Asthma Inhalers: Types, Colours and How They Work
Reliever, preventer and combination inhalers explained: what each colour usually means, how AIR and MART work, how UK treatment is stepped up and down, and which device suits you.
Part of our asthma guide: symptoms, triggers and treatment.
Asthma attack? Get help now. Call 999 if your reliever isn’t helping, you’re too breathless to speak, eat or sleep, your breathing is getting faster, or your lips or fingertips are turning blue or grey. While you wait, sit up straight and take 1 puff of your blue reliever every 30 to 60 seconds, up to 10 puffs, through a spacer if you have one. If the ambulance hasn’t arrived after 10 minutes, repeat. Don’t complete an online consultation in an emergency.
Quick answer: There are three main types of asthma inhaler. Relievers (usually blue) open your airways within minutes. Preventers (often brown) contain an inhaled steroid, taken every day to calm the inflammation behind asthma. Combination inhalers contain a steroid and a long-acting bronchodilator; some can be used as a reliever too (AIR or MART). Since 2024, UK guidance starts most adults on a combination inhaler rather than a blue reliever alone. Colours aren’t standard, so always check the name on the label.
Already prescribed an inhaler? See all our asthma inhalers online.
Order Your Usual Asthma Inhaler
Access Doctor is a GPhC-registered pharmacy (#9011198). If you’re an adult with diagnosed asthma or COPD, a pharmacist independent prescriber reviews your online consultation and supplies your usual inhaler if it’s safe, and we let your GP know. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose. Delivery is free on orders over £40.
Start Asthma Consultation →Who our online service is for. Access Doctor supplies asthma and COPD inhalers to adults aged 18 and over who already have a diagnosis, for the same inhaler, strength and dose they’re prescribed now, and we share the consultation with your GP. We can’t diagnose asthma or start or change treatment online. Children’s inhalers are managed by their GP or asthma nurse.
Types of Asthma Inhaler
Asthma treatment has two jobs: quick relief of symptoms, and long-term control of the inflammation in your airways. Inhalers are grouped by which job they do and how they work. Knowing which one you have matters, both for using it correctly and for knowing what to do in an attack.
| Type | Also known as | When it’s used | Examples |
|---|---|---|---|
| SABA | Reliever, blue inhaler | When you have symptoms | Ventolin, Salamol, Bricanyl |
| ICS | Preventer, steroid inhaler | Every day, even when well | Clenil Modulite, Qvar, Pulmicort, Flixotide |
| ICS+LABA | Combination inhaler | Every day; formoterol types can also be used as a reliever (AIR or MART) | Symbicort, Fostair, Seretide, Relvar |
| LABA | Long-acting bronchodilator | Only with an inhaled steroid, never alone in asthma | Serevent (salmeterol) |
| LAMA | Long-acting muscarinic antagonist | Add-on in severe asthma; commonly used in COPD | Spiriva Respimat |
| SAMA | Short-acting muscarinic antagonist | Mainly COPD, sometimes chronic asthma | Atrovent |
| LTRA (not an inhaler) | Leukotriene receptor antagonist | Daily tablet, add-on | Montelukast |
Asthma Inhaler Colours: Which Is Which?
People often know their inhalers by colour: “the blue one” and “the brown one”. The colours below are the ones you’re most likely to see in the UK, but there’s no official colour standard. The same medicine can come in a different colour from another maker, and the same colour can mean different medicines. Always check the name and strength on the label.
| Colour | Usually means | Examples |
|---|---|---|
| Blue | Reliever (SABA) | Ventolin Evohaler, Salamol, Bricanyl Turbohaler |
| Brown | Preventer (inhaled steroid) | Clenil Modulite, Pulmicort Turbohaler |
| Orange | Preventer (inhaled steroid) | Flixotide (fluticasone) |
| Purple | Combination (steroid and salmeterol) | Seretide Accuhaler and Evohaler |
| Red | Combination (steroid and formoterol) | Symbicort Turbohaler |
| Pink | Combination (steroid and formoterol) | Fostair |
| Green | Long-acting bronchodilator (LABA) | Serevent Evohaler |
Don’t go by colour alone. Picking up the wrong inhaler in an attack, or swapping one brown inhaler for another, can mean the wrong medicine or dose. Beclometasone inhalers are a good example: Clenil Modulite and Qvar contain the same steroid but aren’t interchangeable, because Qvar’s finer particles make it about twice as strong. They’re prescribed by brand for that reason.
