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.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.