The number of people with asthma continues to grow around the world, and asthma remains a poorly controlled disease despite the availability of management guidelines and highly effective medication. Patient noncompliance with therapy is a major reason for poor asthma control. Patients fail to comply with their asthma regimen for a wide variety of reasons, but incorrect use of inhaler devices is amongst the most common. The pressurised metered-dose inhaler (pMDI) is still the most frequently used device worldwide, but many patients fail to use it correctly, even after repeated tuition. Breath-actuated inhalers are easier to use than pMDIs. The rationale behind inhaler choice should be evidence based rather than empirical. When choosing an inhaler device, it is essential that it is easy to use correctly, dosing is consistent, adequate drug is deposited in both central and peripheral airways, and that drug deposition is independent of airflow. Regular checking of inhalation technique is crucial, as correct inhalation is one of the cornerstones of successful asthma management. 1. Introduction The incidence of asthma continues to rise worldwide, doubling over the last 10 years [1–4] and, consequently, asthma places a huge economic burden on healthcare resources [5]. Asthma management guidelines [1, 2] are now available in virtually every country; their aim is to achieve control of the disease with the lowest possible dose of medication prescribed [1, 2]. To this end, asthma guidelines advocate a stepwise pharmacological approach that consists in increasing (“step up”) the numbers of medications as asthma worsens, and decreasing (“step down”) medications when asthma is under control [1, 2]. Once control of asthma has been achieved and maintained for at least three months, a gradual reduction of the maintenance therapy is recommended to identify the minimum therapy required to maintain control [1, 2]. Unfortunately, the current level of asthma control falls far short of the goals for long-term asthma management [2, 6, 7], with many patients reporting day- and night-time symptoms at least once a week, and continuing to require unscheduled visits and hospitalisations [2, 6, 7]. One of the reason why asthma remains poorly controlled is that patients are deriving incomplete benefit from their inhaled medication, primarily because they are unable to use their inhalers correctly [8–11]. The benefits of inhaled therapy for the treatment of obstructive airway diseases, such as asthma, have been recognised for many years. In comparison with oral or parenteral
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