Reliever Inhalers (SABA)
Reliever inhalers contain a short-acting beta-2 agonist (SABA), most commonly salbutamol, available as Ventolin or Salamol, or terbutaline (Bricanyl). They stimulate beta-2 receptors on the muscle around your airways, making it relax so the airways widen. Salbutamol starts working within 5 minutes and lasts 4 to 6 hours. Our guide to what Ventolin is used for covers doses, side effects and technique.
Relievers are for use when you have symptoms, not on a regular schedule. They don’t treat the inflammation underneath, so relying on them alone lets asthma get worse unnoticed. Since 2024, UK guidance (NICE, BTS and SIGN) says no one with asthma should be treated with a SABA reliever alone, and in April 2025 the MHRA reminded prescribers not to supply one without an inhaled steroid.
Always carry your reliever. Whether it’s a blue inhaler or a combination inhaler used as AIR or MART, keep it with you. Needing a blue reliever more than twice a week, waking at night with asthma, or using 3 or more reliever inhalers a year are signs your asthma isn’t controlled. Speak to your GP or asthma nurse.
Reliever · Rx
Ventolin Evohaler 100mcg
Salbutamol aerosol, the blue inhaler. 200 puffs. From £8.99.
View product →Reliever · Rx
Salamol 100mcg
The same medicine, salbutamol, in a different inhaler. From £13.99.
View product →Device
AeroChamber Plus adult spacer
Helps more of each puff reach your lungs. £9.99.
View product →Combination · Rx
Symbicort Turbohaler
Steroid and fast-acting reliever in one; used daily, or as AIR or MART. From £41.99.
View product →Preventer Inhalers (ICS)
Preventer inhalers contain an inhaled corticosteroid (ICS), a steroid that reduces the swelling and irritation inside your airways. They don’t work immediately: the benefit builds up over days to weeks of regular use. That’s why they must be taken every day, even when you feel well. Stopping a preventer because you feel fine is a common reason asthma flares up again. Our preventer inhaler guide explains them in more detail.
Common inhaled steroids in the UK:
- Beclometasone, standard particles (Clenil Modulite): 100 and 200 microgram strengths (the 50 and 250 microgram inhalers are being discontinued at the end of November 2026). One of the most widely used preventers; see our Clenil Modulite guide.
- Beclometasone, extra-fine particles (Qvar, and in Fostair): about twice as strong per microgram as Clenil, so not interchangeable with it.
- Budesonide (Pulmicort Turbohaler, and in Symbicort): a dry powder inhaler. Also available as a nebuliser solution.
- Fluticasone propionate (Flixotide, and in Seretide): an aerosol or Accuhaler, roughly twice as strong as standard beclometasone per microgram.
- Ciclesonide (Alvesco): activated in the lungs, which may mean fewer side effects in the mouth and throat.
Doses are described as low, moderate or high. UK guidance gives these daily ranges for people aged 12 and over; they’re a guide to similar effect, not exact equivalents:
| Inhaled steroid (micrograms a day) | Low | Moderate | High |
|---|---|---|---|
| Beclometasone, standard (Clenil) | 200 to 500 | 600 to 800 | 1,000 to 2,000 |
| Beclometasone, extra-fine (Qvar, Fostair) | 100 to 200 | 300 to 400 | 500 to 800 |
| Budesonide (Pulmicort, Symbicort) | 200 to 400 | 600 to 800 | 1,000 to 1,600 |
| Fluticasone propionate (Flixotide, Seretide) | 100 to 250 | 300 to 500 | 600 to 1,000 |
Side effects at usual doses are generally mild. The most common are oral thrush and a hoarse voice: rinsing your mouth, gargling and spitting after each dose, and using a spacer with an aerosol inhaler, all help.
Are steroid inhalers safe? At the doses used for asthma, very little steroid reaches the rest of the body, and the benefit of controlling asthma far outweighs the risk. At high doses over many years, effects on the adrenal glands and bone density are possible, which is why high doses are reviewed regularly and stepped down when asthma is controlled.
