end  105   c  and an outlet end  106   c . The inlet end  68   c  of the tube  67   c  is connected to the outlet end  103   c  of the tube  101   c  with a collapsible/expandable stiff corrugated plastic tubing  107   c  and similarly the inlet end  71   c  of tube  70   c  is connected to the outlet end  106   c  of tube  104   c  with a collapsible/expandable corrugated plastic tubing  108   c . Quite unlike  FIG. 2A  the collapsible/expandable tubings  107   c  and  108   c  are now demonstrated to be collapsed but still fully patent. The inlet end  66   c  of the tube  64   c  is now fused to the outlet end  100   c  of the tube  98   c . The inlet ends  68   c  and  71   c  may be fused to the outlet ends  103   c  and  106   c  respectively or may stay separated. The nebulizer chamber has an inlet port  109   c  for connection with a standard small volume nebulizer  110   c . The aerosol medication generated with the nebulizer  110   c  can enter the MDI chamber via a central connection between the tubes  60   c  and  98   c  or through the peripheral connections between the tubes  67   c  and  101   c , and  70   c  and  104   c.    
         [0112]     Nebulizer chamber  61   c  may have another inlet  111   c  for connection to a reservoir bag  112   c . The bag  112   c  may have two small inlets  113   c  and  114   c  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  112   c  may be replaced by a corrugated plastic reservoir tubing/chmaber  115   c  that may be connected to inlet  111   c  or to the inlet end  62   c  of the nebulizer chamber  61   c . The reservoir tubing/chamber  115   c  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  116   c  and grooves  117   c . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  118   c  of the coil are demonstrated in the figure as dotted lines. The distance  119   c  and  120   c  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  112   c  or reservoir tubing  115   c  serves to store the aerosol particles generated by the nebulizer  110   c  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  121   c  that may have a hollow cylindrical inlet tube  95   c  with an inlet end  96   c  and an outlet end  97   c . The inlet end  96   c  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI  81   c  can be connected to the inlet  97   c  and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  61   c  to the MDI chamber  58   c  via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister  85   c , the medication aerosol particles are generated through the opening  88   c  of the actuator  87   c , and enter into the chamber  58  through the outlet end  66   c  of the tube  64   c.    
         [0113]      FIG. 2D  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fourth alternative embodiment of the present invention.  FIG. 2D  is a plan view of the invention that may be used with a metered dose inhaler (MDI) or a nebulizer. The illustration here is describes the use of this device preferentially with an MDI. The device has two hollow chambers, a metered dose inhaler chamber  58   d , and a nebulizer chamber  61   d . The MDI chamber  58   d  has an inlet end  59   d  and an outlet end  60   d . The nebulizer chamber  61   d  similarly has an inlet end  62   d  and an outlet end  63   d . The inlet end  59   d  has three hollow cylindrical inlet tubes, a central tube  64   d  and two peripheral tubes  67   d  and  70   d  located at three o&#39;clock to nine o&#39;clock positions. The central hollow cylindrical tube  64   d  has an inlet end  65   d  and an outlet end  66   d . The peripheral tube  67   d  has an inlet end  68   d  and an outlet end  69   d  and the peripheral tube  70   d  similarly has an inlet end  71   d  and an outlet end  72   d . The outlet end  60   d  of the MDI chamber  58   d  has a hollow cylindrical tube  73   d  with an inlet end  74   d  and an outlet end  75   d . The MDI chamber  58   d  may be made of plastic, paper, or metal. The chamber  58   d  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  76   d  and grooves  77   d . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  78   d  of the coil are demonstrated in the figure as dotted lines. The chamber in this figure is demonstrated to be fully or partially collapsed. The distance  79   d  and  80   d  between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. The MDI chamber  58   d  and the nebulizer chamber  61   d  in this figure are illustrated as fully collapsed. When fully collapsed, the inlet end  74   d  of the tube  73   d  may be fused to the outlet end  66   d  of the tube  64   d . The distance  79   d  and  80   d  between the two adjacent ridges, rings of the coil, or grooves may be equal. The inlet end  65   d  of the tube  64   a  is not attached to the MDI  81   d  as demonstrated in  FIG. 1A . The MDI  81   d  is demonstrated separately in this figure. The inhaler  81   d  has a boot  82   d  with an inlet end  83   d  and an outlet end  84   d . A canister  85   d  is introduced into the boot  82   d  through the inlet end  83   d  and the nozzle  86   d  of the MDI  81   d  is attached to an actuator  87   d . The actuator  87   d  has an opening or an aperture  88   d . On actuation of the MDI canister  85   d , the medication aerosol particles are generated through the opening  88   ad  of the actuator  87   d.    
         [0114]     The outlet tube  73   d  of the MDI chamber  58   d  has two valve assemblies disposed between the inlet end  74   d  and the outlet end  75   d —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  89   d  that has a circular opening  90   d  and a flap valve  91   d  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  92   d  that has a circular opening  93   d  and a flap valve  94   d  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  91   d  moves away from the valve seat  89   d  for the aerosol particles to move from the MDI chamber  58   d  to the patient through the opening  90   d  in the valve seat  89   d  of the tube  73   d . On exhalation, the flap valve  91   d  moves towards the flap valve seat  89   d  and closes the opening  90   d  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  58   d  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  89   d  prevents any protrusion of the flap valve  91   d  through the opening  90   d . The exhalation flap valve assembly has a flap valve  94   d  that presses against the flap valve seat  92   d  on inhalation and completely occludes the opening  93   d  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  73   d  on inhalation. On exhalation the flap valve  94   d  moves away from the flap valve seat  92   d  for the air exhaled by the patient to escape into the atmosphere from tube  73   d  through the opening  93   d.    
         [0115]     The nebulizer chamber  61   d  has a hollow cylindrical inlet tube  95   d  with an inlet end  96   d  and an outlet end  97   d . The inlet and  96   d  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The nebulizer chamber  61   d  has a hollow cylindrical outlet tube  98   d  that has an inlet end  99   d  and an outlet end  100   d . The nebulizer chamber also has two hollow cylindrical tubes,  101   d  and  104   d , at three o&#39;clock and nine o&#39;clock positions. Tube  101   d  has an inlet end  102   d  and an outlet end  103   d , whereas the tube  104   d  has an inlet end  105   d  and an outlet end  106   d . The inlet end  68   d  of the tube  67   d  is connected to the outlet end  103   d  of the tube  101   d  with a collapsible/expandable stiff corrugated plastic tubing  107   d  and similarly the inlet end  71   d  of tube  70   d  is connected to the outlet end  106   d  of tube  104   d  with a collapsible/expandable corrugated plastic tubing  108   d . Quite unlike  FIG. 2A  the collapsible/expandable tubings  107   d  and  108   d  are now demonstrated to be collapsed but still fully patent. The inlet end  66   d  of the tube  64   d  is now fused to the outlet end  100   d  of the tube  98   d . The inlet ends  68   d  and  71   d  may be fused to the outlet ends  103   d  and  106   d  respectively or may stay separated. The nebulizer chamber has an inlet port  109   d  for connection with a standard small volume nebulizer  110   d . The aerosol medication generated with the nebulizer  110   d  can enter the MDI chamber via a central connection between the tubes  60   d  and  98   d  or through the peripheral connections between the tubes  67   d  and  101   d , and  70   d  and  104   d.    
         [0116]     Nebulizer chamber  61   d  may have another inlet  111   d  for connection to a reservoir bag  112   d . The bag  112   d  may have two small inlets  113   d  and  114   d  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  112   d  may be replaced by a corrugated plastic reservoir tubing/chamber  115   d  that may be connected to inlet  111   d  or to the inlet end  62   d  of the nebulizer chamber  61   d . The reservoir tubing/chamber  115   d  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  116   d  and grooves  117   d . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  118   d  of the coil are demonstrated in the figure as dotted lines. The distance  119   d  and  120   d  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  112   d  or reservoir tubing  115   d  serves to store the aerosol particles generated by the nebulizer  110   d  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  121   d  that may have a hollow cylindrical inlet tube  95   d  with an inlet end  96   d  and an outlet end  97   d . The inlet and  96   d  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI  81   d  can be connected to the inlet  97   d  and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  61   d  to the MDI chamber  58   d  via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister  85   d , the medication aerosol particles are generated through the opening  88   d  of the actuator  87   d , and enter into the chamber  58  through the outlet end  66   d  of the tube  64   d.    
         [0117]      FIG. 2E  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fifth alternative embodiment of the present invention.  FIG. 2E  is a plan view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber  58   e  has an outlet end  60   e . The nebulizer chamber  61   e  has an inlet end  62   e . The inlet end of the MDI chamber  58   e  and the outlet end of the nebulizer chamber  4   e  are fused together, the point of fusion is labeled as  2   e   6   e . The outlet end  60   e  of the MDI chamber  1   e  has a hollow cylindrical tube  73   e  with an inlet end  74   e  and an outlet end  75   e . The MDI chamber  1   e  may be made of plastic, paper, or metal. The chamber  1   e  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  76   e  and grooves  77 . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  78   e  of the coil are demonstrated in the figure as dotted lines. The distance  79   e  and  80   e  between the two adjacent ridges, rings of the coil, or grooves may be equal. The MDI chamber  58   e  and the nebulizer chamber  61   e  in this figure are illustrated as fully expanded.  
