Inhaler devices for routine treatment of chronic asthma in older children (aged 5 to 15 years)

Given the scarcity of robust research comparing inhaler devices (including spacers) in older children, decision-making is likely to be substantially improved by adequately powered RCT equivalence studies. Ideally, these would include:

• treatment of a full spectrum of chronic asthma severity in generalisable clinical settings

• qualitative assessment of children's experience of devices and factors influencing adherence

• examination of clinically relevant outcome measures (for example, symptoms, activities, time away from school) rather than short-term measures of lung function

• examination of differences in resource use

• epidemiological investigation of the determinants (for example, social factors) of adherence, effectiveness and cost effectiveness of treatment.

NICE acknowledges that such studies would require large numbers of participants and present a significant challenge to manufacturers and other researchers. A parallel or alternative approach would be to undertake epidemiological and qualitative research on the factors influencing adherence and competence.

Given that none of the currently available inhaler devices are completely satisfactory for children, manufacturers should consider research into novel inhalers that can be used effectively with greater ease by children.