• 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.

• Do not prescribe a long-acting beta₂ agonist (LABAs) for someone who is not already using an ICS.
• Do not stop inhaled corticosteroid treatment whilst an individual is using a LABA.
• Do not start anyone with acutely deteriorating asthma on LABA therapy.
• Closely monitor anyone started on an LABA, especially during the first 3 months of treatment.
• Only continue therapy with LABAs if they have shown benefit.
• Advise people who have been prescribed salmeterol that they should not use it to relieve an acute asthma attack.

For full details see Prescribing information.

• When prescribing theophylline, the brand should be specified on the prescription.
• Serum levels of theophylline are increased in people with heart failure or hepatic impairment, in elderly people, and by drugs that inhibit hepatic enzymes (e.g. cimetidine, ciprofloxacin, erythromycin):
• If people whose disease is stable during theophylline therapy begin to take one of these drugs, consider reducing the dose of theophylline.
• Serum levels of theophylline are decreased in people who smoke, in chronic alcoholism, and by drugs that induce hepatic enzymes (e.g. phenytoin, carbamazepine, rifampicin):
• If people whose disease is stable during theophylline therapy begin to take one of those drugs, consider increasing the dose of theophylline.
• If people whose disease is stable during theophylline therapy stop smoking, a reduction in dose may be necessary.
• Once a maintenance dose has been reached, check serum theophylline concentration every 6 to 12 months, or if the person is experiencing adverse effects that might suggest toxicity (e.g. nausea, vomiting, tremor, palpitations, or arrhythmias).

For full details see Prescribing information.

• Zafirlukast: if clinical symptoms or signs suggestive of liver dysfunction occur (e.g. anorexia, nausea, vomiting, right upper quadrant pain, fatigue, lethargy, flu-like symptoms, enlarged liver, pruritus, or jaundice), stop zafirlukast and immediately measure serum transaminases, (in particular, serum alanine aminotransferase). Routine monitoring of liver function is not recommended.
• Use in children: montelukast is the only leukotriene receptor antagonist licensed for use in children (aged 6 months and older).
• Use in pregnancy: do not start a leukotriene receptor antagonist during pregnancy. However, if a woman is already taking a leukotriene receptor antagonist and it is considered essential, treatment can be continued during pregnancy.

For full details see Prescribing information.

• Advise people that inhaled sodium cromoglicate or nedocromil sodium should be used regularly, usually four times a day.
• Cromone inhalers should not be used to relieve an acute attack of asthma.
• If inhalation of the dry powder form of sodium cromoglicate causes bronchospasm, advise the person to use their short-acting btea₂ agonist inhaler (salbutamol or terbutaline) a few minutes prior to using the sodium cromoglicate inhaler.

For full details see Prescribing information.

• Adverse effects are uncommon with infrequent, short courses of oral corticosteroids.
• After recovery from an acute exacerbation, prednisolone can be stopped abruptly, without tapering the dose, unless the course was longer than 3 weeks or the person was previously receiving maintenance oral corticosteroid treatment.

For full details see Prescribing information.