This content is from the BTS, NICE and SIGN guideline - Asthma: diagnosis, monitoring and chronic asthma management (SIGN 245), 2024.

 

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1.6.5 Base the choice of inhaler(s) for asthma on:

  • an assessment of correct technique
  • the lowest environmental impact among suitable devices
  • the preference of the person receiving the treatment.

A spacer should usually be prescribed for use with a metered dose inhaler, particularly in children. See the patient decision aid on asthma inhalers and climate change.

[BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

 

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1.6.6 Give people with asthma information on their inhaler treatments. This should include the medicines they contain, how they work, when they should be taken and the correct technique to use for each device.

[BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

 

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1.6.7 Observe the person using their inhaler device (and spacer if used) to check they can use it properly:

  • at every asthma review, either routine or unscheduled
  • at every consultation
  • when there is deterioration in asthma control
  • when the inhaler device is changed (for example, when a person switches to a generic device)
  • when the person asks for it to be checked or changed.

If the person is assessed as being unable to use a device properly, find an alternative.

[NICE 2017, BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

 

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1.6.8 If possible, prescribe the same type of device to deliver preventer and reliever treatments where more than one inhaler is needed. Consider providing an additional metered dose short-acting beta2 agonist (SABA) inhaler plus spacer for emergency use for children under 12 years who may be unable to activate a dry powder inhaler during an acute asthma attack.

[BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

 

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1.6.9 Encourage people to take their used or expired inhalers to their pharmacy for disposal.

[BTS/SIGN 2019, amended BTS/NICE/SIGN 2024]

 

Digital Inhalers

 

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1.6.10 Digital inhalers are not recommended for routine use in people with asthma.

[BTS/NICE/SIGN 2024]

 

             

Rationale and impact

Why the committee made the recommendation

The committee looked at evidence comparing the use of digital smart inhalers with usual care and with digital inhalers with the feedback utility switched off. The trials included both children and adults with asthma, and a variety of types of inhaler. The evidence showed improvement in adherence to treatment with digital inhalers but this did not result in significant improvement in measures of asthma control. In addition, there was an unexplained increase in hospital admissions among people using digital inhalers when compared with usual care. The participants in the contributing trials varied considerably in terms of baseline adherence and asthma control, and benefit was generally more likely in the studies of people with poorer baseline values.

Digital inhalers are more expensive than conventional devices, partly because of the device itself and partly because of the set-up and monitoring requirements. The committee concluded that digital inhalers are not a cost-effective option for routine use in asthma. However, they are potentially valuable in selected people with asthma, for example those in whom the need for biologic therapy is being considered and there is a need to confirm good adherence. Further research is needed to identify more precisely the people and the circumstances in which they might be used.

How the recommendation might affect practice

Digital inhalers are not recommended for routine use in the NHS, and this is in line with current practice.

Full details of the evidence and the committee’s discussion are in evidence review R: smart inhalers.