Before you begin, have you completed the first two modules in this series about asthma?
Part one: Understanding asthma
Part two: Managing asthma

According to guidelines published by both the National Institute for Health and Care Excellence (NICE) and the British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN), adults aged 17 and over should be offered a low dose inhaled corticosteroid (ICS) – around 400 microgram of beclometasone per day or equivalent – as the first-line maintenance therapy. A short-acting beta2 agonist (SABA) is also offered alongside as reliever therapy. 

Patients should be informed of the importance of taking the ICS regularly every day to reduce the inflammation in their airway and decrease the likelihood of an asthma exacerbation. The SABA should be used when the person experiences asthma symptoms, meaning that an increase in the use of their salbutamol inhaler may indicate deterioration in their asthma control.

Inhalers should only be prescribed once the person has received training on how to use the device from an appropriately trained healthcare professional and when they are able to demonstrate satisfactory technique. In children, a pressurised metered-dose inhaler (pMDI) and spacer are the preferred method of delivery of SABA.

Inhaler technique

According to the Royal College of Physicians (RCP) National review of asthma deaths (NRAD), an assessment of inhaler technique to ensure effectiveness should be routinely undertaken and formally documented at annual review, and also checked by the pharmacist when a new device is dispensed.