         [0118]     The outlet tube  73   e  of the MDI chamber  58   e  has two valve assemblies disposed between the inlet end  74   e  and the outlet end  75   e —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  89   e  that has a circular opening  90   e  and a flap valve  91   e  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  92   e  that has a circular opening  93   e  and a flap valve  94   e  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  91   e  moves away from the valve seat  89   e  for the aerosol particles to move from the MDI chamber  58   e  to the patient through the opening  90   e  in the valve seat  89   e  of the tube  73   e . On exhalation, the flap valve  91   e  moves towards the flap valve seat  89   e  and closes the opening  90   e  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  58   e  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  89   e  prevents any protrusion of the flap valve  91   e  through the opening  90   e . The exhalation flap valve assembly has a flap valve  94   e  that presses against the flap valve seat  92   e  on inhalation and completely occludes the opening  93   e  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  73   e  on inhalation. On exhalation the flap valve  94   e  moves away from the flap valve seat  92   e  for the air exhaled by the patient to escape into the atmosphere from tube  73   e  through the opening  93   e.    
         [0119]     The nebulizer chamber  61   e  has a hollow cylindrical inlet tube  95   e  with an inlet end  96   e  and an outlet end  97   a . The inlet and  96   e  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end  96   e  may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI  81   e  maybe alternatively be connected to the inlet end  96   e  of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  61   e  to the MDI chamber. The inhaler  81   e  has a boot  82   e  with an inlet end  83   e  and an outlet end  84   e . A canister  85   e  is introduced into the boot  82   e  through the inlet end  83   e  and the nozzle  86   e  of the MDI  81   a  is attached to an actuator  87   e . The actuator  87   e  has an opening or an aperture  88   e . On actuation of the MDI canister  85   e , the medication aerosol particles are generated through the opening  88   e  of the actuator  87   e.    
         [0120]     The nebulizer chamber has an inlet port  109   e  for connection with a standard small volume nebulizer  110   e . The aerosol medication generated with the nebulizer  110   e  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  59   e   63   e . Nebulizer chamber  61   e  may have another inlet  111   e  for connection to a reservoir bag  112   e . The bag  112   e  may have two small inlets  113   e  and  114   e  to be connected to one or more gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  112   e  may be replaced by a corrugated plastic reservoir tubing/chamber  115   e  that may be connected to inlet  111   e  or to the inlet end  62   e  of the nebulizer chamber  61   e . The reservoir tubing/chamber  115   e  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  116   e  and grooves  117   e . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  118   e  of the coil are demonstrated in the figure as dotted lines. The distance  119   e  and  120   e  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  112   e  or reservoir tubing  115   e  serves to store the aerosol particles generated by the nebulizer  110   e  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  121   e  that may have a hollow cylindrical inlet tube  95   e  with an inlet end  96   a  and an outlet end  97   e . The inlet end  96   e  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The MDI  81   e  can be connected to the inlet  97   e  and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  61   e  to the MDI chamber  58   e  via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister  85   e , the medication aerosol particles are generated through the opening  88   e  of the actuator  87   e , and enter into the chamber  58   e  through the outlet end  66   e  of the tube  64   e.    
         [0121]      FIG. 2F  is a plan view of the longitudinal length of aerosol delivery apparatus IV according to the fifth alternative embodiment of the present invention.  FIG. 2F  is a plan view of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The MDI chamber  58   f  has an outlet end  60   f . The nebulizer chamber  61   f  has an inlet end  62   f . The inlet end of the MDI chamber  58   f  and the outlet end of the nebulizer chamber  4   f  are fused together, the point of fusion is labeled as  2   f   6   f . The outlet end  60   f  of the MDI chamber  1   f  has a hollow cylindrical tube  73   f  with an inlet end  74   f  and an outlet end  75   f . The MDI chamber  1   f  may be made of plastic, paper, or metal. The chamber  1   f  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  76   f  and grooves  77 . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  78   f  of the coil are demonstrated in the figure as dotted lines. The chamber in this figure is demonstrated to be fully or partially collapsed. The distance  79   f  and  80   f  between the two adjacent ridges, rings of the coil, or grooves is reduced by pulling the rings of the coil, ridges or grooves together. The MDI chamber  58   f  and the nebulizer chamber  61   f  in this figure are illustrated as fully collapsed. When fully collapsed, the inlet end  74   f  of the tube  73   f  may be fused to the outlet end  66   f  of the tube  64   f . The distance  79   f  and  80   f  between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0122]     The outlet tube  73   f  of the MDI chamber  58   f  has two valve assemblies disposed between the inlet end  74   f  and the outlet end  75   f —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  89   f  that has a circular opening  90   f  and a flap valve  91   f  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  92   f  that has a circular opening  93   f  and a flap valve  94   f  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  91   f  moves away from the valve seat  89   f  for the aerosol particles to move from the MDI chamber  58   f  to the patient through the opening  90   f  in the valve seat  89   f  of the tube  73   f . On exhalation, the flap valve  91   f  moves towards the flap valve seat  89   f  and closes the opening  90   f  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  58   f  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  89   f  prevents any protrusion of the flap valve  91   f  through the opening  90   f . The exhalation flap valve assembly has a flap valve  94   f  that presses against the flap valve seat  92   f  on inhalation and completely occludes the opening  93   f  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  73   f  on inhalation. On exhalation the flap valve  94   f  moves away from the flap valve seat  92   f  for the air exhaled by the patient to escape into the atmosphere from tube  73   f  through the opening  93   f.    
         [0123]     The nebulizer chamber  61   f  has a hollow cylindrical inlet tube  95   f  with an inlet end  96   f  and an outlet end  97   f . The inlet and  96   f  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. The inlet end  96   f  may have a boot adapter assembly to accommodate the boot of any commercially available MDI and the MDI  81   f  maybe alternatively be connected to the inlet end  96   f  of the tube and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  61   f  to the MDI chamber. The inhaler  81   f  has a boot  82   f  with an inlet end  83   f  and an outlet end  84   f . A canister  85   f  is introduced into the boot  82   f  through the inlet end  83   f  and the nozzle  86   f  of the MDI  81   f  is attached to an actuator  87   f . The actuator  87   f  has an opening or an aperture  88   f . On actuation of the MDI canister  85   f , the medication aerosol particles are generated through the opening  88   f  of the actuator  87   f.    
         [0124]     The nebulizer chamber has an inlet port  109   f  for connection with a standard small volume nebulizer  110   f . The aerosol medication generated with the nebulizer  110   f  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  59   f   63   f . Nebulizer chamber  61   f  may have another inlet  111   f  for connection to a reservoir bag  112   f . The bag  112   f  may have two small inlets  113   f  and  114   f  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  112   f  may be replaced by a corrugated plastic reservoir tubing/chamber  115   f  that may be connected to inlet  111   f  or to the inlet end  62   f  of the nebulizer chamber  61   f . The reservoir tubing/chamber  115   f  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  116   f  and grooves  117   f . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  118   f  of the coil are demonstrated in the figure as dotted lines. The distance  119   f  and  120   f  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  112   f  or reservoir tubing  115   f  serves to store the aerosol particles generated by the nebulizer  110   f  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  121   f  that may have a hollow cylindrical inlet tube  95   f  with an inlet end  96   f  and an outlet end  97   f . The inlet and  96   f  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. The MDI  81   f  can be connected to the inlet  97   f  and on actuation the aerosol particles generated by the MDI will be transferred from the nebulizer chamber  61   f  to the MDI chamber  58   f  via the central and two peripheral connections between the two chambers as described before. On actuation of the MDI canister  85   f , the medication aerosol particles are generated through the opening  88   f  of the actuator  87   f , and enter into the chamber  58  through the outlet end  66   f  of the tube  64   f.    
         [0125]     FIGS.  3 A, 3 B, 3 C, 3 D, 3 E, and  3 F are the plan views of the MDI chamber  1   a  as described in  FIG. 1A . They also represent the plan views of the reservoir tubing or chamber  115   a  as described in  FIG. 2A . The MDI chamber/reservoir chamber may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber(s) may have a uniform diameter throughout it&#39;s length or alternatively the diameter of the chamber may be uniform for a fixed portion of the total length of the chamber and then change to a different diameter for the rest of it&#39;s length. The chamber(s) may be cylindrical with smooth edges or cylindrical with multiple ridges and grooves. The chamber(s) may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber(s) may be supported with a metal or plastic coil with multiple rings. The distance and between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0126]      FIG. 3A  is an expanded plan view of MDI chamber  1   a  according to the present invention as described in  FIG. 1A .  FIG. 3A  is an expanded plan view of the MDI chamber  1   a  as described in  FIG. 1A . It is also an expanded plan view of the reservoir tubing or chamber  115   a  as described in  FIG. 2A . The MDI chamber/reservoir chamber  122   a  may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end  123   a  and an outlet end  124   a . The chamber(s) has a uniform diameter throughout its length and is cylindrical in shape. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber  122   a  in this figure is illustrated as fully expanded. The multiple rings  125   a  of the coil are demonstrated in the figure as dotted lines. The distance between the two adjacent rings of the coil  126   a  and  127   a  may be equal.  
         [0127]      FIG. 3B  is an expanded plan views of MDI chamber  1   a  according to the present invention as described in  FIG. 1A .  FIG. 3B  is an expanded plan view of the MDI chamber/reservoir chamber  122   a  as described in  FIG. 3A . The chamber(s)  122   b  is a collapsible/expandable chamber. The chamber has an inlet end  123   b  and an outlet end  124   b . The chamber(s) has a uniform diameter throughout it&#39;s length and is cylindrical in shape. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable. The MDI chamber  122   b  in this figure is illustrated as fully or partially collapsed. The multiple rings  125   b  of the coil are demonstrated in the figure as dotted lines. The chamber as is demonstrated here may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together. The distance between the two adjacent rings of the coil  126   b  and  127   b  may be equal.  
