Asthma: huge shift to combined inhalers in ‘quiet revolution’
6 May 2026
Getty/Branimir76By Emma Wilkinson
More than a million patients with asthma in England have been switched to a combined inhaler in response to NICE guidance, figures show.
For the first time, the number of patients prescribed a combination reliever inhaler containing an inhaled corticosteroid outnumber those using a short-acting beta agonist (SABA) alone.
Describing the changes as “quiet revolution” in asthma management, NICE said it would cut GP visits and A&E attendances.
Work is still needed to move more patients on to the combined inhaled corticosteroid (ICS)/formoterol inhalers, which for some can feel daunting when they are used to their blue inhaler, experts added.
The joint NICE, British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) guidance for asthma patients aged 12 and over was updated in 2024 with an emphasis on maintenance or combination treatments to also treat inflammation rather than “reliever-only” inhalers.
Overuse of SABA inhalers has been linked to a higher risk of attacks, hospital admissions and death.
NICE noted that half of all SABA inhaler users in England (48%) were prescribed more than two in 2024/25 - a warning sign that their condition may not be well controlled.
In all, 1.09 million people were using AIR (anti-inflammatory reliever) and MART (maintenance and reliever therapy) without any SABA inhaler between October and December 2025 - a 63% increase compared with the same period the previous year.
This compares with 800,000 people using a SABA inhaler without any combination inhaler, a 16% decrease from the previous year.
NICE has estimated that for every 10,000 people switching to MART inhalers there would be 1133 fewer GP visits and 144 fewer trips to A&E every year.
A small number of people may not tolerate the change in inhaler but patients also need to be supported when switching to get the best results, NICE said.
Dr Amina Al-Yassin, a GP and clinical lead for children and young people's services at Brent Integrated Care Partnership said there had been a “big attitude shift” in the use of SABA inhalers, which only make people feel better 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.”
Dr Sunil Gupta, GP clinical advisor at NICE said the guideline had marked a real turning point for asthma care.
“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.”
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