Combination Inhalers (ICS+LABA)
A combination inhaler contains an inhaled steroid and a long-acting beta-2 agonist (LABA), which keeps the airways open for about 12 hours (or 24 hours for vilanterol). Having both in one device makes it easier to take them together, and it means the LABA is never used without a steroid.
| Inhaler | Steroid | LABA | Device | Can be used as a reliever? |
|---|---|---|---|---|
| Symbicort 100/6, 200/6, 400/12 | Budesonide | Formoterol | Turbohaler (dry powder) | MART: 100/6 and 200/6. AIR: 200/6 only. 400/12: no |
| Fostair 100/6, 200/6 | Beclometasone (extra-fine) | Formoterol | Aerosol or Nexthaler (dry powder) | MART: 100/6 only |
| DuoResp Spiromax | Budesonide | Formoterol | Spiromax (dry powder) | MART: lower strength |
| Seretide | Fluticasone propionate | Salmeterol | Accuhaler (dry powder) or Evohaler (aerosol) | No: salmeterol is too slow |
| Relvar Ellipta | Fluticasone furoate | Vilanterol | Ellipta (dry powder), once a day | No |
Seretide is taken twice a day; Relvar once a day. Fostair’s extra-fine particles reach the smaller airways, so its steroid dose is lower than other beclometasone inhalers for the same effect.
A LABA must never be used on its own in asthma. Using a LABA such as Serevent without an inhaled steroid increases the risk of severe and life-threatening asthma attacks. We only supply Serevent for asthma to people who also have an inhaled steroid on record.
AIR and MART: One Inhaler as Preventer and Reliever
Formoterol, the LABA in Symbicort, Fostair and DuoResp, starts working within minutes, as quickly as salbutamol, and lasts about 12 hours. That means a steroid-and-formoterol inhaler can relieve symptoms and treat inflammation in the same puff. UK guidance (NICE NG245) now builds adult asthma treatment around this:
Anti-inflammatory reliever
Low-dose steroid and formoterol, used only when you have symptoms, instead of a blue reliever. Recommended for adults newly diagnosed with asthma.
Maintenance and reliever therapy
The same kind of inhaler, taken every day plus extra doses for symptoms. Recommended if asthma isn’t controlled on AIR, starting at a low dose.
Why it works better than a daily preventer plus a separate blue reliever:
- Every reliever dose also gives a dose of steroid, so when symptoms flare, you automatically get more anti-inflammatory treatment exactly when it’s needed
- One inhaler instead of two, which makes it easier to stick to
- Trials show fewer severe asthma attacks than with a fixed daily dose of steroid and LABA plus a separate SABA reliever
- Licensed for adults (and, for some inhalers, from age 12) when prescribed this way by a GP or specialist
Dose limits differ by inhaler. Fostair 100/6 as MART: 1 puff twice a day, plus 1 puff for symptoms (another after a few minutes if needed), no more than 8 puffs a day. Symbicort as MART or AIR: no more than 6 inhalations on one occasion; normally no more than 8 a day, up to 12 for a short time. Needing extra doses on most days means your asthma needs a review.
Only inhalers containing formoterol can be used for AIR or MART. Seretide contains salmeterol, which works too slowly to relieve symptoms, so it’s taken every day and you need a separate reliever. Use your inhaler as AIR or MART only if your GP or asthma nurse has set it up and your action plan says so.
LAMA Inhalers
Long-acting muscarinic antagonists (LAMAs) block muscarinic receptors in the airways, relaxing the muscle and reducing mucus. They last 24 hours and are taken once a day. They’re mainly used in COPD. In asthma, tiotropium (Spiriva Respimat) is licensed as an add-on for severe asthma in people aged 6 and over who have had at least one severe attack in the past year despite a steroid and another controller. NICE suggests trying a LAMA or montelukast for 8 to 12 weeks if asthma isn’t controlled on moderate-dose MART and tests don’t point to a specialist referral.
Atrovent (ipratropium) is a short-acting relative, used regularly 3 or 4 times a day, mainly in COPD.
