1.1 It is recommended that in addition to therapeutic need (including chosen drug and dose), the following factors be taken into account when choosing inhaler devices for individual children with chronic asthma:
the ability of the child to develop and maintain an effective technique with the specific device
the suitability of a device for the child's and carer's lifestyles, considering factors such as portability and convenience
the child's preference for and willingness to use a particular device.
1.2 The general recommendations in 1.1 should be taken into account when considering the following specific guidance:
1.2.1 A press-and-breathe pressurised metered dose inhaler (pMDI) and suitable spacer device is recommended as the first-line choice for the delivery of inhaled corticosteroids as part of regular planned daily therapy, with the aim of maximising benefits of preventive therapy in attaining good asthma control, and minimising potential systemic absorption. Where clinicians believe that an individual child's adherence to the press-and-breathe pMDI and spacer combination is likely to be so poor as to undermine effective asthma control, other alternative devices (taking account of the factors outlined in 1.1 and evidence of equivalence of clinical effectiveness) should be considered, bearing in mind the need to minimise the risks of systemic absorption of corticosteroids.
1.2.2 In the case of other inhaled drugs, primarily bronchodilators, it is recommended 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. In such circumstances the factors outlined in 1.1 are likely to be of greater importance in choosing a device.
1.3 Where more than one device satisfies the considerations outlined above in a particular child, it is recommended that the device with the lowest overall cost (taking into account daily required dose and product price per dose) should be chosen.
1.4 On selection of an inhaler device, it is important that consideration is given to other aspects of asthma care that influence the effective delivery of inhaled therapy, including:
individual practical training in the use of the specific device
monitoring of effective inhaler technique and adherence to therapy
regular (i.e. no less than annual) review of inhaler needs, which may change over time with increasing age.