Devices for respiratory conditions (Formulary: Respiratory)

Important: Therapy notes

These devices are NOT prescribable on the NHS and may be purchased by patients or are for use by clinicians during inhaler assessment.

In-Check DIAL® 

• A useful guide for inhaler use checking as part of inhaler assessment.

Patients should receive regular face-to-face review to ensure correct inhaler technique, self-management (where appropriate) and concordance with agreed treatment.

Consider referring patients with COPD to pulmonary rehabilitation.

To achieve optimal compliance with inhaled therapy consider the following:

• base the choice of inhaler device on patient acceptability, suitability and cost.
• patients should only be given a device they can demonstrate they can use; many adults struggle to use metered dose inhalers (MDI) therefore dry powder inhalers (DPI) or other breath activated devices should be considered.
• always take appropriate time to teach and check inhaler technique.
• where possible use the same inhaler device if a patient requires a number of different inhaled medicines.
• reduce the number of inhalers by use of appropriate combination products.

Useful resources:

• NICE Patient decision aid: Asthma inhalers and climate change. British Thoracic Society, National Institute for Health and Care Excellence, and Scottish Intercollegiate Guidelines Network. NICE guideline NG245. November 2024.
• Asthma and Lung UK: How to use your inhaler.
• Beat asthma: Resources for families and children, young people with asthma, schools, primary healthcare professionals, secondary healthcare professionals. 
• My Lungs My Life

Important: Therapy notes

In hospital:

• Nebulised bronchodilator solutions should always be driven by oxygen when administered to a patient with asthma and by air when administered to a patient with COPD or any other diagnosis.

In primary care:

• In both COPD and asthma, only prescribe nebulisers in primary care following a formal assessment through the Respiratory Clinic; evidence suggests that maximising inhaled therapy through a spacer device is the preferred choice.
• For chronic domiciliary use electric compressors should be used to deliver nebulised therapy as the flow rate from an oxygen concentrator is insufficient to nebulise solutions effectively.
• In acute asthma in primary care, nebulisers should be driven by oxygen provided a minimum flow rate of at least 6 litres/min is available. As an alternative to air-driven nebulised therapy, high-dose salbutamol may be delivered by a large volume spacer (Volumatic®) to children aged over 2 years and adults.

Important: Therapy notes

Important: Therapy notes

Useful resources:

• Asthma and Lung UK: Spacers.

Spacer devices improve lung deposition and reduce oropharyngeal deposition of drugs delivered via a metered-dose inhaler.

• A spacer device is recommended for all patients inhaling high-dose steroids (greater than beclometasone 800 micrograms per day or equivalent) via a pressurised, metered-dose inhaler, and when inhaler technique is sub-optimal.
• If patients are able to use a spacer without a mask, that is preferable.
• Lung deposition data is superior for the Volumatic® as compared to the AeroChamber® Plus.
• Where a number of different inhalers are prescribed for the same patient they should be compatible with the selected spacer device, where possible.
• Advise patients to clean devices no more often than once a month and replace every 6 to 12 months. After cleaning, spacers should be air-dried, not dried with a towel.