NHS health expert Dr Ranj Singh has issued important advice to asthma sufferers who use a blue inhaler. The doctor appeared on today's (May 18) episode of BBC's Morning Live to urge people who rely on a blue inhaler for asthma relief to review their treatment.
Who is Dr Ranj Singh?
Dr Ranj Singh is a certified NHS consultant paediatrician and specialises 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 well known for his appearances on TV shows such as CBeebies' Get Well Soon, ITV's This Morning and BBC's Morning Live.
Why the Warning?
During the episode, hosts Helen Skelton and Gethin Jones told viewers about an update that will affect millions of people living with asthma. Dr Ranj went on to say that it is important to check what the colour of your inhaler is, specifically if it is a blue reliever inhaler, which he says is "great for calming symptoms", but "overuse could mask deeper issues".
He also discussed why three is the "magic number" to tell if you are using it too much and might need to switch. His urgent health warning and advice come as people with asthma in the UK are being encouraged to move from the usual blue "reliever" inhalers (salbutamol) to newer combination inhalers.
Health organisations such as the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare products Regulatory Agency (MHRA) caution that relying solely on a blue inhaler can mask serious airway inflammation. Experts also say they can raise the chances of having 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 asked by Helen what the difference is between the blue inhaler and the newer combination inhaler, the health expert said: "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 added: "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."
Don't Panic, But Do Review
However, Dr Ranj stressed that people with a blue reliever inhaler do not need to worry. He said the concern about blue inhalers is overuse. "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 told 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?
Dr Ranj explained why three is the "magic number" when using your inhaler. He explained: "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 says the guidance is for people who've just been diagnosed, are over 12, or need a step up in their treatment. He says there is an option to switch for six to 12-year-olds as well. "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 Use a Blue Inhaler?
Dr Ranj says that if you're currently on a blue inhaler, you should use it as and when you need it. But if you are using it a lot, especially if you are having symptoms more than several times a week, you should be talking to a doctor about it.
"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 to Do for Mild or Severe Symptoms?
Dr Ranj says that if you have occasional symptoms or you only get symptoms at certain types of times of the year, or in certain sorts of trigger situations - for instance, pollen or cold air - then you're going to be put onto what is called 'air treatment'. He says this is 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.
However, if your symptoms are more significant, for instance, if you're getting them quite a lot, or you may be waking up at night with them, then he says you're going to be switched to something called MART, which is maintenance and reliever therapy. He says this is "essentially the same thing, but you're using it a lot more regularly. You're probably going to use it daily".
He stressed: "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."
