Choice of inhaler type – as well as the drug(s) contained within – is vital. Considerations should include the patient’s age, dexterity, coordination and how well they can breathe in. For example, a traditional metered dose inhaler might not be a good option for someone who will struggle to press the canister due to arthritis, and a breath-actuated inhaler might be a poor choice for an individual with very shallow breathing.

In addition, don’t forget about spacers: these devices remove the need for perfect coordination when using metered dose inhalers and are particularly useful for people on high dose corticosteroids as they increase the amount of drug getting into the airways.

Don’t assume that someone knows how to use their prescribed inhalers. Instead, ask them to demonstrate their technique, perhaps using one of the placebo devices available from manufacturers, and then talk them through any possible tweaks they could make in order to improve how effectively they are using their inhaler.

Practice point

• Think about the last time you counselled a patient about their inhaler technique. How confident are you that you correctly assessed their inhaler technique? What went well and what could you improve?