         [0128]      FIG. 3C  is an expanded plan view of MDI chamber  1   a  according the first alternative embodiment of the present invention as described in  FIG. 3A  and  FIG. 3B .  FIG. 3C  is an expanded plan view of the MDI chamber/reservoir chamber  122   a  as described in  FIG. 3A . The chamber(s)  122   c  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end  123   c  and an outlet end  124   c . The chamber(s) is cylindrical in shape but does not have a uniform diameter throughout it&#39;s length as described in  FIG. 3A . It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber  122   c  in this figure is illustrated as fully expanded The multiple rings  125   c  of the coil are demonstrated in the figure as dotted lines. The diameter of the chamber for a portion of the length  126   c  of the chamber is different from the diameter of a portion of the length  127   c  of the chamber. The diameter of the rings  128   c  that support a portion of the length  126   c  of the chamber is different from the diameter of the rings  129   c  that support a portion of the length  127   c  of the chamber. The distance between the two adjacent rings of the coil  130   c  and  131   c  may be equal. Similarly the distance between the two adjacent rings of the coil  132   c  and  133   c  may be equal. The multiple rings  125   c  of the coil are demonstrated in the figure as dotted lines. The chamber here is demonstrated to be fully expanded but it may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together.  
         [0129]      FIG. 3D  is and expanded plan view of MDI chamber  1   a  according to the second alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  FIG. 3D  is a perspective view of the MDI chamber  1   a  as described in  FIG. 1A . It is also a perspective view of the reservoir tubing or chamber  115   a  as described in  FIG. 2A . The MDI chamber/reservoir chamber  122   d  may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end  123   d  and an outlet end  124   d . The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges and grooves throughout the length of the chamber. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber  122   d  in this figure is illustrated as fully expanded. The multiple rings  125   d  of the coil are demonstrated in the figure as dotted lines. The distance and between the two adjacent rings of the coil  126   d  and  127   d  may be equal.  
         [0130]      FIG. 3E  is an expanded plan view of MDI chamber  1   a  according to the second alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  FIG. 3E  is an expanded plan view of the MDI chamber/reservoir chamber  122   d  as described in  FIG. 3D . The chamber(s)  122   e  is a collapsible/expandable chamber. The chamber has an inlet end  123   e  and an outlet end  124   e . The chamber(s) has a uniform diameter throughout it&#39;s length and is cylindrical in shape. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable. The MDI chamber  122   e  in this figure is illustrated as fully or partially collapsed. The multiple rings  125   e  of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance  126   e  and  127   e  between the two adjacent rings of the coil, the ridges, or the grooves may be equal.  
         [0131]      FIG. 3F  is an expanded plan view of MDI chamber  1   a  according to the third alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  FIG. 3F  is an expanded plan view of the MDI chamber/reservoir chamber  122   d  as described in  FIG. 3D . The chamber(s)  122   f  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end  123   f  and an outlet end  124   f . The chamber(s) is cylindrical in shape but does not have a uniform diameter throughout it&#39;s length as described in  FIG. 3D . It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The MDI chamber  122   f  in this figure is illustrated as fully expanded The multiple rings  125   f  of the coil are demonstrated in the figure as dotted lines. The diameter of the chamber for a portion of the length  126   f  of the chamber is different from the diameter of a portion of the length  127   f  of the chamber. The diameter of the rings  128   f  that support a portion of the length  126   f  of the chamber is different from the diameter of the rings  129   f  that support a portion of the length  127   f  of the chamber. The distance and between the two adjacent rings of the coil  130   f  and  131   f  may be equal. Similarly the distance and between the two adjacent rings of the coil  132   f  and  133   f  may be equal. The multiple rings  125   f  of the coil are demonstrated in the figure as dotted lines. The chamber here is demonstrated to be fully expanded but it may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together.  
         [0132]      FIG. 3G  is an expanded plan view of MDI chamber  1   a  according to the fourth alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  FIG. 3G  is an expanded plan view of the MDI chamber  1   a  as described in  FIG. 1A . It is also an alternative plan view of the reservoir tubing or chamber  115   a  as described in  FIG. 2A . The MDI chamber/reservoir chamber  122   g  may be made of plastic, paper, or metal. The chamber(s) may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end  123   a  and an outlet end  124   g . The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges and grooves throughout the length of the chamber. Quite unlike  FIG. 3D , the chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The MDI chamber  122   g  in this figure is illustrated as fully expanded The distance between the two adjacent ridges or grooves  126   g  and  127   g  of the corrugated plastic tubing may be equal.  
         [0133]      FIG. 3H  is an expanded plan views of MDI chamber  1   a  according to the fourth alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  FIG. 3H  is an expanded plan view of the MDI chamber/reservoir chamber  122   g  as described in  FIG. 3G . The chamber(s)  122   h  is a collapsible/expandable chamber. The chamber has an inlet end  123   h  and an outlet end  124   h . The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges and grooves throughout the length of the chamber. The chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The MDI chamber  122   h  in this figure is illustrated as fully or partially collapsed. The distance  126   h  and  127   h  between the two adjacent ridges/grooves of the corrugated plastic tubing may be equal.  
         [0134]      FIG. 3I  is an expanded plan view of MDI chamber  1   a  according to the fifth alternative embodiment of the present invention as described in  FIGS. 3A and 3B .  FIG. 3I  is an expanded plan view of the MDI chamber/reservoir chamber  122   g  as described in  FIG. 3G . The chamber(s)  122   i  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber has an inlet end  123   i  and an outlet end  124   i  The chamber(s) is cylindrical in shape but quite unlike the description in  FIG. 3G , the chamber in  FIG. 3I  does not have a uniform diameter throughout it&#39;s length. The chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The MDI chamber  122   i  in this figure is illustrated as fully expanded The diameter of the chamber for a portion of the length  126   i  of the chamber is different from the diameter of a portion of the length  127   i  of the chamber. The diameter of the ridges/grooves  128   i  of a portion of the length  126   i  of the chamber is different from the diameter of the ridges/grooves  129   i  of a portion of the length  127   i  of the chamber. The distance between the two adjacent ridges/grooves of the tubing  130   i  and  131   i  may be equal. Similarly the distance between the two adjacent ridges/grooves of the tubing  132   i  and  133   i  may be equal. The chamber here is demonstrated to be fully expanded but it may be partially collapsed by pulling some of the ridges/grooves of the tubing together or fully collapsed by pulling all of the ridges/grooves of the tubing together.  
         [0135]     FIGS.  4 A, 4 B, 4 C, 4 D, 4 E, and  4 F are expanded plan views of the collapsible/expandable tubings  50   a  and  51   a  as described in  FIG. 1A  that connect the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical with smooth edges or cylindrical in shape and made of stiff corrugated plastic material with multiple ridges and grooves. The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber(s) may be supported with a metal or plastic coil with multiple rings. The distance and between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0136]      FIG. 4A  is an expanded plan view of tubes  50   a  or  51   a  according to the present invention as described in  FIG. 1A .  FIG. 4A  is an expanded plan view of the collapsible/expandable tubings  50   a  and  51   a  as described in  FIG. 1A  that connects the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as  134   a  may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with smooth edges. The chamber may be supported with a metal or plastic coil with multiple rings. The tubing  134   a  in this figure is illustrated as fully expanded The distance between the two adjacent rings of the coil may be equal. The chamber  134   a  connects the two hollow cylindrical tubes  135   a  and  138   a . Tube  135   a  represents the expanded view of the tubes  10   a  and  13   a  and tube  138   a  represents the expanded view of the tubes  44   a  and  47   a  as shown in  FIG. 1A . Tube  135   a  has an inlet end  136   a  and an outlet end  137   a . Tube  138   a  has an inlet end  139   a  and an outlet end  140   a . The points of attachments of the tubing  134   a  to the tube  135   a  is between the inlet  136   a  and outlet  137   a  and is demonstrated in the figure as  141   a . The points of attachments of the tubing  134   a  to the tube  138  is between the inlet  139  and outlet  140   a  and is demonstrated in the figure as  142   a . The multiple rings  143   a  of the coil are demonstrated in the figure as dotted lines. The distance and between the two adjacent rings of the coil  144   a  and  145   a  may be equal.  
         [0137]      FIG. 4B  is an expanded plan view of tubes  50   a  or  51   a  according to the present invention as described in  FIG. 1A .  FIG. 4B  is an expanded plan view of the collapsible/expandable tubings  50   a  and  51   a  as described in  FIG. 1A  that connect the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of the MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as  134   b  may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. In this figure the tubing  134   b  is demonstrated as partially or fully collapsed. The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with smooth edges. The chamber may be supported with a metal or plastic coil with multiple rings. The tubing  134   b  in this figure is illustrated as fully or partially collapsed. The distance and between the two adjacent ridges, rings of the coil, or grooves may be equal. The chamber or tubing  134   b  connects the two hollow cylindrical tubes  135   b  and  138   b . Tube  135   b  represents the expanded view of the tubes  10   a  and  13   a  and tube  138   b  represents the expanded view of the tubes  44   a  and  47   a  as shown in  FIG. 1A . Tube  135   b  has an inlet end  136   b  and an outlet end  137   b . Tube  138   b  has an inlet end  139   b  and an outlet end  140   b . The points of attachments of the tubing  134   b  to the tube  135   b  is between the inlet  136   b  and outlet  137   b  and is demonstrated in the figure as  141   b . The points of attachments of the tubing  134   b  to the tube  138   b  is between the inlet  139   b  and outlet  140   b  and is demonstrated in the figure as  142   b . The multiple rings  143   b  of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance between the two adjacent rings of the coil  144   b  and  145   b  may or may not be equal when partially collapsed. When fully collapsed, the inlet end  136   b  of the tube  135   b  may fuse or mate with the outlet end  140   b  of the outlet tube  138   b  as has been demonstrated in this figure.  
