One in three patients report worse asthma control after inhaler switch

Around one in three people say control of their respiratory condition worsened after their inhaler was switched, according to new findings from Asthma + Lung UK.

The charity’s latest report, All Puffed Out: How poor inhaler care is failing people with asthma, found that between 31% and 35% of patients reported poorer control of their asthma or other condition such as COPD following a switch.

The report also found that 20% of patients reverted to their previous inhaler, with around one in 10 doing so without informing their GP, ‘likely by buying inhalers online’.

The charity surveyed more than 2,600 patients across two rounds of surveys throughout 2024 to learn about people’s experiences of inhaler switching care.

Results showed that respondents had their inhalers switched for several reasons, including to improve their control of their condition, to improve symptoms and for environmental reasons.

The charity says its findings suggest patients need improved support with changing inhalers in future, in particular to ensure successful implementation of the recent British Thoracic Society (BTS)/NICE/Scottish Intercollegiate Guidelines Network (SIGN) asthma guidelines – which set out a shift away from short-acting beta agonist (SABA)-only treatment, and an overall shift to SABA-free care.

The report, published last week, highlighted gaps in consultation, education and follow-up after inhaler switches. It found that 22% of patients were switched without an appointment, limiting opportunities for discussion, shared decision-making and education.

Nearly 40% of patients also said they received no inhaler technique guidance after switching, while fewer than one in five received what the report describes as ‘gold-standard’ technique support, involving observation and correction by a clinician.

And more than four in 10 respondents said no follow-up was arranged after their inhaler was changed, despite guidance recommending review within four to eight weeks to assess symptoms, technique and suitability of treatment.

Naomi Watt, respiratory nurse specialist and healthcare professional engagement manager at Asthma + Lung UK, said the findings reflected gaps in how switches are carried out rather than problems with the treatments themselves.

‘If patients aren’t properly supported, they’re effectively left to manage a significant treatment change on their own,’ she told Pulse’s sister title Nursing in Practice.

Ms Watt, who has worked as a GP practice nurse, underlined the importance of supporting patients through inhaler transition.

‘If we don’t get inhaler switching right, we risk undermining the relationship with the patient and their understanding of supported self-management,’ she said.

She added: ‘If you give someone a new inhaler and don’t show them how to use it, the medication simply isn’t going to reach its destination.’

‘Poor technique can mean people are effectively underdosed, which can then lead to unnecessary escalation of treatment.’

Ms Watt also pointed out that there can be knock-on effects that aren’t always visible to healthcare workers.

‘What we often see is that people stop taking the inhaler because they feel it isn’t working or they experience side effects,’ she explained.

‘Patients can then feel ashamed about not taking it and avoid coming back to healthcare professionals for help.’

Ms Watt said follow-up reviews were a crucial opportunity to prevent deterioration in control.

‘A good post-switch review is about checking symptoms, observing inhaler technique, troubleshooting side effects and updating the patient’s asthma action plan,’ she said.

‘It’s a chance to catch anything that’s correctable before things worsen.’

The report raised concerns that two in 10 patients had reverted to their previous inhaler and that 10% of those ‘did so without telling their GP, likely by buying inhalers online’.

According to Ms Watt, this behaviour indicates a breakdown in ongoing patient engagement after switching.

‘When patients revert to their old inhaler without telling anyone, it often reflects a breakdown in trust,’ she said.

‘Patients should always feel able to come back and say, “This isn’t working for me,” and be supported to get it right,’ she said.

Asthma + Lung UK believes the report’s findings present an opportunity to support nurses and practices to deliver consistent, high-quality asthma care, especially given the new guidelines.

Ms Watt said: ‘A lot of blanket switching doesn’t come from nurses at all – it often comes from higher up the system.

‘This report can empower nurses to take evidence back to their practice and explain why inhaler switching needs to be done collaboratively, with proper education and follow-up.’

Asthma + Lung UK said in its report: ‘With new asthma guidelines offering a crucial opportunity to improve outcomes, it is essential that the NHS as a whole improves performance in this area and better supports patients being moved onto new inhalers in future.’

It also said it was aware that some integrated care boards (ICBs) were prioritising ‘immediate cost savings over implementing the new national guideline, which would provide longer-term health benefits to patients and greater savings to ICBs’.

The charity stressed that clinicians ‘must be properly supported in translating the new asthma guideline into a meaningful change in practice, prescribing and care’.

‘Good implementation needs clinician engagement and support, and adequate resourcing, including clinician training and clinician and patient education on what optimised asthma care looks like,’ the report added.

Poorly controlled asthma is contributing to more than 300,000 tons of greenhouse gas emissions in the UK every year, a 2024 analysis suggested. Most of the carbon footprint comes from over-reliance on reliever inhalers, the study published in Thorax and carried out by Astra Zeneca found.

However, respiratory experts have warned GPs against blanket switches to powder inhalers because it risks damaging patient relationships and disease control.

A version of this article was first published by Pulse’s sister title Nursing in Practice