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In 2011, over 45 million prescriptions for inhalers containing a bronchodilator, a corticosteroid or both were dispensed in primary care in England with a total cost of over £900 million.1 Four out of the top 10 drugs with the highest total expenditure in 2011 were inhalers (fluticasone, budesonide, tiotropium and beclometasone). A fundamental requirement that underlies all inhaled drugs is the need to use the device correctly in order to achieve the optimal therapeutic response from the drug. Even with correct technique, at best 20–35% of the drug reaches the lungs, at worst 0%.2 How confident are we that patients and clinicians are …