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Asthma management
Asthma pathway
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No additional information
Inhaled corticosteroids
Asthma pathway
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Asthma management
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Asthma pathway
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Asthma management
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These recommendations are from inhaler devices for children aged under 5 years (NICE
technology appraisal guidance 10).
NICE has written information for patients and the public explaining the guidance on inhaler
devices.
Inhaler devices for children aged 515 years
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.
The general recommendations 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 1.1 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 above are likely to be of greater
importance in choosing a device.
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.
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
Asthma pathway
Copyright NICE 2015. Pathway last updated: 13 January 2015
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Asthma management
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Quality standards
The following quality statements are relevant to this part of the pathway.
3.
4.
Inhaler technique
Resources
The following implementation tools are relevant to this part of the pathway.
Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12
years and over: audit support
Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12
years: audit support
Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12
years and over: costing report
Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12
years: costing template
Asthma pathway
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Asthma management
NICE Pathways
Asthma pathway
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Asthma management
NICE Pathways
Quality standards
The following quality statements are relevant to this part of the pathway.
3.
11.
Resources
The following implementation tool is relevant to this part of the pathway.
Omalizumab for treating severe persistent allergic asthma (review of technology appraisal
guidance 133 and 201): costing statement
Acute exacerbations
NICE has published quality statements relevant to people presenting with respiratory symptoms
or exacerbations (see below).
Quality standards
The following quality statements are relevant to this part of the pathway.
6.
7.
Assessing severity
8.
9.
Specialist review
Follow-up
NICE has published a quality statement relevant to people who have received treatment for an
acute exacerbation (see below).
Asthma pathway
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Asthma management
NICE Pathways
Quality standards
The following quality statement is relevant to this part of the pathway.
10.
Asthma pathway
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Asthma management
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Sources
Omalizumab for treating severe persistent allergic asthma (review of technology appraisal
guidance 133 and 201). NICE technology appraisal guidance 278 (2013)
Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12
years and over. NICE technology appraisal guidance 138 (2008)
Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12
years. NICE technology appraisal guidance 131 (2008)
Inhaler devices for routine treatment of chronic asthma in older children (aged 515 years).
NICE technology appraisal guidance 38 (2002)
Guidance on the use of inhaler systems (devices) in children under the age of 5 years with
chronic asthma. NICE technology appraisal guidance 10 (2000)
Bronchial thermoplasty for severe asthma. NICE interventional procedure guidance 419 (2012)
Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO
and Nobreath. NICE diagnostics guidance 12 (2014)
Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.
Copyright
Copyright National Institute for Health and Care Excellence 2015. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
Asthma pathway
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Asthma management
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Contact NICE
National Institute for Health and Care Excellence
Level 1A, City Tower
Piccadilly Plaza
Manchester
M1 4BT
www.nice.org.uk
nice@nice.org.uk
0845 003 7781
Asthma pathway
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