Blue inhaler alert for asthma sufferers as Dr Ranj explains guidelines

NHS health expert Dr Ranj Singh has issued vital guidance to asthma sufferers who rely on a blue inhaler. The doctor appeared on today’s (May 18) edition of BBC’s Morning Live to urge those who depend on a blue inhaler for asthma relief to reassess their treatment.

Dr Ranj Singh is a qualified NHS consultant paediatrician specialising in emergency medicine. He completed his training in London and became a member of the Royal College of Paediatrics and Child Health in 2007. He is widely recognised for his appearances on programmes such as CBeebies’ Get Well Soon, ITV’s This Morning and BBC‘s Morning Live, reports the Mirror.

During the programme, hosts Helen Skelton and Gethin Jones informed viewers of an update set to affect millions of people living with asthma. Dr Ranj went on to stress the importance of checking the colour of your inhaler, particularly if it is a blue reliever inhaler, which he describes as “great for calming symptoms”, but warns that “overuse could mask deeper issues”.

He also explained why three is the “magic number” for determining whether you are using it too frequently and may need to consider switching. His urgent health warning comes as asthma sufferers across the UK are being encouraged to transition away from the traditional blue “reliever” inhalers (salbutamol) in favour of newer combination inhalers.

Health bodies including the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare products Regulatory Agency (MHRA) warn that depending exclusively on a blue inhaler can conceal dangerous airway inflammation. Specialists also state they can increase the likelihood of experiencing severe asthma attacks.

Why should people with blue inhalers switch?

“Over a million people have been switched from using the standard blue inhaler to one of these newer combination ones,” Dr Ranj said. “It’s all based on some guidelines that actually came out in 2024 as an update to the asthma guidelines we use in the UK.

“Essentially, one of the key recommendations is moving from a blue reliever inhaler – it’s a salbutamol, which is the key ingredient inside that that’s a short-acting agent – and switching people over to a combination inhaler, which is a longer-acting one and actually has extra medicine in there to help as well.”

When Helen enquired about the distinction between the blue inhaler and the more recent combination inhaler, the health specialist explained: “For anyone with wheeze or asthma, the standard sort of starting treatment is a blue salbutamol inhaler. That’s a reliever. And what that does is it acts quickly to release the airways, relax them, so your breathing gets better.

“If you’ve got more severe asthma than that, then we would normally add in other medicines. Classic example being steroids. And they’re designed to actually work in the background to reduce inflammation to make it less likely for you to have an asthma attack.”

He went on to say: “Now, the blue inhaler just deals with the tightness. It doesn’t deal with any of the inflammation in the background, really. So, what we want to now do is sort of use newer combination inhalers that can relieve that tightness straight away and they act a bit longer.

“They’ve got a newer agent called formoterol in them, not salbutamol that acts quickly, and it acts for a longer period of time and also has got a bit of steroid in there as well to work on the background inflammation, which hopefully makes it less likely overall for you to have asthma.”

Nevertheless, Dr Ranj was keen to reassure those who rely on a blue reliever inhaler that there is no immediate cause for alarm. He explained that the primary concern surrounding blue inhalers is excessive use. “We now know that actually in the long term if you’re using your blue inhaler excessively it could increase your chances of having more attack, maybe even ended up in hospital or even worse,” he warned viewers.

“The worry is that it could potentially be masking severe asthma and you’re just kind of keeping it at bay by using your blue inhaler too much. If you’ve got mild or occasional symptoms, don’t panic. You’re either going to be contacted if you need a switch, or if you’ve just been diagnosed with asthma, you might go straight onto the new inhalers. Or if you’re having a review or coming up for a review, that would be the time to discuss it.”

What is Dr Ranj’s urgent advice for anyone with asthma?

Dr Ranj outlined why three is the “magic number” when it comes to inhaler use. He said: “If you are using a blue inhaler and you’re using it more than four times in a 24-hour period or you’re using it and it’s not lasting for longer than four hours at a time, you’re probably going to need immediate help.

“You’re having an asthma attack, and therefore you’re probably going to need a bit more treatment than you’re actually doing. That’s what we would call sort of urgent sort of advice for anyone with asthma.”

Dr Ranj states the guidance applies to those newly diagnosed, aged over 12, or requiring escalated treatment. He notes there is also a switching option available for six to 12 year olds. “Essentially, there’s lots in this guidance, but in really simplistic terms, there are two broad arms of treatment to start,” he said.

How often should you be using a blue inhaler?

Dr Ranj advises that if you are currently using a blue inhaler, you should only use it as and when required. However, if you find yourself relying on it frequently, particularly if you are experiencing symptoms several times a week or more, it is important to consult your doctor.

“The other thing I would say is that anybody who is concerned about the overuse of their blue inhaler, if you’re having repeated prescriptions of it quite frequently, maybe two or three times a year, you definitely should be talking to a healthcare professional about it,” he said.

What should you do if you have mild or severe symptoms?

For those who experience only occasional symptoms, or symptoms triggered by specific conditions such as pollen or cold air, Dr Ranj explains that you will likely be prescribed what is known as ‘air treatment’. He describes this as an anti-inflammatory reliever, which is “basically this long-acting airway relaxer and a little bit of steroid in there. You use that as and when you need it,” he said.

For those with more pronounced symptoms — such as frequent flare-ups or night-time disruptions — Dr Ranj says you will likely be moved onto a treatment known as MART, or maintenance and reliever therapy. He explains this is “essentially the same thing, but you’re using it a lot more regularly. You’re probably going to use it daily”.

He emphasised: “If you’re concerned about any of this, do speak to your GP or your asthma nurse. You don’t necessarily need to panic or anything like that. Make sure also everyone with asthma should be getting a review every single year anyway.”