inhaler devices for topical airway treatment in asthma

Last edited 11/2019

Inhaler devices

Technique and training

Prescribe inhalers only after patients have received training in the use of the device and have demonstrated satisfactory technique

Beta 2 agonist:

In acute asthma:

• Children and adults with mild and moderate asthma attacks should be treated with a pMDI (pressurised metered dose inhalers) + spacer with doses titrated according to clinical response.

Stable asthma:

• In children aged 5-12, a pMDI + spacer is as effective as any other hand-held inhaler
• In adults, a pMDI +/- spacer is as effective as any other hand-held inhaler, but patients may prefer some types of DPI (dry powder inhalers)

Inhaled corticosteroids for stable asthma

• In children aged 5-12, a pMDI + spacer is as effective as any other hand-held inhaler
• In adults, a pMDI +/- spacer is as effective as any DPI.

Prescribing devices:

• choice of device may be determined by the choice of drug
  
  
• if the patient is unable to use a device satisfactorily an alternative should be found
  
  
• the patient should have their ability to use the prescribed inhaler device (particularly for any change in device) assessed by a competent healthcare professional
  
  
• the medication needs to be titrated against clinical response to ensure optimum efficacy
  
  
• reassess inhaler technique as part of the structured clinical review
  
  
• generic prescribing of inhalers should be avoided as this might lead to people with asthma being given an unfamiliar inhaler device which they are not able to use properly
  
  
• prescribing mixed inhaler types may cause confusion and lead to increased errors in use. Using the same type of device to deliver preventer and reliever treatments may improve outcomes

Inhaler devices in children

• In children, a pMDI and spacer is the preferred method of delivery of beta 2 agonists and inhaled corticosteroids. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. Where this is ineffective a nebuliser may be required.

Reference:

• SIGN (July 2019). British Guideline on the management of asthma (SIGN158)