         [0138]      FIG. 4C  is an expanded plan view of tubes  50   a  or  51   a  according to the first alternative embodiment of the present invention as described in  FIGS. 4A and 4B .  FIG. 4C  is an expanded plan_view of the collapsible/expandable tubings  50   a  and  51   a  as described in  FIG. 1A  that connect the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as  134   c  may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The tubing  134   c  in this figure is illustrated as fully expanded The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges  146   c  and grooves  147   c  throughout the length of the chamber. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The chamber  134   c  connects the two hollow cylindrical tubes  135   c  and  138   c . Tube  135   c  represents the expanded view of the tubes  10   a  and  13   a  and tube  138   c  represents the expanded view of the tubes  44   a  and  47   a  as shown in  FIG. 1A . Tube  135   c  has an inlet end  136   c  and an outlet end  137   c . Tube  138   c  has an inlet end  139   c  and an outlet end  140   c . The points of attachments of the tubing  134   c  to the tube  135   c  is between the inlet  136   c  and outlet  137   c  and is demonstrated in the figure as  141   c . The points of attachments of the tubing  134   c  to the tube  138   c  is between the inlet  139   c  and outlet  140   c  and is demonstrated in the figure as  142   c . The multiple rings  143   c  of the coil are demonstrated in the figure as dotted lines. The distance  144   c  and  145   c  between the two adjacent rings of the coil  143   c , the ridges  146   c  or the grooves  147   c  may be equal.  
         [0139]      FIG. 4D  is an expanded plan view of tubes  50   a  or  51   a  according to the first alternative embodiment of the present invention as described in  FIGS. 4A and 4B .  FIG. 4D  is an expanded plan_view of the collapsible/expandable tubings  50   a  and  51  as described in  FIG. 1A  that connect the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as  134   d  may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. In this figure the tubing  134   d  is demonstrated as partially or fully collapsed. The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges  146   d  and grooves  147   d  throughout the length of the chamber. It requires additional support with a metal or plastic coil with multiple rings to maintain patency of the chamber if it is collapsible/expandable and may not require any additional support to maintain patency of the chamber if it is a fixed volume chamber. The chamber  134   d  connects the two hollow cylindrical tubes  135   d  and  138   d . Tube  135   d  represents the expanded view of the tubes  10   a  and  13   a  and tube  138   d  represents the expanded view of the tubes  44   a  and  47   a  as shown in  FIG. 1A . Tube  135   d  has an inlet end  136   d  and an outlet end  137   d . Tube  138   d  has an inlet end  139   d  and an outlet end  140   d . The points of attachments of the tubing  134   d  to the tube  135   d  is between the inlet  136   d  and outlet  137   d  and is demonstrated in the figure as  141   d . The points of attachments of the tubing  134   d  to the tube  138   d  is between the inlet  139   d  and outlet  140   d  and is demonstrated in the figure as  142   d . The multiple rings  143   d  of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance  144   d  and  145   d  between the two adjacent rings of the coil  143   d , the ridges  146   d  or the grooves  147   d  may or may not be equal when partially collapsed. When fully collapsed, the inlet end  136   d  of the tube  135   d  may fuse or mate with the outlet end  140   d  of the outlet tube  138   d  as has been demonstrated in this figure.  
         [0140]      FIG. 4E  is an expanded plan view of tubes  50   a  or  51   a  according to the second alternative embodiment of the present invention as described in  FIGS. 4A and 4B .  FIG. 4E  is an expanded plan view of the collapsible/expandable tubings  50   a  and  51   a  as described in  FIG. 1A  that connect the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as  134   e  may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. The tubing  134   e  in this figure is illustrated as fully expanded The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges  146   e  and grooves  147   e  throughout the length of the chamber. Quite unlike  FIG. 4C , the chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber  134   e  connects the two hollow cylindrical tubes  135   e  and  138   e . Tube  135   e  represents the expanded view of the tubes  10   a  and  13   a  and tube  138   e  represents the expanded view of the tubes  44   a  and  47   a  as shown in  FIG. 1A . Tube  135   e  has an inlet end  136   e  and an outlet end  137   e . Tube  138   e  has an inlet end  139   e  and an outlet end  140   e . The points of attachments of the tubing  134   e  to the tube  135   e  is between the inlet  136   e  and outlet  137   e  and is demonstrated in the figure as  141   e . The points of attachments of the tubing  134   e  to the tube  138   e  is between the inlet  139   e  and outlet  140   e  and is demonstrated in the figure as  142   e . The multiple rings  143   e  of the coil are demonstrated in the figure as dotted lines. The distance  144   e  and  145   e  between the two adjacent rings of the coil  143   e , the ridges  146   e  or the grooves  147   e  may be equal.  
         [0141]      FIG. 4F  is an expanded plan view of tubes  50   a  or  51   a  according to the second alternative embodiment of the present invention as described in  FIGS. 4A and 4B .  FIG. 4F  is an expanded plan view of the collapsible/expandable tubings  50   a  and  51   a  as described in  FIG. 1A  that connect the peripheral tubes at 3 and 9 o&#39;clock positions in the inlet of MDI chamber to the peripheral tubes at 3 and 9 o&#39;clock positions in the outlet of the nebulizer chamber. The tubing illustrated here as  134   f  may be made of plastic, paper, or metal. The tubing may be a fixed volume chamber or a collapsible/expandable chamber. In this figure the tubing  134   f  is demonstrated as partially or fully collapsed. The chamber(s) has a uniform diameter throughout it&#39;s length, is cylindrical in shape with multiple ridges  146   f  and grooves  147   f  throughout the length of the chamber. Quite unlike  FIG. 4C , the chamber does not require additional support with a metal or plastic coil with multiple rings to maintain patency as it can be made of a stiff corrugated plastic material that retains the ability to be collapsible/expandable and at the same time not require any additional support to maintain patency of the chamber. The chamber  134   f  connects the two hollow cylindrical tubes  135   f  and  138   f . Tube  135   f  represents the expanded view of the tubes  10   a  and  13   a  and tube  138   f  represents the expanded view of the tubes  44   a  and  47   a  as shown in  FIG. 1A . Tube  135   f  has an inlet end  136   f  and an outlet end  137   f . Tube  138   f  has an inlet end  139   f  and an outlet end  140   f . The points of attachments of the tubing  134   f  to the tube  135   f  is between the inlet  136   f  and outlet  137   f  and is demonstrated in the figure as  141   f . The points of attachments of the tubing  134   f  to the tube  138   f  is between the inlet  139   f  and outlet  140   f  and is demonstrated in the figure as  142   f . The multiple rings  143   f  of the coil are demonstrated in the figure as dotted lines. The chamber may be partially collapsed by pulling some of the rings of the coil together or fully collapsed by pulling all of the rings of the coil together as has been demonstrated in this figure. The distance  144   f  and  145   f  between the two adjacent rings of the coil  143   f , the ridges  146   f  or the grooves  147   f  may or may not be equal when partially collapsed. When fully collapsed, the inlet end  136   f  of the tube  135   f  may fuse or mate with the outlet end  140   f  of the outlet tube  138   f  as has been demonstrated in this figure.  
         [0142]      FIG. 5A  is an expanded cross-sectional view of the inlet end  2   a  of the invention as described in  FIG. 1A .  FIG. 5A  is an expanded cross-sectional view of the inlet end  2   a  of the MDI chamber  1   a  as described in  FIG. 1A .  
         [0143]     The inlet end has been illustrated in this figure as  148   a  (corresponds to  2   a  of  FIG. 1A ) with an outer circumference  149   a . It has three hollow cylindrical inlet tubes, a central tube  150   a  (corresponds to  7   a  of  FIG. 1A ) and two peripheral tubes  151   a  (corresponds to  10   a  of  FIG. 1A ) and  152   a  (corresponds to  13   a  of  FIG. 1A ) located at three o&#39;clock to nine o&#39;clock positions, respectively.  
         [0144]      FIG. 5B  is an expanded cross-sectional view according to the first alternative embodiment of the present invention of the inlet end  2   a  as described in  FIG. 5A . The inlet end has been illustrated in this figure as  148   b  (corresponds to  2   a  of  FIG. 1A ) with an outer circumference  149   b . It has three hollow cylindrical inlet tubes, a central tube  150   b  (corresponds to  7   a  of  FIG. 1A ) and two peripheral tubes  151   b  (corresponds to  10   a  of  FIG. 1A ) and  152   b  (corresponds to  13   a  of  FIG. 1A ) located at three o&#39;clock to nine o&#39;clock positions. The inlet of the peripheral tube  151   b  splits into multiple micrometric openings  153   b  at it&#39;s outlet distributed along one hemisphere of the inlet end  148   b . The inlet of the peripheral tube  152   b  similarly splits into multiple micrometric openings  154   b  at it&#39;s outlet distributed along the other hemisphere of the inlet end  148   b  of the MDI chamber. The aerosol particles from the nebulizer chamber enter into the MDI chamber either through the central inlet tube  150   b  or through the inlet ends  151   b  and  152   b  of the peripheral tubes. After entering the inlet ends  151   b  and  152   b  of the peripheral tubes, the aerosol particles enter into the MDI chamber through the multiple micrometric openings  153   b  and  154   b . Hence the aerosol particles and or gas(es)move from the nebulizer chamber to the MDI chamber through central and or peripheral connections.  
