On March 16, 2009 MannKind submitted an NDA for their inhalable insulin. In 2011 the FDA denied approval of Afrezza and because the design of the delivery device had changed, the FDA requested additional clinical trials to ensure that people would use it the same way as the earlier versions.  After conducting further studies, Mannkind submitted a new application, and in June, 2014, the FDA approved Afrezza for both Type I and Type II adult diabetics, with a label restriction for patients having asthma, active lung cancer or COPD.   In 2014 Mannkind and Sanofi agreed that Sanofi would take over manufacturing and marketing of Afrezza,  but Sanofi said it was dropping the effort in January 2016 due to poor sales of $ million in 2015;  the companies formally terminated the agreement in November 2016.  At the time that Sanofi announced it was dropping the product Mannkind said it would continue alone,  and it had taken over manufacturing and relaunched the drug by July 2016. 
In 1864, the first steam-driven nebulizer was invented in Germany. This inhaler, known as "Siegle’s steam spray inhaler", used the Venturi principle to atomize liquid medication, and this was the very beginning of nebulizer therapy. The importance of droplet size was not yet understood, so the efficacy of this first device was unfortunately mediocre for many of the medical compounds. The Siegle steam spray inhaler consisted of a spirit burner, which boiled water in the reservoir into steam that could then flow across the top and into a tube suspended in the pharmaceutical solution. The passage of steam drew the medicine into the vapor, and the patient inhaled this vapor through a mouthpiece made of glass.