7.1 Clinicians should review their current clinical practice for the management of chronic asthma in children under the age of 5 years against the guidance set out in section 1.
7.2 Relevant clinical guidelines and protocols should be reviewed in light of this guidance and revised if necessary.
7.3 The appropriate selection of inhaler devices as described in this guidance, is only one aspect for the provision of a comprehensive holistic approach to all aspects of asthma management. 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.
7.4 The Montreal Protocol has mandated that CFC propellant should be phased out, and in the UK, the transition to CFC-free propellants is currently under way. The majority of evidence reviewed (see paragraph 4) on the use of devices is based on the use of corticosteroids and bronchodilators with CFC propellants. CFC-free propellants may interact with spacers differently to CFC-propellants, and can therefore affect the dose of drug delivered by the spacer. In addition, not all spacers are compatible with all pressurised metered dose inhalers (pMDIs). The choice of spacer for the chosen pMDI should therefore be guided by the information in the Summary of the Product Characteristics.
7.5 The dosage of drug delivered may vary considerably according to the static charge on spacer devices. It therefore advised that spacers be washed in a household detergent and allowed to air dry. If there are concerns about the possibility of contact dermatitis using this method, the mouthpiece of facemask should be rinsed in water and dried.