         [0145]      FIG. 6A  is an expanded cross-sectional view of the inhalation/exhalation valve assemblies  32   a  or  35   a  of the invention as described in  FIG. 1A . In  FIG. 1A  the outlet tube of the MDI  16   a  has been demonstrated to have two valve assemblies disposed between the inlet end  17   a  and the outlet end  18   a —the inhalation valve assembly and an exhalation valve assembly. The two valve assemblies are illustrated here in  FIG. 6A . The inhalation/exhalation flap valve assembly has a circular flap valve seat  155   a  shown as the shaded area in this figure that has a circular opening  158   a . The flap valve seat has an outer circumference  156   a  and an inner circumference  157   a . A circular flap valve  159   a  is attached to the flap valve seat  155   a  at point  160   a  as demonstrated by a dark curvilinear line. The rest of the flap valve has a free edge  161   a  as demonstrated by the dotted line that rests on the flap valve seat  155   a . On inhalation, the free edge of the inhalation flap valve moves away from the valve seat for the aerosol particles to move from the MDI chamber to the patient through the opening in the valve seat. On exhalation, the free edge of the flap valve moves towards the flap valve seat and closes the opening to prevent any flow of gas exhaled by the patient from entering into the MDI chamber thus avoiding re-breathing of carbon dioxide on the next inhalation. The exhalation flap valve assembly has a flap valve, the free edge of which presses against the flap valve seat on inhalation and completely occludes the opening to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece or MDI chamber on inhalation. On exhalation the free edge of the flap valve moves away from the flap valve seat for the air exhaled by the patient to escape into the atmosphere from the opening in the MDI outlet tube/mouthpiece/facemask.  
         [0146]      FIG. 6B  is an expanded cross-sectional view of the first alternative embodiment of the present invention of the inhalation/exhalation valve assemblies  32   a  or  35   a  as described in  FIG. 6A . In  FIG. 1A  the outlet tube of the MDI  16   a  has been demonstrated to have two valve assemblies disposed between the inlet end  17   a  and the outlet end  18   a —the inhalation valve assembly and an exhalation valve assembly. The expanded views of the two valve assemblies are illustrated here in  FIG. 6B . The inhalation/exhalation flap valve assembly has a circular flap valve seat  155   b  shown as the shaded area in this figure that has a circular opening  158   b . The flap valve seat has an outer circumference  156   b  and an inner circumference  157   b . A circular flap valve  159   b  is attached to the flap valve seat  155   b  at point  160   b  as demonstrated by a dark curvilinear line. The major difference between  FIGS. 6A and 6B  is that the attachment of the flap valve to the valve seat in  FIG. 6B  on the superior aspect of the valve seat as opposed to the lateral aspect as shown in  FIG. 6A . The rest of the flap valve has a free edge  161   b  as demonstrated by the dotted line that rests on the flap valve seat  155   b . On inhalation, the free edge of the inhalation flap valve moves away from the valve seat for the aerosol particles to move from the MDI chamber to the patient through the opening in the valve seat. On exhalation, the free edge of the flap valve moves towards the flap valve seat and closes the opening to prevent any flow of gas exhaled by the patient from entering into the MDI chamber thus avoiding re-breathing of carbon dioxide on the next inhalation. The exhalation flap valve assembly has a flap valve, the free edge of which presses against the flap valve seat on inhalation and completely occludes the opening to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece or MDI chamber on inhalation. On exhalation the free edge of the flap valve moves away from the flap valve seat for the air exhaled by the patient to escape into the atmosphere from the opening in the MDI outlet tube/mouthpiece/facemask.  
         [0147]      FIG. 6C  is an expanded cross-sectional view of the second alternative embodiment of the present invention of the inhalation/exhalation valve assemblies  32   a  or  35   a  as described in  FIG. 6A .  FIG. 6C  is an expanded cross-sectional view of an alternative embodiment of the inhalation or exhalation flap valve assemblies as shown in  FIGS. 6A and 6B . The expanded views of the two valve assemblies are illustrated here in  FIG. 6C . The inhalation/exhalation flap valve assembly has a circular flap valve seat  155   c  shown as the shaded area in this figure that has a circular opening  158   c . The flap valve seat has an outer circumference  156   c  and an inner circumference  157   c . The circular flap valve  159   c  is now split into two hemispheres  160   c  and  161   c . The flap valve  160   c  is attached to the flap valve seat  155   c  at point  162   c  as demonstrated by a dark curvilinear line. The rest of the flap valve has a free edge  163   c  as demonstrated by the dotted line that rests on the flap valve seat  155   c . The flap valve  161   c  is attached to the flap valve seat  155   c  at point  164   c  as demonstrated by a dark curvilinear line. The rest of the flap valve has a free edge  165   c  as demonstrated by the dotted line that rests on the flap valve seat  155   c . The two free edges meet at the center line  166   c  such that there is no gap between the two free edges. On inhalation, the two free edges of the inhalation flap valve move away from the valve seat for the aerosol particles to move from the MDI chamber to the patient through the opening in the valve seat. On exhalation, the free edges of the flap valve move towards the flap valve seat and close the opening to prevent any flow of gas exhaled by the patient from entering into the MDI chamber thus avoiding re-breathing of carbon dioxide on the next inhalation. In the exhalation flap valve assembly, the two free edges of the flap valve presses against the flap valve seat on inhalation and completely occlude the opening to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece or MDI chamber on inhalation. On exhalation the free edges of the flap valve move away from the flap valve seat for the air exhaled by the patient to escape into the atmosphere from the opening in the MDI outlet tube/mouthpiece/facemask.  
         [0148]      FIG. 7A  is a plan view of the longitudinal length of the mouthpiece according to one embodiment of the present invention. The mouthpiece is a hollow cylindrical tube that is connected to the MDI chamber at one end and to the patient at the other end for inhalation of the aerosol medication generated either by the nebulizer or by the MDI in the device demonstrated in  FIG. 1A . In  FIG. 1A  the outlet tube of the MDI  16   a  has been demonstrated to have two valve assemblies disposed between the inlet end  17   a  and the outlet end  18   a —the inhalation valve assembly and an exhalation valve assembly. The mouthpiece that is illustrated in this figure as  166   a  is attached to the outlet end  18   a  of the tube  16   a  shown in  FIG. 1A . The mouthpiece  166   a  has an inlet end  167   a  and an outlet end  168   a . Instead of the flap valve assemblies being located in the outlet tube  16   a  of  FIG. 1A , the inhalation valve assembly and an exhalation valve assembly could alternatively be disposed between the inlet end  167   a  and the outlet end  168   a  of the mouthpiece  166   a . The inhalation flap valve assembly has a circular flap valve seat  169   a  that has a circular opening  170   a  and a flap valve  171   a  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  172   a  that has a circular opening  173   a  and a flap valve  174   a  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  171   a  moves away from the valve seat  169   a  for the aerosol particles to move from the MDI chamber to the patient through the opening  170   a  in the valve seat  169   a  of the mouthpiece  166   a . On exhalation, the flap valve  171   a  moves towards the flap valve seat  169   a  and closes the opening  170   a  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   a  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  169   a  prevents any protrusion of the flap valve  171   a  through the opening  170 . The exhalation flap valve assembly has a flap valve  174   a  that presses against the flap valve seat  172   a  on inhalation and completely occludes the opening  173   a  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece  166   a  on inhalation. On exhalation the flap valve  174   a  moves away from the flap valve seat  172   a  for the air exhaled by the patient to escape into the atmosphere from tube  166   a  through the opening  173   a.    
