There are many inhaler and spacer devices available. Each device will contain instructions on effective use and the patient should be encouraged to follow the advice given. The different spacer devices available include:

Metered dose inhalers (MDIs) €“ the most commonly used inhaler and the most costeffective option. They do require a high degree of co-ordination, so are only effective if the patient can adopt a good inhaler technique. They can be used in combination with spacer devices to improve lung deposition of the medication and reduce side effects (such as thrush with inhaled corticosteroids)

Breath-actuated MDIs €“ these reduce some problems associated with the technique required for using MDIs and the need for co-ordination is reduced

Dry powder inhalers (DPIs) €“ breath activated, these may improve deposition rates as not so much patient co-ordination is required for their use. However, the patient must have sufficient lung function to inhale the dose into the lungs to achieve the required lung deposition.

The NMS can be an effective way of ensuring that when a patient is initiated on an asthma therapy, they are counselled on how to use each device correctly. At the point of dispensing, pharmacists can ensure the patient understands the advice he/she has received. Any shortfalls in technique can be picked up at an early stage, reducing the risk of poor control. When a patient has used inhalers for some time, their technique can deteriorate, leading to symptoms that may be mistaken for drug failure. An MUR is the ideal way to review a patient's inhaler technique to ensure he/she is getting maximum benefit from his/her medication.