Balancing patient needs with updated asthma guidelines: personalised approaches in practice

Overuse of short-acting β₂-agonists (SABAs) remains a significant indicator of poor asthma control in the UK.^1, Despite increased awareness, many patients remain psychologically attached to their “blue” reliever inhaler, relying on its fast-acting relief.^2, As a result, SABA overuse continues to be prevalent, with 58% of people with moderate to severe asthma exceeding recommended use (≥3 SABA/year).^3,

In response, the 2024 BTS/NICE/SIGN guidelines (NG245) introduced a pivotal shift toward SABA-free treatment pathways.^4, While national guidance plays a vital role in setting standards of care, its implementation must be adapted at the local level to account for individual patient needs.^1, In this article, I will explore the importance of looking at each patient as an individual and considering tailored approaches when applying guidelines at a local level.

Avoiding blanket switches

Patients who are already well controlled on their current treatment should remain on it.^4, Unnecessary switching, particularly to a new treatment strategy, can destabilise disease control and may lead to adverse outcomes.^5,6, This principle is clearly reinforced in the guidelines, which advise against changing therapy in stable patients without a specific clinical rationale.^1,

Transitioning all patients to an entirely maintenance and reliever therapy (MART)-focused, SABA-free pathway without individualised assessment can lead to confusion, reduced adherence or loss of asthma control.^6,

This highlights the importance of patient education and support – both to promote optimal asthma control and to ensure proper inhaler use.^7, When selecting treatment, as part of a collaborative decision making, it is critical to consider whether the dosing regimen fits the patient’s lifestyle and preferences.^5,8, A personalised approach that reflects these considerations should be incorporated into local asthma pathways.

Therefore, while the benefits of a SABA-free treatment pathway are recognised, there still remains room for regular maintenance therapy (RMT) in order to support a patient-centred, flexible approach – it is consistent with the guidelines’ emphasis on tailoring treatment to individual patient criteria and shared decision making.^1,

Right device, right patient

In addition to selecting appropriate treatment regimens, inhaler device choice is a key consideration in ensuring asthma control. Tailoring treatment extends beyond drug choice and should also consider device selection. There are many challenges with the use of inhalers, and no one device suits all patients, therefore, appropriate selection and correct inhaler technique is an integral component in asthma management.^7,

BTS/NICE/SIGN guidelines also recommend using the same type of inhaler for both preventer and reliever treatments.^1, This approach is possible for many dual therapies, used as MART or RMT, however for patients who need stepping up to triple therapy, BTS/NICE/SIGN guidelines currently recommend adding a long-acting muscarinic antagonist (LAMA) separately in order to continue MART.^1, While this approach reflects national guidance, adding a LAMA as a separate inhaler may require teaching patients a new inhaler technique, increasing treatment complexity and the risk of errors^9, – a possible cause of uncontrolled asthma as well as increased healthcare resource utilisation.^1,10,

These practical considerations highlight the need for flexibility when translating national guidance into local practice. A broader range of options, including single inhaler triple therapy (SITT), may improve adherence and reduce healthcare burden compared with multiple inhaler regimens.^9,11, A UK Consensus has also recommended that primary care services should consider how appropriate use of SITT can support adult patients with asthma who are uncontrolled on MART.^12,

Using a personalised approach when selecting the most appropriate device for patients is highly recommended to achieve improved disease outcomes and adherence.^7,

Shared decision-making is essential when identifying the most appropriate asthma treatment for patients.^1,13, Embedding this principle into local asthma pathways may support long-term disease control. 

Choosing the right treatment

It is crucial to treat each patient individually and address their specific needs, capabilities and preferences.^1,4, The most effective regimen requires thoughtful selection of both the medication and the delivery device.^5,

A range of treatment options are available to support patient-centric approaches for your local practices and help healthcare professionals deliver the right treatment for the right patient.^5,7,

When choosing a treatment for patients, consider:

• the fit of the dosing regimen according to the patient’s lifestyle and preferences^5,8,
• device suitability, including considerations of age, dexterity, inhaler technique and familiarity^5,7,
• the potential for patient confusion and non-adherence, especially when using multiple or unfamiliar inhalers.^6,9,

Offering a range of evidence-based options empowers both patients and clinicians to make informed choices that, in turn, result in greater potential of achieving asthma control.

Key takeaway

As local guidelines evolve to reflect the updated 2024 BTS/NICE/SIGN recommendations, maintaining a focus on individualised care remains essential.^1, Avoiding blanket treatment switches, selecting appropriate devices and regimens, and supporting adherence through shared decision-making will help deliver better patient outcomes and align practice with evidence-based standards.^1,6,7,13,