Amid rising asthma deaths in the UK, millions of respiratory patients may not be receiving essential medication - due to poor inhaler technique and neglecting to use spacer devices that deliver drugs to the lungs effectively.
That’s the verdict of the country’s leading respiratory experts, who have joined forces to highlight poor pMDI use as a major public health concern.
According to Asthma + Lung UK, up to four million people are estimated to be using pressurised metered dose inhalers (pMDIs) incorrectly,1 meaning vital medication is failing to reach their lungs.
With the charity reporting that around four people each day die from asthma in the UK,2 a taskforce from the UK Inhaler Group (UKIG) has now issued new guidance to address long‑standing inconsistencies in spacer prescribing across the NHS.
This new Consensus Guide was supported by a grant from Trudell Medical - which manufactures over 50 million respiratory health devices globally each year - and it has significant implications for patients with asthma and COPD, and their healthcare providers.
The guide’s launch underscores the urgency of improving respiratory care in the UK, with a 25% rise in asthma deaths in the decade since the National Review of Asthma Deaths. Alarmingly, it also found that two thirds of these deaths are avoidable with better basic care.3
The Consensus Guide has been endorsed by the Association of Respiratory Nurses (ARNS) and the Primary Care Respiratory Society (PCRS). Dr Katherine Hickman, GP, respiratory lead for West Yorkshire and Primary Care Clinical Lead for the National Respiratory Audit Programme (NRAP), was part of the advisory group leading the guide’s production. She said:
“Spacer devices play a critical role in asthma care, mitigating technique, coordination and throat deposition issues, which we know impacts both adults and children.
“In fact, it is estimated that 80% of people have incorrect inhaler technique.”4
Furthermore, a study has shown that without a spacer, just a 0.5 second inhalation delay can reduce lung delivery to around 1% of the intended dose of potentially life-saving medication.5
“As respiratory healthcare professionals (HCPs), we are urging colleagues across the system, plus GPs and pharmacists to recognise that it’s critically important to provide the right spacer for the right inhaler, and for the right patient,” said Dr Hickman.
Trials have shown that using a pMDI alone delivers 50% less medicine to the lungs than using a pMDI with Trudell Medical’s AeroChamber Plus Flow-Vu Spacer.6
Despite compelling evidence on spacer use, just one in 10 respiratory health professionals polled by Trudell Medical believe that spacer prescribing is consistent across the NHS. Two thirds of respondents agreed that lack of spacer use is a major public health concern.7
Deborah Leese, respiratory lead pharmacist for South Yorkshire ICB and Respiratory Champion for Asthma + Lung UK, added: “For the millions of patients in the UK using pMDIs, a spacer will improve medication delivery, reduce side effects and support proper inhaler technique. This ultimately means better asthma control.
“Everyone using a pMDI should be using a spacer too. Speaking personally, it’s very rare for me to see somebody who can actually use a pMDI correctly. We need to strengthen prescribing practices in the UK when it comes to respiratory conditions requiring pMDI inhalers.”
The new Consensus Guide offers a practical framework for spacer (also known as a valved holding chamber) prescription, with advice on pMDI compatibility, technique and maintenance.
Dr Hickman, who is also former Chair of the PCRS, explained: “We need to spread the message about spacer use as far and wide as possible. If HCPs are educated, we can then educate patients too. My key message to HCPs is ‘you wouldn't give patients a tablet they can't swallow – likewise you shouldn't issue a pMDI without a spacer’.
“We've definitely got our work cut out for us to ensure patients are supported to receive the full dose of medication they need from their inhaler – but this is a crucial step forward.”
Liam Clutterbuck, Market Access Development Manager of Trudell Medical UK, concluded: “We passionately believe that respiratory patients should be able to access the appropriate device that enables their medication to be delivered effectively - and it’s clear that knowledge sharing is fundamental to influencing prescribing behaviours.
“That’s why we’re pleased to support the UK Inhaler Group to bring this hugely important Consensus Guide to fruition."
The UKIG Consensus Guide was supported by a grant provided by Trudell Medical. Trudell Medical had no editorial control other than to check factual accuracy. It is available to download here.
References
1. Asthma + Lung UK. ‘Asthma care is in crisis’ - charity sounds the siren as asthma death toll rises. 2024.; Bell, J. P., et al. An Assessment of Pressurized Metered-Dose Inhaler Use in Countries in Europe and the Rest of the World. 2023.; Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention 2021.
Estimation based on 5.4 million in the UK treated for asthma, pMDIs account for 86% of inhaler use and 80% of people have incorrect inhaler technique.
2. Asthma + Lung UK. ‘Asthma care is in crisis’ - charity sounds the siren as asthma death toll rises. 2024.
3. Asthma + Lung UK. All puffed out. 2026.
4. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention 2021.
5. Suggett J et al. The Impact of different Valved Holding Chambers (VHCs) on Lung Drug Delivery: Using Functional Respiratory Imaging (FRI) and a single Metered Dose Inhaler (MDI) type European Respiratory Journal. 2020;56:4015.
6. Dorinsky P, DePetrillo P, DeAngelis K, Trivedi R, Darken P, Gillen M. Relative Bioavailability of Budesonide/Glycopyrrolate/Formoterol Fumarate Metered Dose Inhaler Administered With and Without a Spacer: Results of a Phase I, Randomized, Crossover Trial in Healthy Adults. Clin Ther. 2020;42:634-648.
7. Trudell PCRS webinar survey. March 2026.