NICE asthma guidelines should be updated so reliever inhalers are no longer prescribed without preventative treatment, amid overuse of the reliever inhaler, the charity Asthma + Lung UK said.

The warning against overuse of reliever inhalers comes as its survey of more than 8,000 people with asthma suggests 21% are using their reliever inhaler too often, using six or more every year - triple the amount experts recommend.

The charity said the reasons for overuse are 'complex,' but suggested one reason could be that patients have not been prescribed a preventer inhaler because 'outdated' NICE guidelines 'recommend a reliever inhaler as the first line treatment for people who don’t have regular asthma symptoms'.

Sarah Woolnough, CEO of Asthma + Lung UK, warned that 'people with asthma are being let down by dismal rates of basic care caused by pressures on the NHS and outdated treatment guidelines’, adding that ‘we don’t want to see any more lives needless cut short’.

She added: 'We are urging NICE to update its guidelines for healthcare professionals so that relievers are no longer prescribed without preventative treatment, and we need to see an urgent increase in basic care such as yearly asthma reviews and inhaler technique checks so people are better equipped to manage their symptoms and use their inhalers effectively.

'Overusing a reliever inhaler puts people more at risk of an asthma attack, hospitalisation and even death, because their asthma is less likely to be under control.'

The charity is also calling for 'a joined-up approach' to tackle the overuse.

'Healthcare professionals need to have the time and resources available to understand each asthma patient to ensure they get the basic care they need and understand what their inhalers are for and how to use them,' the charity said.

Overusers urged to speak to pharmacist

Asthma + Lung UK also urged everyone with asthma to speak to their asthma nurse, pharmacist or GP if they are using their reliever inhaler more than three times every week, as 'it is a sign their asthma is not under control and they are at a greater risk of an asthma attack’.

It said: 'These changes, along with an increased awareness of the seriousness of lung conditions, would be a vital stepping stone in tackling the dismal state of asthma care in the UK.

'We have one of the worst asthma death rates in Europe, and Asthma + Lung UK - which funds research into lung conditions, campaigns for better diagnosis and access to treatment and campaigns for clean air - is urging government, the NHS and research funders to help cut deaths from lung conditions by 20% by 2027.'

Currently, 75,000 people are hospitalised for asthma every year and four people die every day from an asthma attack, the charity said.

But it warned that there’s a 'lack of education and understanding about how serious asthma can be, what the signs and symptoms are and how to manage them.'

According to Asthma + Lung UK's survey, last year in the UK 70% of people with asthma missed out on getting the three elements of basic asthma care from their asthma nurse or GP - an inhaler technique check, a written asthma plan and an annual review.

'This equates to around 3.8 million people with asthma not getting even the most basic elements of care,' the charity said.

NICE updating guidelines

NICE told The Pharmacist that it is in the process of updating the self-management of its asthma: diagnosis, monitoring and chronic asthma management guidelines in partnership with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network.

The spokesperson added: ‘In line with standard procedure, we will review the impact of new evidence and will make updates to our recommendations as necessary.

Digital interventions such as ‘smart’ inhalers and text message prompts can improve asthma medication adherence by 15% and may cut the risk of asthma attacks by half, research has suggested.

Analysis has found women in the UK with asthma are almost twice as likely to die from an asthma attack as men.

There was a substantial and persistent reduction in asthma exacerbations across England in the 18 months after the first lockdown, a large study found, likely due to a reduction in exposure to common respiratory viruses.