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Combined inhalers advised in children

NICE has provisionally recommended use of combined inhalers as an option for children treated with inhaled steroids and long-acting ß-agonists.

The ruling follows similar draft advice for treatment of adults released last month, and should help to relieve pressure on GPs not to use more expensive inhalers.

Decisions on whether to use combined inhalers should be made on an individual basis, taking into account likely adherence and patient preference, NICE said.

The institute recommended a 'step-approach' to treating childhood asthma, bringing its advice in line with the BTS/SIGN guidance used by many GPs.

Step one – mild intermittent asthma – calls for inhaled short-acting ß-agonists with step two involving regular preventer therapy using inhaled steroids.

There is no precise dose threshold for moving to step three – add-on therapy – but equivalent to 400µg of beclometasone dipropionate may be appropriate. Before using doses higher than 800µg equivalent, referral to specialist care should be considered, NICE said.

But the guidance does not deal with the complex issue of CFC inhalers, which are soon to be discontinued. This potentially leaves GPs with a problem as the guidance currently states they should use the least costly products that are suitable.

Dr David Bellamy, a GP expert in respiratory medicine, said the change to non-CFC 'makes things slightly more complicated'. He added: 'If you have new patients or you're having to change therapies it makes sense to go for a CFC-free inhaler.'

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