Most people with poorly controlled asthma are using the wrong inhaler technique, not the wrong inhaler.
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Asthma is inflammation and narrowing of the airways that varies over time. The variability is the point — symptoms come and go, are typically worse at night and early morning, and are provoked by identifiable triggers. Airways that are narrowed all the time and never improve point to something else, usually COPD.
Around one in eleven people in the UK has asthma. Most of it is well controlled. But the UK has persistently poor outcomes compared with similar countries, and the National Review of Asthma Deaths found that the majority of asthma deaths involve factors that were preventable — over-reliance on reliever inhalers, under-use of preventers, missed warning signs and no written action plan.
Two things follow, and they shape this whole page. Using your blue reliever inhaler more than three times a week is not managing asthma — it is a warning sign. And inhaler technique matters more than which inhaler you were given; a large proportion of people get little of the dose into their lungs, and nobody has ever watched them use it.
Video consultation is genuinely useful here for exactly that reason — a GP can watch you use your inhaler, which is impossible over the phone.
What distinguishes asthma is not the symptoms themselves but how they behave:
Any one of these means the treatment plan needs revisiting, not that you need more reliever.
If your symptoms improve on days off, at weekends or on holiday, and return when you go back to work, that is occupational asthma until proven otherwise. It affects bakers, paint sprayers, healthcare and cleaning staff, woodworkers and hairdressers among others. It matters enormously because early removal from exposure can lead to full recovery, while continued exposure causes permanent damage — and because it carries employment and compensation rights. This question is very rarely asked.
Asthma is diagnosed on a suggestive history plus objective evidence of variable airflow obstruction. Symptoms alone are not enough, and both over- and under-diagnosis are common — a meaningful proportion of adults labelled asthmatic do not have it, and a meaningful proportion with it have never been diagnosed.
We cannot perform spirometry or FeNO testing by video, and we will not label someone asthmatic without objective evidence. What we can do is take a detailed history, watch your inhaler technique, set up and interpret a peak flow diary, arrange formal lung function testing, and review and optimise treatment for anyone already diagnosed — which is the majority of what asthma care actually involves.
This is the highest-value part of an asthma consultation and the most consistently neglected. Studies repeatedly find that a large proportion of people use their inhaler incorrectly, delivering a fraction of the dose to the lungs. On video the GP can watch you use it and correct it in two minutes.
A spacer transforms delivery from a metered-dose inhaler and should be used by far more adults than currently do. It is not a children's device.
Treatment has moved decisively away from relying on a blue reliever inhaler alone.
A personalised plan setting out your normal treatment, what to do when symptoms worsen, and exactly when to seek help. Having one roughly halves the chance of hospital admission, and most people with asthma do not have one. We write one at your consultation.
Difficult or severe asthma, suspected occupational asthma, frequent oral steroid courses, or any diagnostic uncertainty needs respiratory specialist input, including for biologic treatments that have transformed severe asthma. Anyone needing two or more steroid courses a year should be referred, and often is not.
Call 999 immediately if:
While waiting for an ambulance: sit upright — do not lie down; take one puff of your reliever through a spacer every 30 to 60 seconds, up to 10 puffs; try to stay calm and slow your breathing. If you have a rescue steroid supply and your plan says to, take it.
Seek same-day assessment for:
Book a review if: you use your reliever three or more times a week, you have had a course of steroid tablets in the last year, you have never had your inhaler technique checked, or you do not have a written action plan. Never stop or reduce a preventer inhaler without discussing it.
Knowing your personal best and checking against it turns a vague sense of being worse into a number you can act on. It is the most useful thing you can do to catch a deterioration early, and takes seconds.
Have your inhalers with you so the GP can watch your technique, and bring a peak flow reading if you have a meter. Those two things make a remote asthma review far more useful than a conversation alone.
NHS asthma care is free and is the right home for this — annual review, spirometry, inhaler technique checks, personalised asthma action plans and all medication. Anyone on regular asthma medication in England is entitled to a medical exemption certificate giving free NHS prescriptions for everything, which many people do not claim.
The single most valuable free intervention is inhaler technique. A large proportion of people use their inhaler incorrectly, which means the drug does not reach the lungs — and no change of medication fixes that. Your pharmacist will check it free, and it takes a few minutes.
The second is a written personalised asthma action plan, which is free, reduces attacks and admissions, and which most people with asthma do not have.
The most important safety point is about reliever overuse. Needing your blue reliever inhaler three or more times a week is a sign the asthma is not controlled and carries increased risk — it is not a sign to buy more relievers. UK asthma deaths are consistently associated with reliever overuse and preventer underuse.
Where a private consultation adds something is a prompt review when control has slipped, and a proper conversation about whether the preventer is being taken.
What needs emergency care: breathlessness that stops you speaking in full sentences, a reliever not working, or worsening despite treatment. Call 999.
NICE, BTS and SIGN published a joint guideline on asthma diagnosis, monitoring and management (NG245) in 2024, which is now the governing UK guidance. It recommends objective testing for diagnosis — including FeNO and spirometry with bronchodilator reversibility — rather than diagnosis on symptoms alone.
NG245 recommends AIR (anti-inflammatory reliever) and MART regimens using combination ICS-formoterol inhalers rather than short-acting beta agonist monotherapy, reflecting evidence that SABA-only treatment is associated with worse outcomes.
The guideline emphasises inhaler technique checks at every review and the provision of a personalised asthma action plan.
The National Review of Asthma Deaths (NRAD) identified excessive reliever use and inadequate preventer use as recurring factors in asthma deaths — the basis for the safety point above.
NICE also covers environmental considerations, including the transition to lower global warming potential inhalers where clinically appropriate.
Because they do different things. The blue reliever opens the airways for a few hours and does nothing to the underlying inflammation — so it treats the symptom while the disease continues. The preventer reduces the inflammation, which is what actually prevents attacks. Relying on the reliever alone is the pattern most consistently identified in asthma deaths.
Ideally not at all, and no more than twice a week. Three or more times a week means your asthma is not controlled. Getting through more than three canisters a year is a recognised marker of risk and a reason for review.
Inhaled steroids are given at very low doses directly to the lungs and are not comparable to steroid tablets. The risks of untreated asthma — attacks, hospital admission, permanent airway remodelling, and repeated courses of oral steroids — are considerably greater. Rinse your mouth after each use to avoid thrush and hoarseness.
Not without discussing it. Feeling well on the preventer means it is working, not that it is unnecessary. Treatment can sometimes be stepped down once control has been good for several months — but that is a planned, supervised reduction, not a decision made in July.
Many children have far fewer symptoms as teenagers, though the underlying tendency usually remains and can return in adulthood. Asthma starting in adulthood is less likely to resolve. Either way, current symptoms need treating rather than waiting out.
Yes, and you should. Fitness improves asthma control, and there are Olympic champions with asthma. If exercise triggers symptoms, that means your asthma needs better control — not that you should stop. Use your reliever 15 minutes before, and warm up properly.
Possibly, and it is worth taking seriously. If symptoms improve at weekends or on holiday and return at work, occupational asthma is likely. Identifying it early matters a great deal — removal from exposure can lead to complete recovery, while continued exposure causes permanent damage.
Not safe, and not neutral. Vaping is a recognised airway irritant and triggers symptoms in many people with asthma. If you are using it to stop smoking, that is a reasonable trade in the short term — but the aim should be to stop both.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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