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Asthma care has improved since the implementation of a joint asthma guideline, but structural and resource issues persist, a report from Asthma and Lung UK has found.
The report, published in December 2025, based its findings on interviews with clinicians and analysed the state of asthma care one year on from the implementation of the chronic asthma guideline.
It recommended that all patients aged over 12 years who have been diagnosed with asthma for the first time should be prescribed a low-dose combination of inhaled corticosteroids (ICS) with formoterol to reduce inflammation and relieve symptoms.
The report also suggested that short-acting beta-2 agonists (SABA), or ‘reliever’, inhalers should not be prescribed without ICS to anyone diagnosed with asthma.
The chronic asthma guideline, published in November 2024, was co-produced by the British Thoracic Society, National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network.
The Asthma and Lung UK report noted: “One year on, NG245 has begun to positively reshape asthma care in the UK, with participants in this briefing’s research identifying early improvements in diagnosis, prescribing practices and patient management pathways directly linked to better outcomes.”
However, it also found that “persistent structural and resource challenges must be addressed for these benefits to be fully realised”.
For example, the report highlighted that the shift to anti-inflammatory reliever (AIR) and maintenance and reliever therapy (MART) regimes has resulted in patients reporting “improved satisfaction and adherence to treatment, less relapse to older regimens and overall better asthma control”.
“The early impact includes reduction in harmful SABA prescribing and modest improvements in exacerbation rates — reflecting improved clinical outcomes and patient safety,” the report added.
“However, many patients are not well supported when they switch inhalers, and this was thought to undermine the change and cause knock-on problems, such as poor treatment adherence.”
The report also said that while clinicians had reported “heightened confidence” in diagnosing asthma and a decrease in primary care referrals to secondary care, “widespread lack of access” to FeNO and spirometry testing often resulted in delayed diagnoses and poorer outcomes in some settings.
As a result of the report, Asthma and Lung UK has produced a series of recommendations to improve asthma care, including providing access to point-of-care FeNO testing in every primary care network and ensuring MART/AIR use post-discharge, along with inhaler technique checks and personalised asthma action plans.
Commenting on the report, Darush Attar-Zadeh, clinical fellow respiratory pharmacist at North West London Integrated Care Board, said that it “likely reflects the reality many of us are seeing in practice”.
“Across north west London, and echoed in discussions with Primary Care Respiratory Society colleagues nationally, access to objective diagnostic testing remains a significant barrier. Obtaining FeNO and quality-assured spirometry is challenging, and this is often even more problematic for children and young people, as some diagnostic hubs currently provide services for adults only. This risks delays in diagnosis and inequity of care.
“It is encouraging to see new diagnoses increasingly initiated on AIR or MART when appropriate, although switching patients established on conventional regimens can be challenging and requires shared decision-making and not dangerous ‘blanket switching’,” he added.
“For many patients with asthma, moving from two inhalers down to one, which treats the cause and the symptoms, and is better for the environment, is certainly a great upgrade. Inhaler technique coaching as always is of paramount importance.”
On 15 December 2025, the Medicines and Healthcare products Regulatory Agency approved depemokimab (Exdensur; GSK) — the first twice-yearly biological medicine for use as an add-on treatment for asthma in patients aged 12 years and over and severe chronic rhinosinusitis with nasal polyps in adults.
The drug works by blocking the protein interleukin-5 and reducing type 2 inflammation, which play a major role in both conditions. The medicine is administered via subcutaneous injection once every six months.
