'I no longer feel asthmatic': more than a million people now using new style inhalers
The change follows a landmark guideline published jointly in 2024 by NICE, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN).
For decades, the little blue inhaler was a lifeline for millions of people with asthma. But doctors now know it can make the condition worse - and a quiet revolution in treatment is already transforming lives.
Lee Newton-Proctor has had asthma since he was 3 years old. By the time he reached his late thirties, he had been hospitalised 18 times and was using up to 18 blue inhalers a year. In the year before he changed treatment, he missed over 5 weeks of work.
"I was dependent on it for day-to-day activities," he says. "It was my psychological safety net."
Then he switched his inhaler on his doctor's advice. Today, Lee, 41, runs, cycles and exercises regularly. "My life has been transformed. I no longer feel asthmatic. I can do what I want, when I want."
Lee is one of more than a million people in England now using a combination inhaler that prevents and relieves - and for the first time, that number has overtaken those still relying on the blue inhaler alone. It is a tipping point that doctors are calling a life-saving cultural shift in how asthma is treated.
The landmark guideline recommended that patients move away from the traditional blue inhaler - known medically as a short-acting beta2 agonist or SABA - towards combination inhalers that don't just relieve symptoms but tackle the underlying inflammation that causes attacks in the first place.
The problem with the blue inhaler, doctors say, is that it masks the problem without fixing it. Overuse is linked to a higher risk of attacks, hospital admissions and death. Nearly half of all blue inhaler users in England (48%) were prescribed more than two in 2024 to 2025, a level that specialists consider a warning sign.
"They make people feel better, but only briefly," says Dr Amina Al-Yassin, a GP and clinical lead for children and young people's services at Brent Integrated Care Partnership. "We now know that over time they are likely to make asthma worse. Seeing a blue inhaler used alone is now a dangerous sign to me."
With good asthma control, a person should have few or no symptoms and rarely need to use their reliever inhaler.
A shift towards prevention
Following the new guideline, people aged 12 and over who are newly diagnosed or need step‑up treatment are expected to move to combination inhalers.
These combine an inhaled steroid and a long-acting beta2 agonist (LABA) medicine called formoterol in a single device. They treat the inflammation and prevent flare-ups while also providing immediate relief. The new treatment plans are known as AIR (Anti-inflammatory Reliever) which uses the inhaler only as needed, and MART (Maintenance and Reliever Therapy), which uses the inhaler daily as well as when needed, for those with more frequent or severe symptoms.
“I use the inhaler twice a day, morning and night,” says Lee, “but if my symptoms are bad, I can use it as a reliever as well.”
Donna Peat, Respiratory Advanced Practitioner working in acute care at Lancashire Teaching Hospitals NHS Trust says: “The guideline has led to a significant shift in the management of asthma, focusing on prevention and that will help reduce the risk of attacks. AIR and MART inhalers are suitable for most people with asthma, not just those with poor control.”
Donna is also part of the Asthma + Lung UK Respiratory Champions programme.
The number of people using AIR or MART inhalers has been growing while SABA use has fallen. This shift was already under way before the guideline was published, but it has accelerated considerably since. For the first time, more people are now managing their asthma without the blue inhaler than those still relying on it alone.
Around 1.09 million people were using AIR or MART inhalers without any SABA inhaler between October and December 2025. That is a 63% increase compared with the same period the previous year. In contrast, around 800,000 people were using a SABA inhaler without any combination inhaler, a 16% decrease from the previous year.
“The blue inhaler or SABA was the mainstay of asthma treatment for years, but that has changed. There is a big attitude shift,” says Dr Al-Yassin. “The NICE guideline gave us the confidence we needed to strongly recommend this change to our patients.”
This milestone shows asthma care is moving in the right direction. Relying on blue inhalers alone can increase the risk of serious attacks. These newer treatments address the root cause of asthma and are helping patients achieve better control and fewer emergencies.
This is a life-saving cultural shift in asthma care. With continued support for patients, we can further reduce preventable attacks and improve lives.”
Better outcomes for patients
AIR and MART regimens are linked to fewer severe flare-ups and hospitalisations.
“Patients who switch often report fewer symptoms and attacks. They describe it as genuinely life-changing, having spent years accepting their symptoms as normal,” says Donna.
NICE estimates that for every 10,000 people switching to MART inhalers there would be:
The new inhalers are more expensive but can save NHS resources through fewer hospital and GP visits and benefit the wider economy through fewer sick days in school and at work.
This guideline marks a real turning point for asthma care in England. Seeing more than a million people already using these new inhalers is genuinely encouraging. We know change takes time, but the direction of travel is right. Better asthma control means fewer emergencies, which is good for patients and good for the NHS.
It’s encouraging to see that so many people have already switched to a combination inhaler, as recommended by the latest asthma guideline. If someone with asthma needs to use their reliever inhaler three or more times a week, it’s a sign that they may be at risk of a potentially life-threatening asthma attack, and they should make an appointment with their healthcare professional to have their medication reviewed as soon as possible.
Emma continued: “We want to see people with asthma living active and healthy lives like Lee which is why we advocate patients being helped to switch to a combination inhaler where this is the best treatment for them. It’s vital that the change is made collaboratively with patients, to ensure they understand why their medicine is being changed and can have proper inhaler technique training.”
SIGN is delighted that the joint guideline has been so well received. In Scotland too, there has been great interest in evidence-based changes to diagnosis and treatment particularly around the switch from SABA to AIR/MART inhalers. This will benefit patients across the UK.
Challenge ahead
Many people have relied on the blue inhaler for years and find it hard to let go. “For many patients, SABA remains deeply ingrained as their main go-to treatment,” says Donna. “It is going to take time and a consistent, repeated message across all services to change that behaviour. Helping patients understand that these inhalers work just as quickly while delivering better long-term protection is key.”
There is also widespread misinformation. Dr Al-Yassin says: “There is a lot of misleading content on social media about the risks of the long-term use of steroid inhalers. These claims are usually exaggerated, and the risks of avoiding treatment are far more serious.”
Although the new inhalers will benefit most patients, a small number of people may not tolerate them. People also need to be supported when switching to get the best results. NICE recommends that patients are given information about their inhaler treatments and that their technique is checked at every review or when their device is changed.
Donna says: “We are still seeing inappropriate SABA prescribing, particularly in urgent and emergency care. Moving away from SABA towards anti-inflammatory therapy is not just a guideline update, it is a life-saving cultural shift. This simple intervention can be life-changing and, in some cases, literally save a life."