         [0149]      FIG. 7B  is a plan view of the longitudinal length of the facemask according to one embodiment of the present invention. The facemask is connected to the MDI chamber at one end and to the patient at the other end for inhalation of the aerosol medication generated either by the nebulizer or by the MDI as demonstrated in the device in  FIG. 1A . In  FIG. 1A  the outlet tube of the MDI  16   a  has been demonstrated to have two valve assemblies disposed between the inlet end  17   a  and the outlet end  18   a —the inhalation valve assembly and an exhalation valve assembly. The facemask that is illustrated in this  FIG. 7B  as  166   b  is attached to the outlet end  18   a  of the tube  16   a  shown in  FIG. 1A . The facemask  166   b  has an inlet end  167   b  and an outlet end  168   b . Instead of the flap valve assemblies being located in the outlet tube  16   a  of  FIG. 1A , the inhalation valve assembly and an exhalation valve assembly could alternatively be disposed between the inlet end  167   b  and the outlet end  168   b  of the facemask  166   b . The inhalation flap valve assembly has a circular flap valve seat  169   b  that has a circular opening  170   b  and a flap valve  171   b  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  172   b  that has a circular opening  173   b  and a flap valve  174   b  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  171   b  moves away from the valve seat  169   b  for the aerosol particles to move from the MDI chamber to the patient through the opening  170   b  in the valve seat  169   b  of the mouthpiece  166   b . On exhalation, the flap valve  171   b  moves towards the flap valve seat  169   b  and closes the opening  170   b  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   a  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  169   b  prevents any protrusion of the flap valve  171   b  through the opening  170   b . The exhalation flap valve assembly has a flap valve  174   b  that presses against the flap valve seat  172   b  on inhalation and completely occludes the opening  173   b  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the mouthpiece  166   b  on inhalation. On exhalation the flap valve  174   b  moves away from the flap valve seat  172   b  for the air exhaled by the patient to escape into the atmosphere from tube  166   b  through the opening  173   b .  FIG. 7B  demonstrates an additional inhalation flap valve assembly disposed between the inlet end and the outlet end of the facemask located diametrically opposite to the one described before ( 166   b ,  167   b ,  168   b ). The additional inhalation valve assembly is optional. It has a circular flap valve seat  175   b  that has a circular opening  176   b  and a flap valve  177   b  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  177   b  moves away from the valve seat  175   b  for the aerosol particles to move from the MDI chamber to the patient through the opening  176   b  in the valve seat  175   b  of the mouthpiece  166   b . On exhalation, the flap valve  177   b  moves towards the flap valve seat  175   b  and closes the opening  176   b  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  1   b  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  175   b  prevents any protrusion of the flap valve  177   b  through the opening  176   b.    
         [0150]      FIG. 8A  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to an alternative embodiment of the present invention as described in  FIG. 1E .  FIG. 8A  is an expanded plan view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in  FIG. 1E  with a modification. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0151]     The MDI chamber  178   a  has an outlet end  180   a . The nebulizer chamber  181   a  has an inlet end  182   a . The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as  1792   a   183   a . The outlet end  180   a  of the MDI chamber  178   a  has a hollow cylindrical tube  193   a  with an inlet end  194   a  and an outlet end  195   a . The MDI chamber  178   a  may be made of plastic, paper, or metal. The chamber  178   a  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  196   a  and grooves  197   a . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  198   a  of the coil are demonstrated in the figure as dotted lines. The distance  199   a  and  200   a  between the two adjacent ridges, rings of the coil, or grooves may be equal. The outlet tube  193   a  of the MDI chamber  178   a  has two valve assemblies disposed between the inlet end  194   a  and the outlet end  195   a —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  209   a  that has a circular opening  210   a  and a flap valve  211   a  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  212   a  that has a circular opening  213   a  and a flap valve  214   a  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  211   a  moves away from the valve seat  209   a  for the aerosol particles to move from the MDI chamber  178   a  to the patient through the opening  210   a  in the valve seat  209   a  of the tube  193   a . On exhalation, the flap valve  211   a  moves towards the flap valve seat  209   a  and closes the opening  210   a  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  178   a  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  209   a  prevents any protrusion of the flap valve  211   a  through the opening  210   a . The exhalation flap valve assembly has a flap valve  214   a  that presses against the flap valve seat  212   a  on inhalation and completely occludes the opening  213   a  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  193   a  on inhalation. On exhalation the flap valve  214   a  moves away from the flap valve seat  212   a  for the air exhaled by the patient to escape into the atmosphere from tube  193   a  through the opening  213   a . The nebulizer chamber  181   a  has a hollow cylindrical inlet tube  215   a  with an inlet end  216   a  and an outlet end  217   a . The inlet and  216   a  can be attached to a single or multiple gas sources to obtain a mixture of gases with a desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles and/or to deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, a universal actuator  207   a  may be disposed between the inlet end  216   e  and the outlet end  217   a  of the tube  215   a . The nozzle  206   a  of a canister  205   a  of any commercially available MDI may be attached to an actuator  207   a . The actuator  207   a  has an opening or an aperture  208   a . On actuation of the MDI canister  205   a , the medication aerosol particles are generated through the opening  208   a  of the actuator  207   a.    
         [0152]     The nebulizer chamber has an inlet port  229   a  for connection with a standard small volume nebulizer  230   a . The aerosol medication generated with the nebulizer  230   a  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  179   a   183   a . Chamber  181   a  also has another inlet  231   a  for connection a reservoir bag  232   a . The reservoir bag  232   a  serves to store the aerosol particles generated by the nebulizer  230   a  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  232   a  has two small inlets  233   a  and  234   a  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0153]      FIG. 8B  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in  FIG. 8A .  FIG. 8B  is an expanded plan view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in  FIG. 8A  with modifications. At the inlet end of the nebulizer chamber, there are two hollow concentric tubes, an inner and an outer. A universal actuator is disposed between the inlet end and the outlet end of the inner concentric tube. The inlet end of the inner concentric hollow tube is closed and the outlet end is open and in communication with the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI into the nebulizer chamber through outlet end of the tube that is in communication with the nebulizer chamber. The outlet concentric tube is fused with the inlet end of the nebulizer chamber at one end and is open at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber from the inlet open inlet end of the outer concentric tube through the connection between the outlet end of the outer concentric tube and the inlet end of the nebulizer chamber. The flow is only peripheral and there is no central flow as the inlet end of the inner concentric tube is closed. The open end of the outer concentric tube can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0154]     The MDI chamber  178   b  has an outlet end  180   b . The nebulizer chamber  181   b  has an inlet end  182   b  which may be a single opening or it may have multiple micrometric openings. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as  179   b   183   b . The outlet end  180   b  of the MDI chamber  178   b  has a hollow cylindrical tube  193   b  with an inlet end  194   b  and an outlet end  195   b . The MDI chamber  178   b  may be made of plastic, paper, or metal. The chamber  178   b  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  196   b  and grooves  197   b . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  198   b  of the coil are demonstrated in the figure as dotted lines. The distance  199   b  and  200   b  between the two adjacent ridges, rings of the coil, or grooves may be equal. The outlet tube  193   b  of the MDI chamber  178   b  has two valve assemblies disposed between the inlet end  194   b  and the outlet end  195   b —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  209   b  that has a circular opening  210   b  and a flap valve  211   b  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  212   b  that has a circular opening  213   b  and a flap valve  214   b  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  211   b  moves away from the valve seat  209   b  for the aerosol particles to move from the MDI chamber  178   b  to the patient through the opening  210   b  in the valve seat  209   b  of the tube  193   b . On exhalation, the flap valve  211   b  moves towards the flap valve seat  209   b  and closes the opening  210   b  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  178   b  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  209   b  prevents any protrusion of the flap valve  211   b  through the opening  210   b . The exhalation flap valve assembly has a flap valve  214   b  that presses against the flap valve seat  212   b  on inhalation and completely occludes the opening  213   b  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  193   b  on inhalation. On exhalation the flap valve  214   b  moves away from the flap valve seat  212   b  for the air exhaled by the patient to escape into the atmosphere from tube  193   b  through the opening  213   b.    
         [0155]     The nebulizer chamber  181   b  is connected to two hollow cylindrical concentric tubes—a hollow cylindrical inner inlet tube  215   b  with an inlet end  216   b  and an outlet end  217   b . The inlet end  216   b  of the inner concentric hollow tube is closed and the outlet end  217   b  is open and in communication with the nebulizer chamber  181   b . A universal actuator  207   b  may be disposed between the inlet end  216   b  and the outlet end  217   b  of the tube  215   b . The nozzle  206   b  of a canister  205   b  of any commercially available MDI may be attached to an actuator  207   b . The actuator  207   b  has an opening or an aperture  208   b . On actuation of the MDI canister  205   a , the medication aerosol particles are generated through the opening  208   b  of the actuator  207   b  and the medication delivered into the nebulizer chamber  181   b  through outlet end  217   b  of the tube  215   b . The outlet concentric tube  235   b  is fused with the inlet end  182   b  of the nebulizer chamber  181   b  at one end and has an opening  236   a  at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber  181   b  from the inlet opening  236   b  of the outer concentric tube  235   b  through the connection between the outer concentric tube and the inlet end  182   b  of the nebulizer chamber  181   b . The flow is only peripheral and there is no central flow as the inlet end  216   b  of the inner concentric tube  215   b  is closed. The open end  236   b  of the outer concentric tube  235   a  can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0156]     The nebulizer chamber has an inlet port  229   b  for connection with a standard small volume nebulizer  230   b . The aerosol medication generated with the nebulizer  230   b  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  179   e   183   e . Chamber  181   b  also has another inlet  231   b  for connection a reservoir bag  232   b . The reservoir bag  232   b  serves to store the aerosol particles generated by the nebulizer  230   b  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  232   b  has two small inlets  233   b  and  234   b  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0157]      FIG. 8C  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in  FIG. 8A .  FIG. 8C  is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in  FIG. 8B  with a single modification. At the inlet end of the nebulizer chamber, there are two hollow concentric tubes, an inner and an outer. A universal actuator is disposed between the inlet end and the outlet end of the inner concentric tube. The inlet end of the inner concentric hollow tube is open in this figure as opposed to the closed end observed in  FIG. 8B  and the outlet end is open and in communication with the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI into the nebulizer chamber through outlet end of the tube that is in communication with the nebulizer chamber. The outlet concentric tube is fused with the inlet end of the nebulizer chamber at one end and is open at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber from the inlet open inlet end of the outer concentric tube through the connection between the outlet end of the outer concentric tube and the inlet end of the nebulizer chamber. The flow is only peripheral and there is no central flow as the inlet end of the inner concentric tube is closed. The open end of the outer concentric tube can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0158]     The MDI chamber  178   c  has an outlet end  180   c . The nebulizer chamber  181   c  has an inlet end  182   c  which may be a single opening or it may have multiple micrometric openings. The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as  179   c   183   c . The outlet end  180   c  of the MDI chamber  178   c  has a hollow cylindrical tube  193   c  with an inlet end  194   c  and an outlet end  195   c . The MDI chamber  178   c  may be made of plastic, paper, or metal. The chamber  178   c  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  196   c  and grooves  197   c . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  198   c  of the coil are demonstrated in the figure as dotted lines. The distance  199   c  and  200   c  between the two adjacent ridges, rings of the coil, or grooves may be equal. The outlet tube  193   c  of the MDI chamber  178   c  has two valve assemblies disposed between the inlet end  194   c  and the outlet end  195   c —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  209   c  that has a circular opening  210   c  and a flap valve  211   c  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  212   c  that has a circular opening  213   c  and a flap valve  214   c  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  211   c  moves away from the valve seat  209   c  for the aerosol particles to move from the MDI chamber  178   c  to the patient through the opening  210   c  in the valve seat  209   c  of the tube  193   c . On exhalation, the flap valve  211   c  moves towards the flap valve seat  209   c  and closes the opening  210   c  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  178   c  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  209   c  prevents any protrusion of the flap valve  211   c  through the opening  210   c . The exhalation flap valve assembly has a flap valve  214   c  that presses against the flap valve seat  212   c  on inhalation and completely occludes the opening  213   c  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  193   c  on inhalation. On exhalation the flap valve  214   c  moves away from the flap valve seat  212   c  for the air exhaled by the patient to escape into the atmosphere from tube  193   c  through the opening  213   c.    
