Calling All Asthmatics: Chronic Asthma Management Has Changed

Asthma management in 2025: What has changed?

In late 2024, we finally saw the publication of a combined guideline from the British Thoracic Society, SIGN and NICE, which has introduced a number of radical changes to traditional chronic asthma management.

As we know, the symptoms of asthma are caused by inflammation (swelling) in the airways of the lungs, which may be triggered by different things in different people. The inflammation causes the muscles around the airways to squeeze (contract), which gives wheezing and breathlessness. The inflammation also causes the lining of the airways to make extra mucus, which causes cough and further blockage to the airflow (1).

Traditionally, a short-acting beta agonist (SABA) or Salbutamol (the blue inhaler) has been used to temporarily help with the constriction of the lungs to help with wheezing and breathlessness. Studies have shown that the overuse of this drug can lead to worsening and more frequent asthma attacks as the underlying inflammation isn’t controlled. For the inflammation to be controlled, an inhaled corticosteroid (ICS) has to be used (2).

Why the change in asthma guidelines?

Papers in the BJGP explain that the UK has among the worst asthma outcomes in high-income countries worldwide, with higher rates of preventable attacks, death and asthma-related healthcare costs (3).

A UK National Review of Asthma Deaths published a decade ago identified overuse of short-acting beta agonists (e.g. salbutamol), under-prescribing of inhaler corticosteroids (ICS), and failure of healthcare professionals to take asthma seriously as a chronic disease that can kill as major preventable factors (4)

So what can we do?

Instead of the traditional blue inhaler (SABA) alone, the guidelines now recommend using a combined inhaler containing an inhaled corticosteroid (ICS) plus a longer-acting salbutamol-type medication. It can be used as an Anti-inflammatory reliever (AIR), which allows it to be used just when you need it. If you need your AIR inhaler more than three times a week, your symptoms aren’t well-controlled. The same inhaler can then be used regularly, but still with scope to use it as a reliever on top of this. They have coined the term MART (maintenance and reliever therapy), and it avoids the need for two separate inhalers (2).

By treating both symptoms and the inflammation that causes it, there will be a reduction in the risk of flare-up, hospital admission and salbutamol reliance.  Of note, no damage will have been done to the lungs by being on salbutamol alone over the years; the new regimen is simply to optimise therapy and prevent flare-ups.

What to expect at your asthma review?

1) Check that your diagnosis is correct

Asthma is both under- and over-diagnosed, with objective tests being under-utilised to clarify suspected asthma. Changes to the guidelines include the addition of a simple blood test to check your eosinophil count (part of your immune system), which, alongside your clinical picture, can help with diagnosis. The use of Fractional exhaled nitric oxide (FeNO) is a further change in the guidelines, which is a simple diagnostic breath test which can be performed under a Respiratory Consultant.

2) Reviewing symptoms and impact on daily life

A discussion about your symptoms—how often you need inhaler use, night-time waking, exercise limitations.

3) Checking inhaler technique and device choice

Inhaler technique check, and confirming you’re on the correct device. Rightbreathe.com is an excellent resource for listing the different devices and how to use them.

4) Planning for stepping down treatment

Planning for stepping down treatment when stable, to keep medication at the lowest necessary dose.

5) Updating your asthma action plan

Ensuring you have an up‑to‑date Asthma Action Plan, including what to do if symptoms increase.

How can you be eco-friendly with your asthma meds?

Environmental concerns around inhalers have been prominent in recent years: metered dose inhalers have around 40 times the carbon footprint of dry powder inhalers, while the latter have at least equal efficacy and are often easier to use.

So, by switching to a combined (SABA + ICS) inhaler, not only will your asthma be controlled, but you will also be doing your bit for the environment. Greeninhaler.org is another great resource which compares the different inhalers and their impact on the environment(4).

Book your asthma review

If you or a family member has asthma, now is the perfect time to review your medication. Book your asthma review online here or call us on 0207 245 9333.

References

1. patient.co.uk asthma
2. CKS guideline update May 2025
3. BJGP(2024;74(739)86)
4. NB medical Hot topics