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Brief Summary

GUIDELINE TITLE

Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years).

BIBLIOGRAPHIC SOURCE(S)

  • National Institute for Clinical Excellence (NICE). Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). London (UK): National Institute for Clinical Excellence (NICE); 2002 Mar. 19 p. (Technology appraisal guidance; no. 38).

GUIDELINE STATUS

BRIEF SUMMARY CONTENT

 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

  1. It is recommended that in addition to therapeutic need (including chosen drug and dose), the following factors be taken into account when choosing inhaler devices for individual children with chronic asthma:
    • The ability of the child to develop and maintain an effective technique with the specific device
    • The suitability of a device for the child's and carer's lifestyles, considering factors such as portability and convenience
    • The child's preference for and willingness to use a particular device.
  1. The general recommendations in section 1 above should be taken into account when considering the following specific guidance:
    • A press-and-breathe pressurised metered dose inhaler (pMDI) and suitable spacer device is recommended as the first-line choice for the delivery of inhaled corticosteroids as part of regular planned daily therapy, with the aim of maximising benefits of preventive therapy in attaining good asthma control, and minimising potential systemic absorption. Where clinicians believe that an individual child's adherence to the press-and-breathe pMDI and spacer combination is likely to be so poor as to undermine effective asthma control, other alternative devices (taking account of the factors outlined in section 1 above and evidence of equivalence of clinical effectiveness) should be considered, bearing in mind the need to minimise the risks of systemic absorption of corticosteroids.
    • In the case of other inhaled drugs, primarily bronchodilators, it is recommended that a wider range of devices be considered to take account of their more frequent spontaneous use, the greater need for portability, and the clear feedback that symptom response provides to the device user. In such circumstances the factors outlined in section 1 above are likely to be of greater importance in choosing a device.
  1. Where more than one device satisfies the considerations outlined above in a particular child, it is recommended that the device with the lowest overall cost (taking into account daily required dose and product price per dose) should be chosen.
  2. On selection of an inhaler device, it is important that consideration is given to other aspects of asthma care that influence the effective delivery of inhaled therapy, including:
    • Individual practical training in the use of the specific device
    • Monitoring of effective inhaler technique and adherence to therapy
    • Regular (i.e., no less than annual) review of inhaler needs, which may change over time with increasing age

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically stated.

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • National Institute for Clinical Excellence (NICE). Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). London (UK): National Institute for Clinical Excellence (NICE); 2002 Mar. 19 p. (Technology appraisal guidance; no. 38).

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2002 Mar (reviewed 2005)

GUIDELINE DEVELOPER(S)

National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]

SOURCE(S) OF FUNDING

National Institute for Health and Clinical Excellence (NICE)

GUIDELINE COMMITTEE

Appraisal Committee

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Committee Members: Dr Jane Adam, Radiologist, St George's Hospital, London; Dr Sunil Angris, General Practitioner, Waterhouses Medical Practice; Professor David Barnett (Chair) Professor of Clinical Pharmacology, University of Leicester; Professor Carol Black, Consultant Physician, Royal Free Hospital & UCL, London; Professor John Brazier, Health Economist, University of Sheffield; Professor Bruce Campbell, Consultant Surgeon, Royal Devon & Exeter Hospital; Professor Mike Campbell, Statistician, Institute of General Practice & Primary Care, Sheffield; Dr Karl Claxton, Health Economist, University of York; Professor Jack Dowie, Health Economist, London School of Hygiene & Tropical Medicine, London; Dr Paul Ewings, Statistician, Taunton & Somerset NHS Trust; Sally Gooch, Director of Nursing, Mid-Essex Hospital Services Trust; Liz Heyer, Chief Executive, Barnet & Chase Farm Hospitals NHS Trust; Ruth Lesirge, Patient Representative; Director, Mental Health Foundation; Dr George Levvy, Patient Representative; Chief Executive, Motor Neurone Disease Association; Dr Gill Morgan, CEO, North & East Devon Health Authority; Professor Miranda Mugford, Health Economist, University of East Anglia; Siân Richards, General Manager, Cardiff Local Health Group; Professor Philip Routledge, Professor of Clinical Pharmacology, University of Wales College of Medicine; Dr Rhiannon Rowsell, Pharmaceutical Physician, AstraZeneca UK Ltd; Dr Stephen Saltissi, Consultant Cardiologist, Royal Liverpool University Hospital; Professor Andrew Stevens, Professor of Public Health, University of Birmingham; Professor Ray Tallis, Consultant Physician, Hope Hospital, Salford; Professor Mary Watkins, Head of Institute of Health Studies, University of Plymouth; Dr Norman Waugh, Public Health Consultant, University of Southampton; Dr Trisha Greenhalgh, Director, Open Learning Unit, Primary Care and Population Sciences, University College London

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Committee members are asked to declare any interests in the technology to be appraised. If it is considered there is a conflict of interest, the member is excluded from participating further in that appraisal.

GUIDELINE STATUS

GUIDELINE AVAILABILITY

AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

Print copies: Available from the National Health Service (NHS) Response Line 0870 1555 455. ref: N0048. 11 Strand, London, WC2N 5HR.

Additionally, Audit Criteria are available in Appendix D of the original guideline document.

PATIENT RESOURCES

The following is available:

  • Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). London (UK): National Institute for Health and Clinical Excellence (NICE); 2002 Mar. 8 p. (Technology appraisal 38).

Electronic copies: Available in English and Welsh in Portable Document Format (PDF) from the National Institute for Health and Clinical Excellence (NICE) Web site.

Print copies: Available from the NHS Response Line 0870 1555 455. ref: N0050. 11 Strand, London, WC2N 5HR.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC STATUS

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

DISCLAIMER

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