Brits who bank on puffing a blue inhaler to open their airways and ease their breathing have been urged to urgently contact their GP.
Millions of people in the UK use them to help alleviate asthma symptoms such as coughing, wheezing, shortness of breath and tightness in the chest.
However, it has now emerged that blue inhalers might be doing more harm than good to those who suffer from the common condition.
The National Institute for Health and Care Excellence (NICE) updated its guidelines about the trusty sidekick asthma sufferers rely on – and explained that over time, they are actually ‘likely to make it worse’.
Doctors say that blue inhalers tend to mask the problem without fixing it – while warning that overuse ‘is linked to a higher risk of asthma attacks, hospital admissions and death’.
That’s why those in the UK who use one of these inhalers have been urged to get in touch with their GP to ‘review their asthma action plans’ as soon as they can.
In 2024, NICE, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) published new guidelines surrounding how asthma should be treated.
Prior to this, the blue inhaler was largely considered as the first line of defence against the respiratory condition, as after a couple of puffs, it would subside asthma symptoms for sufferers.
What are blue inhalers? 
Blue inhalers aren’t the saviour that a lot of people thought they were, according to NICE (ANTHONY WALLACE/AFP via Getty Images)
Blue inhalers are packed with a medication known as salbutamol – or the brand names Ventolin, Airomir, Asmalal, Easyhaler, Pulvinal, Salamol, Easi-Breathe, Salbulin.
This substance helps to relieve symptoms of asthma and also chronic obstructive pulmonary disease (COPD).
Medications like salbutamol are referred to as bronchodilator and these work by ‘relaxing the muscles of the airways into the lungs, which makes it easier to breathe’, the NHS says.
Currently, its guidance states that blue inhalers are ‘safe and effective with few side effects’, as well as being suitable for women to use while pregnant or breastfeeding.
However, it does state that if you are an asthma sufferer who needs to use it more than twice a week, ‘it could be a sign that your condition is not well controlled’.
“It’s very important that you use your inhaler properly,” the NHS adds. “This is so you get the right amount of salbutamol into your lungs and the most benefit from it.”
“If you need to use your inhaler more than 4 times in 24 hours, it may mean that your condition is getting worse and that you need different treatment.”
What has NICE said about blue inhalers? 
Asthma sufferers are being urged to discuss switching inhalers with their doctors as soon as they can (Getty Stock Image)
NICE is urging asthma sufferers to hand over their blue inhalers to instead try out combination inhalers, as these ‘relieve symptoms and tackle the underlying inflammation that causes attacks in the first place’.
People who are 12 or over should instead use these combination inhalers, which are a mix of an inhaled steroid and a long-acting beta2 agonist (LABA) medicine called formoterol in a single device.
According to NICE, they ‘treat the inflammation and prevent flare-ups while also providing immediate relief’.
It explains: “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. For the first time, more people are now managing their asthma without the blue inhaler than those still relying on it alone.”
Explaining why blue inhalers were only something of a temporary fix for those who have asthma, Dr Amina Al-Yassin said: “They make people feel better, but only briefly.
“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.”
Blue inhalers ‘likely to make asthma worse’ in the long run according to experts (Getty Stock Image)
NICE states that those who have ‘good control’ of their respiratory condition should experience ‘few or no symptoms and rarely need to use their reliever inhaler’.
Dr Al-Yassin, a GP and clinical lead for children and young people’s services at Brent Integrated Care Partnership, went on: “The blue inhaler or SABA was the mainstay of asthma treatment for years, but that has changed.
“There is a big attitude shift. The NICE guideline gave us the confidence we needed to strongly recommend this change to our patients.”
Dr Sunil Gupta, GP clinical advisor at NICE, said tons of people have already made the switch to combination inhalers.
|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,” he added.
What have experts said about the new advice around using blue inhalers?
So, blue inhalers are out and combination ones are in – and health experts reckon it’s a huge step ‘in the right direction’ for bettering treatment for people who have asthma.
Lee Newton-Proctor, who has had the condition since he was three-years-old, said his ‘life has been transformed’ since switching, adding: “I no longer feel asthmatic. I can do what I want, when I want.”
Previously, he has been hospitalised 18 times and was using up to 18 blue inhalers a year – and he admitted he became ‘dependent on it for day-to-day activities’.
Lee, 41, dubbed the blue inhaler his ‘psychological safety net’ and explained that he can now run, cycle and exercise a lot easier since binning off his old inhaler.
He is one of more than a million people in England now using a combination inhaler to ease asthma symptoms.
Professor Ewan Maule said: “We now know that asthma is not just about keeping the airways open, it’s also about controlling the inflammation, or swelling, that causes the symptoms in the first place.
“By upgrading to a combined treatment inhaler patients not only get the relief they need but also benefit from treatment that treats the root cause of their asthma.
Combination inhalers have been ‘transforming’ the lives of some Brits who have already made the change (NICE)
“This can lead to fewer flare-ups, fewer hospital visits, and better long-term lung health,” the director of medicines and pharmacy at the North East and North Cumbria Integrated Care Board (ICB) said.
The ICB advised: “Anyone currently using a blue reliever treatment inhaler is being encouraged to contact their GP practice to review their asthma plan to see if a new combination inhaler might work better for them.”
Claire Adams, ICB respiratory clinical lead, said combination inhalers ‘offer more protection and better control, helping people to live well and breathe more easily’.
Urging Brits to go and chat to their doctors, she added: “Reviewing your asthma action plan with a healthcare professional will ensure you understand how to use the right inhaler correctly and get the best protection for your lungs, helping you to live symptom-free!”
Professor Richard Russell, Chair of the British Thoracic Society, hailed the inhaler overhaul as a ‘milestone’ in asthma care.
He said: “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.”
Donna Peat, Respiratory Advanced Practitioner working in acute care at Lancashire Teaching Hospitals NHS Trust also added: “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.”