How UK Asthma Treatment Is Stepped Up
Older guidance described asthma treatment as five numbered steps, starting with a blue reliever on its own. That changed in November 2024. The joint NICE, BTS and SIGN guideline (NG245) sets out this pathway for adults and young people aged 12 and over:
1
Newly diagnosed: AIR therapy
A low-dose steroid-and-formoterol inhaler used only when you have symptoms. If you have frequent symptoms or have had a severe attack, you start on low-dose MART instead. People who’ve been using a blue reliever alone should be offered AIR.
2
Not controlled: low-dose MART
The same kind of inhaler taken every day, plus extra doses for symptoms. People already on a daily preventer with a blue reliever who aren’t controlled may be moved to MART too.
3
Still not controlled: moderate-dose MART
A higher daily dose of the same approach.
4
Still not controlled: tests, then add-on or specialist
If you’re taking your treatment correctly, your GP checks FeNO (a breath test) and a blood eosinophil count. If either is raised, you’re referred to an asthma specialist. If neither is, montelukast or a LAMA is tried for 8 to 12 weeks; if that doesn’t control it, you’re referred.
5
Specialist care
Severe asthma clinics can offer high-dose treatment, biologic injections and other options. People on high-dose inhaled steroids who aren’t controlled should be referred.
Your asthma is treated as not controlled if you’ve needed steroid tablets for an attack, or you have frequent symptoms, such as using your reliever on 3 or more days a week or waking at night once a week or more. Many people with well-controlled asthma stay on a daily preventer and a separate reliever; you don’t need to switch if your asthma is controlled, but ask about AIR or MART at your next review.
Stepping Up and Stepping Down
Treatment moves in both directions. It should be stepped up when asthma isn’t controlled, and stepped down to the lowest dose that keeps it controlled once it has been well controlled for a while, usually at least 3 months. Stepping down reduces the long-term steroid dose; it’s done one change at a time by your GP or asthma nurse, never by stopping a preventer yourself.
Before any step up, your GP or asthma nurse should check:
- Inhaler technique: errors are very common and one of the main reasons treatment seems not to work. See our guide to how to use an asthma inhaler
- Whether you’re taking it as prescribed, especially a daily preventer
- Triggers you can change: smoking or vaping, second-hand smoke, allergens, damp and mould, or work exposures
- Whether the diagnosis is right: not all wheeze or breathlessness is asthma. See how asthma is diagnosed
Treatments Beyond Inhalers
Most people with asthma are controlled with inhalers. For those who aren’t, other treatments include:
- Montelukast: a daily tablet (a leukotriene receptor antagonist), sometimes helpful when asthma comes with hay fever or is triggered by exercise. It carries an MHRA warning about mood and sleep changes, which should be reported to your prescriber.
- Steroid tablets (prednisolone): a short course for an asthma attack. Long-term use is kept to severe asthma under specialist care because of side effects such as bone thinning and diabetes.
- Theophylline: an older tablet, now rarely used, which needs blood tests because the gap between an effective and a toxic level is small.
- Biologic injections: mepolizumab, benralizumab, dupilumab, tezepelumab and omalizumab, given by severe asthma specialists to people who meet strict criteria.
- Bronchial thermoplasty: a specialist procedure for a small number of people with severe asthma.
Our guide to advanced asthma treatments explains each one in detail.
Inhaler Devices: pMDI, DPI and SMI
The same medicine can come in several kinds of device. The right one is the one you can use well, every time:
| Device | How it works | Key points |
|---|---|---|
| pMDI (pressurised metered-dose, or aerosol, inhaler) | A canister in a plastic holder. You press and breathe in slowly at the same time. E.g. Ventolin, Clenil, Seretide Evohaler. | Needs good timing, so use it with a spacer. Works even when you’re very breathless. The propellant gas gives it the highest carbon footprint. |
| DPI (dry powder inhaler) | Your own fast, deep breath pulls the powder out. E.g. Turbohaler, Accuhaler, Ellipta, Nexthaler. | No timing needed and no propellant, so a much lower carbon footprint. Needs a strong breath in, which can be hard during an attack. Not used with a spacer. |
| Breath-actuated pMDI | An aerosol that fires automatically as you breathe in. E.g. Qvar Autohaler, Easi-Breathe inhalers. | Removes the timing problem; helpful if a standard aerosol is hard to use. |
| SMI (soft mist inhaler) | Releases a slow-moving mist. E.g. Spiriva Respimat. | Easier to coordinate than an aerosol; no propellant. |
The environment: aerosol inhalers have a much bigger carbon footprint than dry powder inhalers because of their propellant. If you’d like a lower-carbon option, ask at your next review; never switch on your own. Return used or unwanted inhalers to a pharmacy rather than putting them in household waste, and don’t puncture or burn aerosol canisters.
