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NICE inhaler go-ahead

By Emma Wilkinson

Institute gives cautious backing to use of asthma combination devices

NICE has given the go-ahead to use of combined inhalers for asthma – but has been criticised for not backing them as the preferred treatment option.

GPs warned PCTs might continue to place restrictions on use of combined inhalers because of the failure of NICE to give them its full backing.

Its final appraisals of steroid use in adults and children recommended combination devices as an option for patients with asthma who require both inhaled ster-oids and long-acting ß-agonists.

The guidance also states the cheapest device suitable for the patient should be chosen, which experts say is often the combination inhaler.

Decisions on combination versus separates should be made on what is best for the patient and how likely they are to adhere to treatment, said NICE.

But Dr Kevin Gruffydd-Jones, committee member of the General Practice Airways Group and a GP in Box, Wiltshire, said PCTs might continue to back separates – supposedly for their greater flexibility – despite this being 'potentially dangerous'.

'NICE should have said combination devices were the preferred choice because PCTs will see that as the green light to say use separates,' he warned.

Dr Dermot Ryan, fellow member of the group and a GP in Loughborough, Leicestershire, said: 'Many patients will only take the ß-agonist, putting them at increased risk of death.'

Institutes inhaler guidelines

Where an inhaled steroid is considered appropriate, the least costly product is recommended.

For adults and children aged 12 years and older with chronic asthma in whom treatment with an inhaled steroid and long-acting ß-agonist is considered appropriate, the following apply:

• the use of a combination device is an option

• decision should be based on therapeutic need and the likelihood of treatment adherence

• if a combination device is chosen, the least costly device is recommended.

Source: NICE

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