Short-acting beta 2 agonists (SABA): reminder of risks from overuse in asthma and changes to prescribing guidelines

- excessive use of SABA to relieve acute asthma symptoms may mask progression of the underlying disease and contribute to an increased risk of severe and potentially life-threatening asthma exacerbations

- do not prescribe SABA to people of any age with asthma without a concomitant prescription of an inhaled corticosteroid (see Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) NICE guideline [NG245], 2024)

- ensure all patients with asthma receive optimal anti-inflammatory maintenance therapy even when their asthma is well controlled and that treatment is individualised to the patient

- review and adjust asthma treatment in patients who take more than twice weekly “as needed” SABA

- urgently review patients where there has either been an increase in the number of prescriptions requested for SABA reliever inhalers or a failure to collect prescribed anti-inflammatory maintenance treatment

- anti-inflammatory reliever (AIR) therapy and maintenance and reliever therapy (MART) are recommended alternatives for people over 12 years of age with poorly controlled asthma

- report suspected adverse drug reactions via the Yellow Card scheme

- seek urgent medical assistance if worsening asthma symptoms (for example, chest tightness, wheezing, coughing, or difficulty breathing) are not relieved by using the asthma reliever medicines prescribed by a healthcare professional to be used during an asthma attack

- if a blue inhaler is prescribed as the asthma reliever medication to be used during an asthma attack, a separate asthma preventer therapy will always be prescribed for regular daily use as well

- use the asthma anti-inflammatory maintenance medication as prescribed by a healthcare professional even when asthma is well-controlled and the blue inhaler is rarely or never needed

- if the blue inhaler does not have a dose counter, manually track the doses used and ensure you always have access to a spare inhaler before your current inhaler runs out or expires

- follow your agreed asthma plan if you have one or ask your healthcare professional for an asthma review if the prescribed asthma blue reliever inhaler is needed more than twice a week

- your healthcare professional can provide advice on recommended alternative treatments (to the blue inhaler) for people over 12 years of age with poorly controlled asthma

The asthma reliever medications salbutamol and terbutaline are prescription-only SABA medications used to treat breathing problems in people with asthma and similar conditions.

Prior to December 2024, inhaled SABA was recommended to be used as required as reliever therapy for people with symptomatic asthma. In a small minority of people with asthma with infrequent, short-lived wheeze, and normal lung function, occasional use of inhaled SABA reliever therapy was considered as potentially the only treatment needed to manage their symptoms.