Asthma Management Handbook
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Table. Considerations for choice of inhaler device type when prescribing inhaled medicines

Clinical situation

Consideration

Acute asthma (all patients) Recommend use of spacer when using reliever via pMDI for acute asthma

Any patient using a pMDI for an inhaled corticosteroid

Recommend use of a spacer every time (except for breath-actuated pMDIs)

Infants and small children

Use a spacer with a facemask

Poor manual dexterity (e.g. weak hands or arthritis)

Consider either of:

  • a Haleraid device with relevant pMDIs (available for salbutamol, fluticasone, fluticasone/salmeterol)
  • a breath-actuated inhaler

Difficulty connecting spacer to pMDI (e.g. elderly patient with weakness or poor coordination)

Leave spacer connected: pharmacist can attach spacer to inhaler each time canister is replaced, and leave attached until medicine is used up. (If patient uses more than one pMDI, provide a separate spacer for each device.

Consider a breath-actuated inhaler.

Inability to form a good seal around the mouthpiece of the inhaler or spacer (e.g. person with cognitive impairment or facial weakness)

Consider a spacer plus age-appropriate facemask

Difficulty speaking or reading English

Give a physical demonstration

Use videos

Use an interpreter or provide written instructions in the person’s first language

Using multiple inhalers

Choose the same type for each medicine, if possible, to avoid confusion

If not possible, train person in the correct inhaler technique for each of their devices, emphasising any key differences (e.g. speed of inhalation, shake pMDIs but not dry-powder inhalers)

Last reviewed version 2.0

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