Age (years) | First choice | Second choice | Comments |
0–2 | MDI + spacer and facemask | Nebuliser | Ensure optimum spacer use Avoid “open vent” nebulisers |
3–6 | MDI + spacer | Nebuliser | Very few children at this age can use dry powder inhalers adequately |
6–12 (bronchodilators) | MDI + spacer, breath actuated or dry powder inhaler | – | If using breath actuated or dry powder inhaler, also prescribe MDI + spacer for acute exacerbations |
6–12 (steroids) | MDI + spacer | Dry powder inhaler | May need to adjust dose if switching between inhalers Advise mouth rinsing or gargling |
12+ (bronchodilators) | Dry powder inhaler or breath actuated MDI | – | |
12+ (steroids) | MDI + spacer | Dry powder inhaler or breath actuated MDI | May need to adjust dose if switching between inhalers Advise mouth rinsing or gargling |
Acute asthma (all ages) | MDI + spacer | Nebuliser | Ensure optimum spacer use and appropriate dosing Nebulise for a set period of time Written instructions for what to do in acute asthma |
MDI, pressurised metered dose inhaler.