People with asthma should try to avoid frequent use of the blue inhaler containing the short-acting β2 adrenergic agonist (SABA) salbutamol to treat their symptoms. It is important to treat asthma appropriately and reduce the need for an emergency reliever. This is because overuse can actually worsen people’s symptoms rather than make them better.
“SABA is not for overuse as it is for when the patient has poor control of their symptoms, but should not be used for routine treatment,” said Dr Steve Holmes, a general practitioner (GP) partner at The Park Medical Partnership in Shepton Mallet, Somerset, UK. If 100 people with or without asthma were to use a SABA twice a day, 2-3 days a week, for 1-2 months, most would develop asthma-like symptoms “because of the blue inhaler”. This is termed airway or bronchial hyperresponsiveness and has been well-described since the late 1990s. There are also new options highlighted by the Global Initiative for Asthma (GINA) guidance that should be considered. According to GINA, asthma is a chronic condition in which there is inflammation of the airways. Even when there are no symptoms and the asthma appears mild, underlying inflammation puts people who are not on appropriate long-term medication at-risk for experiencing an asthma exacerbation or flare-up. Over the years, treatment has evolved to try to prevent asthma from worsening. Now, treatment has moved to more of an as-required approach, which is often how patients take their medication in practice.
Asthma care really is about getting the basics right. Asthma care in the UK can be “an absolute minefield”, however, especially as there are two out-of-date guidelines, the National Institute for UK Health and Care Excellence (NICE) guidance that was last updated 3 years ago in 2021. New UK-wide guidelines have been drafted and should be finalised by the end of 2025. This time there will be a single guideline to help clinicians. One of the expected changes is a new asthma pathway, stand-alone guidelines for the management of acute and uncontrolled asthma are also being produced.
