A press-and-breathe pressurised metered dose inhaler used with an appropriate spacer is recommended as the first choice of inhaler for use with inhaled corticosteroid medicines for asthma (preventers). If a clinician believes that it is so unlikely that an individual child will use the press-and-breathe inhaler and spacer properly that his or her asthma control may be affected, other inhalers should be considered.

For other inhaled medicines for asthma, such as bronchodilators (relievers), a wider range of inhalers should be considered. This recommendation takes into account that the child is more likely to have to carry this inhaler around with him or her so that it is available for use when needed.

The choice of inhaler should be determined by individual needs, including the medicine the child needs, and the child’s ability and willingness to use a particular inhaler. If, after these factors have been taken into account, there is more than one inhaler to choose from, the inhaler with the lowest overall cost to the NHS should be chosen.

The health professionals who help to look after a child with asthma will support the proper use of the inhaler. From time to time, they will check that the inhaler being used remains the best one for the child.

Your responsibility

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.