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| Choose |
| (i) Choose the most appropriate inhaler device for the patient before prescribing. Consider the medication options, the available devices, patient skills, and cost |
| (ii) If different options are available, encourage the patient to participate in the choice |
| (iii) For pMDIs, use of a spacer improves delivery and (with ICS) reduces the potential for side effects |
| (iv) Ensure that there are no physical barriers, for example, arthritis, that limit the use of the inhaler |
| (v) Avoid use of multiple different inhaler types where possible, to avoid confusion |
|
| Check |
| (vi) Check inhaler technique at every opportunity |
| (vii) Ask the patient to show you how they use their inhaler (do not just ask if they know how to use it) |
| (viii) Identify any errors using a device-specific checklist |
|
| Correct |
| (ix) Show the patient how to use the device correctly with a physical demonstration, for example, using a placebo inhaler |
| (x) Check technique again, paying attention to problematic steps. You may need to repeat this process 2-3 times |
| (xi) Only consider an alternative device if the patient cannot use the inhaler correctly after several repeats of training |
| (xii) Recheck inhaler technique frequently. After initial training, errors often recur within 4–6 weeks |
|
| Confirm |
| (xiii) Clinicians should be able to demonstrate correct technique for each of the inhalers they prescribe |
| (xiv) Pharmacists and nurses can provide highly effective inhaler skills training |
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