Spacers: Why and How to Use One
A spacer is a plastic chamber that fits onto an aerosol inhaler and holds the spray while you breathe it in. More medicine reaches your lungs and less lands in your mouth and throat. A spacer such as the AeroChamber Plus is recommended for anyone using an aerosol inhaler, and matters most:
- if you find it hard to time pressing the inhaler with breathing in
- with steroid inhalers, especially at high doses, because it cuts the steroid left in your mouth and the risk of thrush
- during an asthma attack: a reliever through a spacer works as well as a nebuliser for most attacks
- for children, who should always use one with an aerosol inhaler
To use one: shake the inhaler, fit it to the spacer, press once, then breathe in slowly and deeply through the mouthpiece and hold your breath for up to 10 seconds (or take 4 or 5 normal breaths). Press only one puff into the spacer at a time.
Looking after your spacer. Wash it about once a month in warm soapy water and let it air-dry without rubbing, which creates static that makes the medicine stick. Replace it about every 12 months, or sooner if it’s cracked or damaged, or as the maker advises.
Choosing the Right Inhaler
There isn’t one best inhaler for asthma. The right one depends on your symptoms, what UK guidance recommends for your stage of treatment, and which device you can use correctly and consistently. Your GP or asthma nurse should check your technique when you start a new inhaler and at every review. Things to think about:
- Can you time a press with your breath? If not, a dry powder or breath-actuated inhaler, or a spacer, may suit you better
- Can you breathe in hard and fast? Dry powder inhalers need a strong breath, which can be difficult if you’re very breathless
- Would one inhaler suit you? AIR or MART means one device for both prevention and relief
- Carbon footprint: dry powder and soft mist inhalers have a much lower footprint than aerosols
- Cost: all these inhalers are available on NHS prescription; ask your pharmacist about a prescription prepayment certificate if you pay for several items in England
What Well-Controlled Asthma Looks Like
The aim of treatment is that asthma barely affects your life:
- no daytime symptoms most days, and no waking at night
- no limits on work, exercise or daily activities
- a blue reliever needed no more than twice a week (or, on AIR or MART, few extra doses)
- no asthma attacks needing steroid tablets or hospital care
Everyone with asthma should have a written asthma action plan and a review with their GP or asthma nurse at least once a year. If any of the above isn’t true for you, book a review before your next one is due.
Managing Asthma Without Medicines
Medicines are the main treatment, but other steps help keep asthma controlled:
- Stop smoking and vaping: smoking makes asthma harder to control and makes inhaled steroids work less well. Your GP practice or local NHS stop smoking service can help.
- Know your triggers: such as pollen, pets, dust, mould, cold air or chest infections. Our asthma triggers guide covers how to reduce them. Single measures such as special mattress covers have limited evidence on their own.
- Vaccinations: most adults with asthma who use a steroid inhaler can have a free NHS flu vaccine every year. Ask your GP practice which other vaccines you’re eligible for.
- Breathing exercises: breathing retraining taught by a physiotherapist can improve symptoms and quality of life for some people.
- A healthy weight: being overweight is linked to harder-to-control asthma, and losing weight can help.
- A written asthma action plan: from your GP or asthma nurse, saying what to take every day, what to do when symptoms get worse, and when to get help.
Getting Your Inhaler Online
All asthma inhalers are prescription-only medicines in the UK. Access Doctor is a GPhC-registered pharmacy (registration number 9011198). If you’re an adult with diagnosed asthma or COPD, you can order the same reliever, preventer or combination inhaler you already use after an online consultation. A pharmacist independent prescriber checks it’s safe, and we share the consultation with your GP. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose. Delivery is free on orders over £40.
See our guide to ordering an asthma inhaler online for how the service works, or go straight to all our asthma inhalers online.
