Asthma Care: Inhaler Technique, Action Plans and the New Guidance

What happens in asthma?

Asthma is a long-term condition where the airways become inflamed and sensitive. When triggered, the muscles around them tighten, the lining swells and mucus builds up, making it harder to breathe. Common symptoms are wheezing, breathlessness, a tight chest and coughing, often worse at night or with exercise.

According to Asthma + Lung UK, around 5.4 million people in the UK are receiving treatment for asthma. Most asthma deaths are thought to be preventable with good routine care.

How treatment has changed

In 2024, NICE, the British Thoracic Society and SIGN published a joint UK guideline (NG245). A key change is that people should no longer be treated with a short-acting reliever (such as a blue salbutamol inhaler) on its own, because this does not treat the underlying inflammation.

Instead, many people now use an inhaler that combines an inhaled corticosteroid with formoterol:

• AIR (anti-inflammatory reliever): used as needed for symptoms in mild asthma
• MART (maintenance and reliever therapy): the same inhaler used every day and also as needed for symptoms

Do not change your treatment yourself. If you are still using only a blue inhaler, book a review with your GP, asthma nurse or pharmacist.

Signs your asthma is not well controlled

• Using your reliever three or more times a week
• Waking at night because of asthma symptoms
• Symptoms stopping you from exercising or working
• Needing a course of steroid tablets or an urgent appointment for asthma

Getting your inhaler technique right

Studies consistently show that many people do not use their inhaler correctly, which means less medicine reaches the lungs. There are two main types:

Pressurised metered-dose inhaler (pMDI)

• Shake the inhaler and remove the cap.
• Breathe out gently, away from the mouthpiece.
• Seal your lips around the mouthpiece, start to breathe in slowly and steadily, and press the canister once.
• Keep breathing in, then hold your breath for up to 10 seconds.
• Using a spacer with a pMDI helps more medicine reach your lungs and is recommended for children and many adults.

Dry powder inhaler (DPI)

• Load the dose as instructed for your device. Do not shake it.
• Breathe out away from the mouthpiece.
• Seal your lips and breathe in quickly and deeply.
• Hold your breath for up to 10 seconds.

If you use a steroid inhaler, rinse your mouth and spit afterwards to reduce the risk of oral thrush. Asthma + Lung UK has short videos for every common inhaler type, and your pharmacist can check your technique for free.

Your personal asthma action plan

A written action plan, agreed with your clinician, tells you which medicines to take every day, how to recognise when your asthma is getting worse, and what to do in an attack. People who use one are much less likely to need hospital treatment.

What to do in an asthma attack

• Sit up straight and try to stay calm.
• Use your reliever inhaler as described in your action plan.
• If you are not getting better, or you are worried at any point, call 999.

Common triggers

Colds and flu, pollen, dust mites, animal fur, smoke, pollution, cold air and stress can all trigger symptoms. Getting your annual flu vaccine is recommended for many people with asthma.