         [0159]     The nebulizer chamber  181   c  is connected to two hollow cylindrical concentric tubes—a hollow cylindrical inner inlet tube  215   c  with an inlet end  216   c  and an outlet end  217   c . The inlet end  216   c  of the inner concentric hollow tube is open and the outlet end  217   c  is in communication with the nebulizer chamber  181   c . A universal actuator  207   c  may be disposed between the inlet end  216   c  and the outlet end  217   c  of the tube  215   c . The nozzle  206   c  of a canister  205   c  of any commercially available MDI may be attached to an actuator  207   c . The actuator  207   c  has an opening or an aperture  208   c . On actuation of the MDI canister  205   c , the medication aerosol particles are generated through the opening  208   c  of the actuator  207   c  and the medication delivered into the nebulizer chamber  181   c  through outlet end  217   c  of the tube  215   c . The outlet concentric tube  235   c  is fused with the inlet end  182   c  of the nebulizer chamber  181   c  at one end and has an opening  236   c  at the opposite end. Hence the gas(es) from the atmosphere or another outside gas source can flow into the nebulizer chamber  181   c  from the inlet openings  236   c  of the outer concentric tube  235   c  and the inlet opening  216   c  of the inner concentric tube  235   c  through the connections between the outer concentric tube  235   c  and the nebulizer chamber  181   c  and the inner concentric tube  215   c  and the inlet end  182   c  of the nebulizer chamber  181   c . The flow is now both central and peripheral from the outside source to the nebulizer chamber. The open end  236   c  of the outer concentric tube  235   c  and the open end  216   c  of the inner tube  215   c  can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0160]     The nebulizer chamber has an inlet port  229   c  for connection with a standard small volume nebulizer  230   c . The aerosol medication generated with the nebulizer  230   c  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  179   c   183   c . Chamber  181   c  also has another inlet  231   c  for connection a reservoir bag  232   c . The reservoir bag  232   c  serves to store the aerosol particles generated by the nebulizer  230   c  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  232   c  has two small inlets  233   c  and  234   c  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0161]      FIG. 8D  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the alternative embodiment of the present invention as described in  FIG. 2E .  FIG. 8D  is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in  FIG. 2E  with modifications. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0162]     The MDI chamber  178   d  has an outlet end  180   d . The nebulizer chamber  181   d  has an inlet end  182   d . The inlet end of the MDI chamber land the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as  179   d   183   d . The outlet end  180   d  of the MDI chamber  178   d  has a hollow cylindrical tube  193   d  with an inlet end  194   d  and an outlet end  195   d . The MDI chamber  178   d  may be made of plastic, paper, or metal. The chamber  178   d  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  196   d  and grooves  197   d . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  198   a  of the coil are demonstrated in the figure as dotted lines. The distance  199   d  and  200   d  between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0163]     The outlet tube  193   d  of the MDI chamber  178   d  has two valve assemblies disposed between the inlet end  194   d  and the outlet end  195   d —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  209   d  that has a circular opening  210   d  and a flap valve  211   d  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  212   d  that has a circular opening  213   d  and a flap valve  214   d  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  211   d  moves away from the valve seat  209   d  for the aerosol particles to move from the MDI chamber  178   d  to the patient through the opening  210   d  in the valve seat  209   d  of the tube  193   d . On exhalation, the flap valve  211   d  moves towards the flap valve seat  209   d  and closes the opening  210   d  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  178   d  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  209   d  prevents any protrusion of the flap valve  211   d  through the opening  210   d . The exhalation flap valve assembly has a flap valve  214   d  that presses against the flap valve seat  212   d  on inhalation and completely occludes the opening  213   d  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  193   d  on inhalation. On exhalation the flap valve  214   d  moves away from the flap valve seat  212   d  for the air exhaled by the patient to escape into the atmosphere from tube  193   d  through the opening  213   d.    
         [0164]     The nebulizer chamber  181   d  has an hollow cylindrical inlet tube  215   d  at it&#39;s inlet end  182   d . The inlet tube  215   d  has an inlet end  216   d  and an outlet end  217   d . The inlet end  182   d  of the nebulizer chamber  181   d  may be closed at it&#39;s periphery  246   d  shown as the shaded area in the figure and open in the center  247   d  where it fuses with the tube  215   d  and the two openings  217   d  and  247   d  fuse with each other. A universal actuator  207   d  may be disposed between the inlet end  216   d  and the outlet end  217   d  of the tube  215   d . The nozzle  206   d  of a canister  205   d  of any commercially available MDI may be attached to an actuator  207   d . The actuator  207   d  has an opening or an aperture  208   d . On actuation of the MDI canister  205   d , the medication aerosol particles are generated through the opening  208   d  of the actuator  207   d . The flow of the gas(es) from the nebulizer chamber  181   d  to the MDI chamber is central through the opening  216   d  of the tube  215   d  as the peripheral part of the MDI chambers inlet  182   d  is closed.  
         [0165]     The nebulizer chamber has an inlet port  229   d  for connection with a standard small volume nebulizer  230   d . The aerosol medication generated with the nebulizer  230   d  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  179   e   183   e . Chamber  181   d  also has another inlet  231   d  for connection a reservoir bag  232   d . The reservoir bag  232   d  serves to store the aerosol particles generated by the nebulizer  230   d  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  232   d  has two small inlets  233   d  and  234   d  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient. Alternatively, the reservoir bag  232   d  may be replaced by a corrugated plastic reservoir tubing  237   d  that may be connected to inlet end  216   d  of the nebulizer chamber  181   d . The reservoir tubing  237   d  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  238   d  and grooves  239   d . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  240   d  of the coil are demonstrated in the figure as dotted lines. The distance  241   d  and  242   d  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  232   d  or reservoir tubing  237   d  serves to store the aerosol particles generated by the nebulizer  230   d  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  238   d  that may have a hollow cylindrical inlet tube  243   d  with an inlet end  244   d  and an outlet end  245   d . The inlet end  244   d  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI  205   d  can be connected to the inlet end  244   d  of the inlet tube  243   d  and on actuation the aerosol particles generated by the MDI will be transferred from the reservoir tubing  232   d  to the nebulizer chamber  181   d  and then to the MDI chamber  178   d.    
         [0166]      FIG. 8E  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the first alternative embodiment of the present invention as described in  FIG. 8D .  FIG. 8E  is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in  FIG. 2E  with modifications. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0167]     The MDI chamber  178   e  has an outlet end  180   e . The nebulizer chamber  181   e  has an inlet end  182   e . The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as  179183   e . The outlet end  180   e  of the MDI chamber  178   e  has a hollow cylindrical tube  193   e  with an inlet end  194   e  and an outlet end  195   e . The MDI chamber  178   e  may be made of plastic, paper, or metal. The chamber  178   e  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  196   e  and grooves  197   e . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  198   e  of the coil are demonstrated in the figure as dotted lines. The distance  199   e  and  200   e  between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0168]     The outlet tube  193   e  of the MDI chamber  178   e  has two valve assemblies disposed between the inlet end  194   e  and the outlet end  195   e —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  209   e  that has a circular opening  210   e  and a flap valve  211   e  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  212   e  that has a circular opening  213   e  and a flap valve  214   e  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  211   e  moves away from the valve seat  209   e  for the aerosol particles to move from the MDI chamber  178   e  to the patient through the opening  210   e  in the valve seat  209   e  of the tube  193   e . On exhalation, the flap valve  211   e  moves towards the flap valve seat  209   e  and closes the opening  210   e  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  178   e  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  209   e  prevents any protrusion of the flap valve  211   e  through the opening  210   e . The exhalation flap valve assembly has a flap valve  214   e  that presses against the flap valve seat  212   e  on inhalation and completely occludes the opening  213   e  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  193   e  on inhalation. On exhalation the flap valve  214   e  moves away from the flap valve seat  212   e  for the air exhaled by the patient to escape into the atmosphere from tube  193   e  through the opening  213   e.    
