NICE has recommended that for children under the age of 5 years who have chronic stable asthma:

  • both corticosteroids and bronchodilator therapy should routinely delivered by Pressurised Metered Dose Inhaler (pMDI) and spacer system, with a facemask where necessary.
  • where this combination is not clinically effective for the child, and depending on the child's condition, nebulised therapy may be considered and in the case of children aged 3 to 5 years, a dry powder inhaler (DPI) may also be considered.
  • the choice of which pMDI device and spacer to use should be determined by the specific needs of the child and how well it works for them. Once these factors have been taken into account the choice should be made on the basis of reducing costs.

Clinicians should review their current clinical practice for the management of chronic asthma in children under the age of 5 years against this guidance.

The appropriate selection of inhaler devices as described is only one aspect for the provision of a comprehensive approach to all aspects of managing asthma. In particular, parents/carers need education, support and guidance, on how to manage their child's condition. General practitioners, the practice nurse, the specialist asthma nurse, the health visitor and school nurse and other community health carers have an essential role in the provision of this service and advice on general management may result in additional improvements in clinical and cost effectiveness.