Poor control in a child on a preventer often reflects how the inhaler is used and how regularly, not the dose. Ask the child to demonstrate with their own device, watch the technique and check that a spacer is being used with a pressurised inhaler.
Ask how many days a week the preventer is actually taken, and who gives it. Look at the repeat-prescription record. Correct technique and adherence first; if control is still poor, then consider stepping up, after confirming the diagnosis and other triggers such as smoke exposure or allergic rhinitis.
- Watch the child use their own inhaler and spacer.
- Ask how often the preventer is actually taken and by whom.
- Check the prescription record for gaps.
- Step up only after technique and adherence are right.
Why it matters
Stepping up a drug that is not reaching the lungs adds cost and side effects without benefit.
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