case fatality rates in inhaled anthrax can approach 100%. Anthrax bacteria, after being inhaled, use three toxins— protective antigen, oedema factor, and lethal factor—to enter, appropriate, and kill alveolar macrophages. Seven copies of protective antigen assemble and facilitate entry of oedema factor and lethal factor into macrophages. Oedema factor weakens the ability of macrophages to kill the bacteria. Lethal factor causes macrophages to elaborate large amounts of inflammatory cytokines such as TNF . Death typically results from an artificial sock-like picture caused by these cytokines. Administration of ACTH might be able to reverse the inflammatory cytokine milieu, buying time for antibiotics and other supportive measures to preserve life. Since ACTH is inexpensive, easy to use, and has few side-effects, it might be considered for inhaled anthrax.