Summary points from NICE guidance include:
When choosing inhaler devices for individual children with chronic asthma, in addition to therapeutic need, the following factors should be taken into account:
- the child's ability to develop and maintain an effective technique
- suitability of a device for a child's and carer's lifestyles, considering factors such as convenience and portability
- the child's preference and willingness to use a specific device
While considering the above general guidance, the following specific guidance points were included:
- the first-line choice for delivery of inhaled corticosteroids as the part of regular planned daily therapy is a press-and-breathe metered dose inhaler (pMDI) and suitable spacer device.(note that where clinicians believe that an individual child's adherence to the press-and-breathe pMDI and spacer combination is likely to so poor so as to undermine effective control of a child's asthma, then alternative devices should be considered)
- in the case of other inhaled drugs, primarily bronchodilators, NICE recommend that a wider range of devices be considered to take account of their more frequent spontaneous use, the greater need for portability, and the clear feedback that symptom response provides to the device user
On NICE review (2) it has been decided that the original guidance has become static (i.e. the guidance remains valid, but does not require a scheduled review).
Reference:
- NICE (March 2002). Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). www.nice.org.uk
- NICE Review Decision (August 2005).Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). www.nice.org.uk