         [0169]     The nebulizer chamber  181   e  has an hollow cylindrical inlet tube  215   e  at it&#39;s inlet end  182   e . The inlet tube  215   e  has an inlet end  216   e  and an outlet end  217   e . The inlet end  182   e  of the neulizer chamber  181   e  is open quite unlike the closed periphery  246   e  shown as the shaded area in  FIG. 8D . The inlet end  216   e  of the inlet tube  215   e  is closed. A universal actuator  207   e  may be disposed between the inlet end  216   e  and the outlet end  217   e  of the tube  215   e . The nozzle  206   e  of a canister  205   e  of any commercially available MDI may be attached to an actuator  207   e . The actuator  207   e  has an opening or an aperture  208   e . On actuation of the MDI canister  205   e , the medication aerosol particles are generated through the opening  208   e  of the actuator  207   e . The flow of the gas(es) from the nebulizer chamber  181   e  to the MDI chamber is peripheral through the opening  246   e  of the nebulizer chamber  181   e . There is no central flow of gas(es)from the nebulizer chamber to the MDI chamber as the inlet end  216   e  of the inlet tube tube  215   e  is closed.  
         [0170]     The nebulizer chamber has an inlet port  229   e  for connection with a standard small volume nebulizer  230   e . The aerosol medication generated with the nebulizer  230   e  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  179   e   183   e . Chamber  181   e  also has another inlet  231   e  for connection a reservoir bag  232   e . The reservoir bag  232   e  serves to store the aerosol particles generated by the nebulizer  230   e  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  232   e  has two small inlets  233   e  and  234   e  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0171]     Alternatively, the reservoir bag  232   e  may be replaced by a corrugated plastic reservoir tubing  237   e  that may be connected to inlet end  216   e  of the nebulizer chamber  181   e . The reservoir tubing  237   e  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  238   e  and grooves  239   e . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  240   e  of the coil are demonstrated in the figure as dotted lines. The distance  241   e  and  242   e  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  232   e  or reservoir tubing  237   e  serves to store the aerosol particles generated by the nebulizer  230   e  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  238   e  that may have a hollow cylindrical inlet tube  243   e  with an inlet end  244   e  and an outlet end  245   e . The inlet end  244   e  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI  205   e  can be connected to the inlet end  244   e  of the inlet tube  243   e  and on actuation the aerosol particles generated by the MDI will be transferred from the reservoir tubing  232   e  to the nebulizer chamber  181   e  and then to the MDI chamber  178   e.    
         [0172]      FIG. 8F  is an expanded plan view of the longitudinal length of aerosol delivery apparatus IV according to the second alternative embodiment of the present invention as described in  FIG. 8D .  FIG. 8F  is an expanded view of an alternative embodiment of the invention that may be used with both a metered dose inhaler (MDI) or a nebulizer. The device is similar to the description of the invention in  FIG. 2E  with modifications. A universal actuator is disposed between the inlet end and the outlet end of the tube located at the inlet end of the nebulizer chamber. The nozzle of any commercially available MDI canister can be attached to the universal actuator and medication delivered by actuation of the MDI. The inlet end of the tube located at the inlet end of the nebulizer chamber can be attached to one or more gas sources to yield a mixture of gas(es) with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0173]     The MDI chamber  178   f  has an outlet end  180   f . The nebulizer chamber  181   f  has an inlet end  182   f . The inlet end of the MDI chamber and the outlet end of the nebulizer chamber are fused together, the fused ends are labeled as  179   f   183   f . The outlet end  180   f  of the MDI chamber  178   f  has a hollow cylindrical tube  193   f  with an inlet end  194   f  and an outlet end  195   f . The MDI chamber  178   f  may be made of plastic, paper, or metal. The chamber  178   f  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  196   f  and grooves  197   f . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  198   f  of the coil are demonstrated in the figure as dotted lines. The distance  199   f  and  200   f  between the two adjacent ridges, rings of the coil, or grooves may be equal.  
         [0174]     The outlet tube  193   f  of the MDI chamber  178   f  has two valve assemblies disposed between the inlet end  194   f  and the outlet end  195   f —the inhalation valve assembly and an exhalation valve assembly. The inhalation flap valve assembly has a circular flap valve seat  209   f  that has a circular opening  210   f  and a flap valve  211   f  as demonstrated by the dotted line. The exhalation valve assembly has a circular flap valve seat  212   f  that has a circular opening  213   f  and a flap valve  214   f  as demonstrated by the dotted line. On inhalation, the inhalation flap valve  211   f  moves away from the valve seat  209   f  for the aerosol particles to move from the MDI chamber  178   f  to the patient through the opening  210   f  in the valve seat  209   f  of the tube  193   f . On exhalation, the flap valve  211   f  moves towards the flap valve seat  209   f  and closes the opening  210   f  to prevent any flow of gas exhaled by the patient from entering into the MDI chamber  178   f  thus avoiding re-breathing of carbon dioxide on the next inhalation. The flap valve seat  209   f  prevents any protrusion of the flap valve  211   f  through the opening  210   f . The exhalation flap valve assembly has a flap valve  214   f  that presses against the flap valve seat  212   f  on inhalation and completely occludes the opening  213   f  to prevent any room air entrainment i.e. not allowing the air from the atmosphere to enter into the tube  193   f  on inhalation. On exhalation the flap valve  214   f  moves away from the flap valve seat  212   f  for the air exhaled by the patient to escape into the atmosphere from tube  193   f  through the opening  213   f.    
         [0175]     The nebulizer chamber  181   f  has an hollow cylindrical inlet tube  215   f  at it&#39;s inlet end  182   f . The inlet tube  215   f  has an inlet end  216   f  and an outlet end  217   f . The inlet end  182   f  of the neulizer chamber  181   f  is open quite like the opening in  FIG. 8E . The inlet end  216   f  of the inlet tube  215   f  is also open unlike the closed inlet end in  FIG. 8E . A universal actuator  207   f  may be disposed between the inlet end  216   f  and the outlet end  217   f  of the tube  215   f . The nozzle  206   f  of a canister  205   f  of any commercially available MDI may be attached to an actuator  207   f . The actuator  207   f  has an opening or an aperture  208   f . On actuation of the MDI canister  205   f , the medication aerosol particles are generated through the opening  208   f  of the actuator  207   f . The flow of the gas(es) from the nebulizer chamber  181   f  to the MDI chamber is peripheral through the opening  246   f  of the nebulizer chamber  181   f . There is central and peripheral flow of gas(es)from the nebulizer chamber to the MDI chamber through the inlet end  216   f  of the inlet tube tube  215   f  and the inlet opening  182   f  of the nebulizer chamber  181   f , respectively.  
         [0176]     The nebulizer chamber has an inlet port  229   f  for connection with a standard small volume nebulizer  230   f . The aerosol medication generated with the nebulizer  230   f  can enter the MDI chamber via a central connection between the MDI chamber and the nebulizer chamber  179   f   183   f . Chamber  181   f  also has another inlet  231   f  for connection a reservoir bag  232   f . The reservoir bag  232   f  serves to store the aerosol particles generated by the nebulizer  230   f  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The bag  232   f  has two small inlets  233   f  and  234   f  to be connected to one or more gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the delivery of aerosol particles as well as deliver a fixed concentration of oxygen to a hypoxemic patient.  
         [0177]     Alternatively, the reservoir bag  232   f  may be replaced by a corrugated plastic reservoir tubing  237   f  that may be connected to inlet end  216   f  of the nebulizer chamber  181   f . The reservoir tubing  237   f  may be a fixed volume chamber or a collapsible/expandable chamber. The chamber may be cylindrical with smooth edges or cylindrical with multiple ridges  238   f  and grooves  239   f . The chamber may be made of stiff corrugated plastic that may not require any additional support to maintain patency of the chamber. Alternatively the chamber may be supported with a metal or plastic coil with multiple rings. The multiple rings  240   f  of the coil are demonstrated in the figure as dotted lines. The distance  241   f  and  242   f  between the two adjacent ridges, rings of the coil, or grooves may be equal. The reservoir bag  232   f  or reservoir tubing  237   f  serves to store the aerosol particles generated by the nebulizer  230   f  during the exhalation phase to be inhaled on the next breath thus improving aerosol medication delivery. The reservoir bag may be made of plastic, neoprene, paper, or metal. The reservoir tubing has an inlet end  238   f  that may have a hollow cylindrical inlet tube  243   f  with an inlet end  244   f  and an outlet end  245   f . The inlet end  244   f  can be attached to a single or multiple gas sources to obtain a mixture of gases with desired density, oxygen concentration, viscosity, and humidity to improve the The MDI  205   f  can be connected to the inlet end  244   f  of the inlet tube  243   f  and on actuation the aerosol particles generated by the MDI will be transferred from the reservoir tubing  232   f  to the nebulizer chamber  181   f  and then to the MDI chamber  178   f.    
         [0178]     It is noted that the illustration (drawings) and description of the preferred embodiments have been provided merely for the purpose of explanation and although the invention has been described herein with reference to particular means, materials and embodiments, the invention is not intended to be limited to the particulars disclosed herein; rather the invention intents to all functionally equivalent structures, methods and uses such as are within the scope of the appended claims.