PCRS Position Statement - Rescue/Reliever Inhalers in Asthma

2024 marked a pivotal change in the management of asthma in the UK with the publication of a joint British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guideline. This guideline, ‘Asthma: diagnosis, monitoring and chronic asthma management’, has the potential to be the paradigm shift that is needed to improve asthma care in the UK. 

In this position statement we outline the background, key issues and PCRS position on rescue/reliever inhalers. As part of this, the Primary Care Respiratory Society (PCRS) advocates that:

• inhaled corticosteroids (ICS) be offered by clinicians to prevent and relieve symptoms in people diagnosed with asthma of all ages;
• bronchodilator therapy should not be prescribed without a concomitant prescription of ICS. 

People aged 12 and above:

• who are newly diagnosed with mild asthma with infrequent symptoms should be offered treatment with anti-inflammatory reliever therapy (AIR), a low-dose combination of ICS and formoterol to be taken as needed;
• presenting with frequent symptoms or an asthma exacerbation, should be offered low-dose maintenance and reliever therapy (MART). However, where this does not control symptoms moderate dose MART should offered.

Children aged 5-11years old:

• newly diagnosed with asthma should be offered twice-daily paediatric low-dose ICS with a reliever inhaler;
• not controlled on this regimen, paediatric low-dose MART should be considered, but only if they are assessed to have the ability to manage a MART regimen.

Children under 5 years old:

• newly diagnosed or suspected asthma should be offered paediatric low-dose ICS with a reliever inhaler as needed.