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NICE set to end use of separate inhalers

New NICE guidance is set to end the use of separate inhalers for prevention and symptom relief in patients with asthma, writes Jennifer Rigby.

The institute has provisionally ruled that combination devices should be used ahead of separate inhalers where treatment with inhaled steroids and long-acting ß-agonists is appropriate.If confirmed, the guidance will help GPs resist pressure from pharmaceutical advisers to prescribe separate inhalers on cost grounds.The draft technology appraisal on the use of steroids gives the stamp of approval to combined inhalers for chronic adult asthma, recommending them at step three of the BTS/SIGN guidelines.GPs have welcomed the ruling. Dr Kevin Gruffydd-Jones, committee member of the General Practice Airways Group and a GP in Box, Wiltshire, said: 'For patients at step three who need inhaled steroids and ß-agonists, combined inhalers should be used. In fact, it is potentially dangerous not to.'The combined inhaler is a safety mechanism. The separate inhaler will only be used in exceptional cases in future.'Dr Tony Crockett, a GP in Shrivenham, Wiltshire, and a hospital practitioner in asthma, added: 'The guidelines are very sensible. Hopefully those saying we should prescribe separately will shut up now.'The draft guidance recommends that for those who only require low-dose steroids, and for those where high-dose inhaled steroids are appropriate, GPs should select the least expensive product that is suitable.Whenever possible, the use of a press-and-breathe pressurised metered-dose inhaler and suitable spacers is recommended. If the patient is not able to use these, alternative devices should be considered. Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, who conducts research on the use of steroids, said: 'In cases where compliance is a problem, combined inhalers can simplify the regime. However, sometimes separate inhalers offer more flexibility.'

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