In 2025, there has been a ‘Major change of practice’ in asthma advice across the UK. New joint guidelines from NICE, BTS, and SIGN (published November 2024) have replaced older separate ones, bringing fresh approaches to diagnosing, monitoring and managing asthma.
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These guidelines mark a turning point — or what many are calling a ‘Major change of practice’ in asthma advice — especially in how inhalers are prescribed, how overuse of relief inhalers is tackled, and how diagnosis is confirmed with newer tests.
What Triggers This “Major Change of Practice” in Asthma Advice
The push for ‘Major change of practice’ in asthma advice comes from accumulating evidence that some traditional asthma treatments, particularly reliance on short-acting beta-2 agonists (SABAs) alone, may not be the safest or most effective over time. The new guidance recommends that asthma treatment starts, in many cases, using combination inhalers that include anti-inflammatory medication (ICS) even for mild asthma.
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This shift reflects research showing better control of symptoms, fewer exacerbations, and long-term lung health when inflammation is addressed early — a core part of this ‘Major change of practice’ in asthma advice.
Key Changes: Diagnosis and Tests
One of the central components of the ‘Major change of practice’ in asthma advice is diagnostic testing. Under the new guideline from BTS/NICE/SIGN, objective tests such as FeNO (Fractional exhaled Nitric Oxide) and blood eosinophil counts are encouraged even early in the diagnostic process.
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This emphasises identifying type of inflammation, not just airflow obstruction. In previous guidance, diagnosis often focused primarily on reversible airflow limitation (spirometry, bronchodilator response). The ‘Major change of practice’ in asthma advice means doctors will increasingly rely on these inflammation markers to tailor treatments more precisely.
Key Changes: Treatment Strategy — Towards Anti-Inflammatory Reliever (AIR) and MART
Perhaps the most dramatic shift in the ‘Major change of practice’ in asthma advice is in how reliever inhalers are used. The new guidelines strongly discourage using SABA inhalers alone without inhaled corticosteroids. Instead, they promote combination approaches:
AIR (Anti-Inflammatory Reliever) therapy: using a combination inhaler (for example ICS/formoterol) both as needed for relief and to treat inflammation.
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MART (Maintenance And Reliever Therapy): using single inhaler therapy that serves both maintenance and relief roles. This was less emphasised previously in many UK practices. The ‘Major change of practice’ in asthma advice is that AIR and MART are now considered cornerstones for many patients aged 12 and over.
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Why This Matters for Patients with Asthma
This ‘Major change of practice’ in asthma advice could make a big difference in day-to-day life for people with asthma. Some implications are:
Fewer severe asthma attacks, hospital visits, and emergencies by preventing inflammation rather than just treating symptoms.
Better long-term lung health, fewer flare-ups and less chronic damage.
Reduced dependence on SABA inhalers — which, if overused, are linked to worse asthma control and higher risk of exacerbations.
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More personalised treatment: monitoring eosinophils, FeNO, inhaler technique, checking adherence. All part of the ‘Major change of practice’ in asthma advice to make care more precise and patient-centred.
What Changes Patients Should Expect
Because of this ‘Major change of practice’ in asthma advice, patients may notice several differences in how their asthma is managed:
Inhaler prescription changes: If you have been using a blue SABA alone, you may be offered a combination inhaler (AIR) instead.
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More tests: Your GP or respiratory clinic may ask you to have new tests such as FeNO or blood eosinophil count to guide treatment.
Review of inhaler technique and adherence: The guidelines emphasise checking you are using inhalers correctly, and that you are taking them as prescribed — core to the ‘Major change of practice’ in asthma advice.
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More regular reviews: Annual asthma reviews, monitoring of symptom control, and looking out for over-use of rescue inhalers are now standard parts of practice.
Common Concerns and Misconceptions
With any ‘Major change of practice’ in asthma advice, there will be questions and worries. Let’s address a few:
“Is it safe to combine relief and maintenance in one inhaler?” Yes — studies show that for many patients, AIR and MART reduce exacerbations and are cost-effective. The new UK guideline backs this.
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“Do I still keep a rescue inhaler?” Yes, but the reliance on separate rescue-only inhalers (high-dose SABAs alone) is reduced. The relief provided by an anti-inflammatory reliever inhaler that also includes ICS helps address symptoms and inflammation together.
“Will I need more inhalers / will treatment be more complex?” Not necessarily; for many people, the change simplifies treatment by reducing the number of inhalers. However, there may be adjustments during the transition.
How to Make This New Advice Work for You
To benefit from the ‘Major change of practice’ in asthma advice, here are practical steps:
Talk to your healthcare provider: Ask if your treatment plan is aligned with the new guidelines. If you are using SABA alone, enquire about AIR or MART options.
Check inhaler technique: Many problems stem from incorrect use. Make sure your inhaler, spacer (if needed), dose timing are correct.
Keep an asthma action plan: Ensure that you have a written plan that includes triggers, warning signs, what to do in flare-ups, and who to contact.
Monitor your symptoms and inhaler use: If you find you’re using rescue inhalers often, that’s a sign your asthma may not be well controlled. This data helps your doctor decide whether treatment needs adjusting.
Lifestyle supports: Avoid smoking, maintain a healthy weight, exercise safely, reduce pollution or triggers in the home. These non-medical supports complement the new prescription practices in this ‘Major change of practice’ in asthma advice.
What This Means for NHS Practice, GPs, Pharmacists
The ‘Major change of practice’ in asthma advice affects not just patients, but how asthma care is delivered:
Practices will need to update formularies, ensure clinicians are aware of new guidelines, and have access to combination inhalers.
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Training may be required so healthcare workers can interpret new tests (FeNO, eosinophils), review inhaler technique, and manage AIR/MART strategies.
Health systems may need to monitor usage of SABAs, track asthma control metrics, reduce SABA overuse.
Cost-effectiveness: guidance indicates that AIR/MART not only improve outcomes but in many cases are cost-effective, meaning savings or cost neutrality over time.
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Challenges & What To Watch For
Even with this ‘Major change of practice’ in asthma advice, there are hurdles:
Not all clinics or GP surgeries may have easy access to FeNO testing or fast eosinophil count results.
Some inhalers (combination ICS/formoterol) might be off-label for certain age groups or under-12s, so special care/expert advice may be needed there.
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Patient acceptance: changes mean old habits (using blue inhaler when wheezy) may need rethink. Education and communication are crucial.
Costs and availability: even when guidelines recommend certain inhalers, supply, licensing, and cost can vary regionally.
Summary: What “Major Change of Practice” in Asthma Advice Means for You
To sum up, the ‘Major change of practice’ in asthma advice is not a minor tweak — it’s a shift toward early anti-inflammatory treatment, reducing overreliance on SABA alone, using newer tests to guide care, and emphasising inhaler technique, adherence, and regular reviews. For people with asthma, this means more tailored, safer, evidence-based treatment that aims not just to relieve symptoms, but to prevent flare-ups, preserve lung function, and improve quality of life.
Final Thoughts
While change can feel unsettling, this ‘Major change of practice’ in asthma advice offers hope. If you or someone you care for has asthma, now is a good time to review your asthma plan, talk with your GP or nurse, ask about new inhaler options, tests, and whether your treatment matches the latest guidance. Over time, these changes should lead to fewer emergency visits, fewer sleepless nights, and breathing more comfortably. That’s the promise behind this major change — breathing better, living better.
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