NHS Dudley Health Economy Medicines Formulary
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3.1.5 Peak flow meters, inhaler devices and nebulisers

General guidance

  • Regular measurement and recording of peak flow is especially useful in those patients who experience difficulty detecting deterioration in their asthma and for those with moderate or severe asthma.

General guidance – inhaler devices

  • Spacer devices reduce deposition of inhaled drugs in the oropharynx thereby reducing local adverse effects. They should therefore be used with all high dose inhaled corticosteroid treatments.
  • Spacing devices are also useful for those with poor inhalational technique and for children.
  • The device should be washed once every 2-4 weeks in diluted household detergent and then allowed to drip-dry overnight without rinsing with water.

General guidance - nebulisers

  • Nebulisers can be useful for a range of indications. However, generally speaking if patients can use conventional inhaler devices these are preferable to nebulisers.
  • Seek specialist advice before commencing long term nebulised therapy.
  • Nebulisers for home use by children should be prescribed only in exceptional circumstances under guidance from a paediatrician with an interest in asthma.


Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary


Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

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