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The change follows a landmark guideline published jointly in 2024 by NICE, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN).

For decades, the little blue inhaler was a lifeline for millions of people with asthma. But doctors now know it can make the condition worse - and a quiet revolution in treatment is already transforming lives.

Lee Newton-Proctor has had asthma since he was 3 years old. By the time he reached his late thirties, he had been hospitalised 18 times and was using up to 18 blue inhalers a year. In the year before he changed treatment, he missed over 5 weeks of work.

"I was dependent on it for day-to-day activities," he says. "It was my psychological safety net."

Then he switched his inhaler on his doctor's advice. Today, Lee, 41, runs, cycles and exercises regularly. "My life has been transformed. I no longer feel asthmatic. I can do what I want, when I want."

Lee is one of more than a million people in England now using a combination inhaler that prevents and relieves - and for the first time, that number has overtaken those still relying on the blue inhaler alone. It is a tipping point that doctors are calling a life-saving cultural shift in how asthma is treated.

The landmark guideline recommended that patients move away from the traditional blue inhaler - known medically as a short-acting beta2 agonist or SABA - towards combination inhalers that don't just relieve symptoms but tackle the underlying inflammation that causes attacks in the first place.

The problem with the blue inhaler, doctors say, is that it masks the problem without fixing it. Overuse is linked to a higher risk of attacks, hospital admissions and death. Nearly half of all blue inhaler users in England (48%) were prescribed more than two in 2024 to 2025, a level that specialists consider a warning sign.

"They make people feel better, but only briefly," says Dr Amina Al-Yassin, a GP and clinical lead for children and young people's services at Brent Integrated Care Partnership. "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."

With good asthma control, a person should have few or no symptoms and rarely need to use their reliever inhaler.

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