If you’ve ever found yourself wheezing when stressed or needing your trusty Ventolin just a couple of times a week but suddenly being told you need to use daily inhalers instead you are not alone.
The latest asthma guidelines from NICE recommend something called Maintenance and Reliever Therapy (MART) which means using a combined inhaler containing steroids and a fast-acting bronchodilator every day even if your symptoms are mild or infrequent. This is meant to reduce flare-ups and improve long-term control. When I asked what are the long terms effects of this, I didn’t get a reply…
For many people, especially those who experience wheezing triggered mainly by stress or anxiety rather than classic asthma inflammation, this shift feels like an overreach. You might be managing well with occasional Ventolin use just as you always have, but the new guidelines can make you feel pressured to use daily steroids when you don’t feel you need them. As I say “if it isn’t broken, why try and fix it”?
Some asthma nurses and clinics are strict about this new approach. When you raise concerns or explain your experience you may feel unheard as if the guideline alone is the only truth. They have their speech and it will continue…
Worse still I wa advised that Ventolin prescriptions are going to be limited to just two inhalers a year because “it’s not longer best practice”. That can be frustrating and stressful especially if your wheezing only flares with stress and you don’t want to commit to a daily inhaler routine.
“I don’t get wheezy when I’m on holiday” I said
“That’s because you’re in the warm” she replied
“January in Toulouse? It was sunny but still only 5C..”
Her: “Oh”
This isn’t just about medication it’s about being listened to and having your treatment tailored to you. Guidelines are important but they can’t capture every individual’s reality especially when conditions overlap with mental health or stress-related triggers. This point too was ignored.
If you feel like your care is being driven by a one-size-fits-all policy, remember you have the right to ask questions about your treatment. You deserve a healthcare team who listens to your experience. Managing asthma or asthma-like symptoms is as much about you as it is about the guidelines. We are all different…
Inhaled steroids used in asthma treatment are designed to act mainly in the lungs, reducing inflammation locally with far less impact on the rest of the body compared to oral steroids. This is why healthcare professionals often say they are “not systemic.” However, even though the risk of widespread side effects is lower, inhaled steroids can still cause issues such as throat irritation, hoarseness, oral thrush, and in some cases, effects on bone density or adrenal function if used long term or at high doses.
Using steroids daily, especially when symptoms are mild or infrequent, can sometimes lead to the need for gradually higher doses over time to maintain the same effect (as if our NHS needs another cost in the future). This can increase the risk of side effects and may feel unnecessary or overwhelming for people whose asthma is triggered mainly by stress or occasional wheezing.
There’s also now a growing push to replace the familiar blue inhalers with dry powder versions, all in the name of reducing the NHS’s carbon footprint. While helping the planet is clearly important, it’s frustrating to see yet another decision being driven from the top down. These dry powder inhalers don’t suit everyone because they require a strong, fast breath in, which can be difficult during a flare-up, or for people with stress-triggered wheezing or underlying fatigue.
Some users report throat irritation, coughing, or even a strange aftertaste with certain powders.
There are also practical concerns. Dry powder devices are more sensitive to moisture, and some can clog up or fail if not stored correctly. Unlike the old-style puffer, where you can hear or feel the dose being delivered, powders can be harder to trust, if the device jams or malfunctions, it’s not always obvious until it’s too late.
In terms of effectiveness, studies show that dry powder inhalers can deliver medication as well as or better than metered dose inhalers when used correctly, but that “correct use” can be challenging for some patients, especially during acute symptoms. It’s not fair to be made to feel guilty or unsustainable just because we prefer what works, especially when the switch seems more about environmental policy than personal care.
If this resonates with you, don’t suffer in silence. Speak up share your story and connect with others who feel the same.
If you find yourself stuck with limited Ventolin prescriptions or pressured to use daily inhalers you’re not comfortable with, ask about alternative management plans tailored to your symptoms, referral to respiratory specialists or breathing therapists and support for stress and anxiety as part of your treatment. I’m told the “prescription department of my local PCT will decide if i can be prescibed meds and only a GP can over ride this.
Moral of the story: from now on, take up valuable GP appointments to write me prescriptions I know my body needs and have kept me healthy for quite some years now … what a fabulous use of their time!
