• Only prescribe inhalers after the person using them (or their carer) has received training in the use of the device and has demonstrated acceptable technique.
• When choosing an inhaler device for a person with asthma, consider:
• The availability of the drug and dose in the specific device
• The ability of the person to develop and maintain an effective technique with the specific device
• The suitability of the device to the person's (and carer's) lifestyles
• The person's preference for and willingness to use a particular device
• Cost
• For adults:
• A pressurized metered-dose inhaler (pMDI) with or without a spacer is generally recommended for delivery of inhaled corticosteroids and bronchodilators.
• A dry-powder inhaler (DPI) or a breath-actuated MDI is recommended for people who are unable or unwilling to use a standard pMDI and spacer.
• For children aged 5 to 15 years:
• For inhaled corticosteroids, a pMDI with a suitable spacer device is recommended. If the child is unable or unwilling to use a standard pMDI and spacer, consider a DPI or a breath-actuated MDI.
• For bronchodilators, consider a wider range of devices (e.g. DPI, breath-actuated MDI), taking into account the need for portability (for symptomatic relief when needed).
• For children younger than 5 years:
• A pMDI with a suitable spacer device, with a face mask where necessary, is recommended for the delivery of inhaled corticosteroid and bronchodilators.

For more information on delivery devices see Choice of inhaled delivery system.

• Use the lowest dose of inhaled corticosteroid (ICS) that maintains effective control of asthma.
• Prescribe CFC-free beclometasone inhalers by brand name (Clenil Modulite^® or Qvar^®); they are not equivalent and must not be interchanged.
• To reduce the risk of oral candidiasis, especially with high doses of ICS:
• Recommend a large-volume spacer device for people using a pMDI.
• Advise people to rinse their mouth with water (or clean children's teeth) after inhalation of a dose of ICS.
• In people using high doses of ICS for prolonged periods, advise on general measures to counteract osteoporosis (such as regular exercise, smoking cessation, and adequate calcium intake).
• In all children receiving prolonged treatment with ICS measure height regularly and record on a growth chart. If there is any slowing of growth reduce the dose if possible and/or refer to a specialist.
• For children treated with 800 micrograms or more of beclometasone or equivalent daily, provide specific written advice about steroid replacement in the event of a severe intercurrent illness. Consider use of a steroid warning card. Note: any child receiving this dose should be under the care of a specialist paediatrician.
• Consider the possibility of adrenal insufficiency in any child maintained on inhaled steroids presenting with shock or decreased consciousness:
• Check serum biochemistry and blood glucose levels urgently.
• Consider whether intramuscular hydrocortisone is required.
• Advise parents to immediately report non-specific symptoms, such as anorexia, abdominal pain, weight loss, tiredness, headache, nausea, vomiting, decreased consciousness, hypoglycaemia, and seizures, in children using ICS.

For full details see Prescribing information.