New NICE asthma guidance sees doctors told to stop prescribing blue inhalers

Doctors have been told to stop prescribing blue salbutamol inhalers to millions of asthmatics in Britain over fears for the climate and concerns they’re not very effective. The National Institute for Health and Care Excellence (NICE) advises the blue inhaler, over 17 million of which were prescribed in Britain last year, directly contributes to greenhouse gas emissions and only relieves asthma symptoms without treating the cause of asthma flare ups.

Instead GPs are being told to offer a low-dose combination inhaler to be taken as needed for everyone aged 12 and above. The combination inhalers, which are now taken by unclipping the attached mouthpiece (not removing altogether) and taking a long breath in, are powder-based and do not include any gas.

Patients are being told by GPs that the blue inhalers are bad for the environment as they contain hydrofluorocarbon propellant. When attending routine annual check-ups asthmatics are being advised to transfer from blue inhalers to the combination inhalers.

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For the first time NICE, the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) have worked together to produce a new UK-wide joint guidance for the diagnosis and management of chronic asthma in adults, young people and children.

Their research showed an over-reliance on the blue inhalers has worsened the risk of flare ups in the long-term for asthmatics. The blue inhalers have offered short-term relief to asthmatics for decades and tend to be taken alongside at least one other “prevention” inhaler, such as beclometasone.

NICE said if a patient wants to continue with a blue inhaler then a blue inhaler shouldn’t be prescribed unless the patient is also given a combination inhaler. The independent guideline committee looked at evidence which showed using the combined inhalers when required led to people suffering fewer severe asthma attacks.

Professor Jonathan Benger, chief medical officer at NICE, said: “I am delighted BTS, NICE and SIGN have collaborated to develop this useful and useable guideline. It aims to help ease the pressure on the health service by reducing hospital admissions due to asthma and lowering the use of less effective monitoring tests."

Dr Paul Walker, chair of BTS, added: "The treatment changes represent a true pivot in the principles of asthma care and will contribute to improved outcomes. The society wishes to thank the very many people who have worked to deliver this guideline. This is only the start of much hard work in dissemination, education and implementation but this will ultimately deliver better care for people with asthma.” For the latest health news, sign up to our newsletter here.