For the first time, more than 1.09 million people in England are using AIR or MART combination inhalers without a SABA blue reliever, marking a major shift driven by 2024 NICE guidelines.
A fundamental change in asthma treatment has reached a tipping point across England, with combination inhalers now surpassing traditional blue reliever inhalers in patient numbers for the first time.
Between October and December 2025, 1.09 million people in England used combination AIR or MART inhalers without a SABA inhaler – a striking 63% increase year-on-year, according to NHS England data released by the National Institute for Health and Care Excellence. During the same period, about 800,000 people used a SABA blue inhaler alone, representing a 16% decrease from the previous year.
The Guidelines Behind the Shift
The transformation follows new NICE, British Thoracic Society and Scottish Intercollegiate Guidelines Network recommendations from 2024. These guidelines now recommend combination inhalers containing an inhaled steroid and formoterol LABA for those aged 12 and over who are newly diagnosed or need step-up treatment.
Traditional blue SABA inhalers provide short-acting symptom relief but don’t address underlying airway inflammation. Overuse can potentially worsen asthma symptoms over time. The newer approach uses AIR therapy – where the combination inhaler is used as needed – or MART therapy, which involves daily use plus additional doses when required for more frequent symptoms.
Warning Signs in the Data
The urgency for change becomes clear when examining prescribing patterns. Nearly half – 48% – of SABA inhaler users in England were prescribed more than two inhalers in 2024-25, according to NHS England prescribing data. This level of usage is considered a clinical warning sign by respiratory specialists.
Yet the shift represents more than just changing medication. Clinicians and NICE describe it as a life-saving cultural transformation that improves asthma control while reducing deaths and health inequalities.
Patient Experience and NHS Economics
Patient testimonials collected by NICE reveal the real-world impact of the change. Some report feeling “no longer asthmatic” with better daily life and fewer attacks after switching to combination therapy.
The economics present a complex picture. Combination inhalers cost more upfront than traditional blue relievers, creating short-term prescribing budget pressures noted by healthcare analysts. But the long-term savings to NHS resources come through fewer emergency admissions, GP visits, and reduced sick days.
The shift aims to prevent flare-ups and hospital admissions before they occur, rather than simply treating symptoms after they develop.
Source: @bmj_latest
Key Takeaways
- Over 1.09 million people in England now use combination AIR or MART inhalers without blue relievers, a 63% year-on-year increase
- Traditional blue inhaler-only users dropped to 800,000, down 16% from the previous year
- New 2024 NICE guidelines recommend combination inhalers for people aged 12+ with asthma diagnosis or treatment escalation
What This Means for Kent Residents
Kent residents with asthma aged 12 and over should consult their GPs about transitioning to AIR or MART inhalers in line with the national guidelines, with services available through NHS Kent and Medway ICB. Local GP practices and pharmacies across the Kent and Medway Integrated Care System are implementing this shift, which could reduce pressure on Kent’s A&E departments by preventing asthma emergencies. Patients can access the new treatment approach through routine appointments, and while no specific Kent-wide shortages have been reported, residents should check with their local NHS services for availability and discuss the best treatment option for their individual circumstances.