Jane Scullion provides some simple and practical advice on optimal inhaler device selection for adults and children, in the first of two feature articles.

Getting the device right for the patient is an important clinical need, but we also need to be aware of patient factors. If people are not engaged with us, then they are less likely to use their inhaler.7

There are additions to devices, such as dose counters, and more intuitive devices with fewer operational factors, but we need to ensure that these features contribute to making the person comfortable in using their inhaler, rather than be dazzled by yet another new device.

The use of nebulisers is not routinely recommended unless there is a clinical need. This type of device can give out high doses of medication and can cause problems, such as hypokalemia, and can lead patients to rely on them rather than seeking appropriate medical help.3, 8


The optimal device for both children and adults is dependent on many factors. Given that there is little difference in terms of clinical effectiveness, in the end it generally comes down to what medication is required within its product licence, the required inspiratory flow rate, and whether a person can and will use it.

Read the next article in the series, which focuses on therapeutic options for the management of asthma and COPD.


  1. NICE. Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma. NICE Technology Appraisal 10. NICE, 2000. Available at: www.nice.org.uk/ta10.
  2. Vincken W, Levy M, Scullion J et al. Spacer devices for inhaled therapy: why use them, and how? ERJ Open Res 2018;4 (2): 00065-2018.
  3. NICE. Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years). NICE Technology Appraisal 38. NICE, 2002. Available at: www.nice.org.uk/ta38.
  4. van Aalderen W, Garcia-Marcos L, Gappa M et al. How to match the optimal currently available inhaler device to an individual child with asthma or recurrent wheeze. NPJ Prim Care Respir Med 2015; 25 14088.
  5. Brocklebank D, Ram F, Barry P et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature.Health Technol Assess 2001; 5: 1–149.
  6. Dekhuijzen P, Vincken W, Virchow J et al. Prescription of inhalers in asthma and COPD: Towards a rational, rapid and effective approach. Respir Med 2013; 107: 1817–1821.
  7. Usmani O, Capstick T, Chowan H et al. Choosing an appropriate inhaler device for the treatment of adults with asthma or COPD. Originally developed for Guidelines 2016; also published on Guidelines for Nurses 2016. Available at: www.GuidelinesforNurses.co.uk/WPG/inhaler-choice
  8. Asthma UK. Getting emergency treatment through a nebuliser. www.asthma.org.uk/advice/nhs-care/emergency-asthma-care/nebulisers (accessed 12 April 2019).