The Pharmaceutical Journal
Vol 268 No 7194 p521-527
20 April 2002

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National Institute for Clinical Excellence (www.nice.org.uk)

NICE endorses costly inhaler devices for children if asthma better controlled

Press-and-breathe metered dose inhalers (MDIs) with a suitable spacer device should be used first-line to deliver inhaled corticosteroids for routine treatment of chronic asthma in children aged 5–15 years, says the National Institute for Clinical Excellence.

However, NICE recognises that some children may have difficulty with the actuation-inhalation co-ordination needed with these MDI devices. "If ... a clinician considers that a particular device would be more likely to achieve good asthma control in a particular child than cheaper ones available, then that device should be chosen," the guidance states.

For other inhaled drugs used to relieve the symptoms of acute exacerbations of asthma, NICE recommends that a wider range of devices is considered for first-line treatment. This is because such drugs are used spontaneously and there is a greater need for portability.

In both circumstances, NICE recommends that the following factors are taken into account:

• The ability of the child to develop and maintain an effective technique with a specific device
• The suitability of a device for the child and his or her carer's lifestyle in terms of convenience and portability
• The child's preference for and willingness to use a particular device

The guidance notes that evidence to distinguish between devices is generally limited in quantity and quality. There are, however, substantial differences in the costs associated with them (see Panel). NICE recommends that no device be excluded on grounds of cost-effectiveness but when more than one device is suitable then the one with the lowest overall cost should be chosen.

NICE also recommends that clinical staff involved in the prescribing, supply and administration of inhaler devices to children should receive suitable education and training as well as give training in the proper use of the selected devices.

In its patient/carer information, NICE suggests that those using inhalers who are unsure about the type of device that they use, should discuss the guidance with their doctor, pharmacist or nurse.

The full guidance is available on the NICE website (www.nice.org.uk).