Safety, your GP and free NHS options
Asthma inhalers are prescription-only medicines in the UK. Before anything is supplied, a GPhC-registered pharmacist independent prescriber reviews your consultation, including the other medicines you take; some, such as beta-blockers, can make asthma worse.
- Relievers on their own: since 2024, UK guidance (NICE, BTS and SIGN) says no one with asthma should be treated with a reliever alone, and in April 2025 the MHRA told prescribers not to prescribe one without an inhaled steroid to people of any age with asthma. If you don’t use a preventer, we can supply a reliever once and will ask you to see your GP or asthma nurse.
- How many: up to 2 reliever inhalers per order. If you’ve needed 3 or more in the last 12 months, we’ll ask you to have an asthma review first; needing that many is linked to a higher risk of severe attacks.
- Read the leaflet in the pack, and ask a pharmacist or asthma nurse to check your technique.
- Report side effects to a pharmacist or doctor. You can also report them to the MHRA through the Yellow Card scheme.
We share your consultation with your GP because asthma needs ongoing care. Access Doctor is a private service, and there are free NHS options:
- Your GP practice: asthma reviews (at least once a year) and repeat prescriptions; many practices let you order repeats through the NHS App.
- Prescription charges: NHS prescriptions are free in Scotland, Wales and Northern Ireland. In England a charge applies unless you’re exempt, and a prepayment certificate can save money if you need several items.
- Urgent advice: NHS 111 (NHS 24 on 111 in Scotland), or 999 in an emergency.
Need Your Usual Inhaler?
Access Doctor is a GPhC-registered pharmacy (#9011198). If you’re an adult with diagnosed asthma or COPD, a pharmacist independent prescriber reviews your online consultation and supplies your usual inhaler if it’s safe, and we let your GP know. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose. Delivery is free on orders over £40.
Start Asthma Consultation →Frequently Asked Questions
What is the difference between a reliever and a preventer inhaler?
A reliever inhaler (usually blue) contains a fast-acting bronchodilator such as salbutamol. It opens the airways within minutes and is used when you have symptoms. A preventer inhaler contains an inhaled steroid that reduces the inflammation in your airways over time. It must be taken every day, even when you feel well, and takes days to weeks to reach full effect. A preventer on its own doesn’t relieve sudden symptoms. Some combination inhalers do both jobs (AIR and MART).
What is a combination inhaler?
A combination inhaler contains an inhaled steroid and a long-acting bronchodilator (LABA) in one device. Examples include Symbicort (budesonide and formoterol), Fostair (beclometasone and formoterol) and Seretide (fluticasone and salmeterol). Most are taken every day. Those containing formoterol can also be used as a reliever (AIR or MART) if your GP or asthma nurse has set them up that way; those containing salmeterol can’t.
Can I get an asthma inhaler online?
Yes, if you already have a diagnosis. Asthma inhalers are prescription-only. Access Doctor (GPhC reg. no. 9011198) supplies relievers, preventers and combination inhalers to adults with diagnosed asthma or COPD, for the same inhaler, strength and dose they already use, after a pharmacist independent prescriber reviews an online consultation. We share the consultation with your GP. New symptoms, a first inhaler or a change of treatment need your GP or asthma nurse. See our guide to ordering an asthma inhaler online.
What does a blue inhaler do?
A blue inhaler is usually a reliever containing salbutamol (such as Ventolin or Salamol) or terbutaline (Bricanyl). It relaxes the muscles around the airways within about 5 minutes, making breathing easier, and lasts 4 to 6 hours. It doesn’t treat the inflammation behind asthma. Needing it more than twice a week means your asthma needs a review; UK guidance says adults shouldn’t rely on a blue reliever alone.
Do I need a spacer with my inhaler?
A spacer is recommended for anyone using an aerosol (metered-dose) inhaler. It holds the spray while you breathe in slowly, so more medicine reaches your lungs and less stays in your mouth and throat. It matters most if you find it hard to time a press with your breath, use a high-dose steroid, or are having an asthma attack. Dry powder and breath-actuated inhalers aren’t used with a spacer. Spacers such as the AeroChamber Plus are available on NHS prescription or to buy.
What is the first-line treatment for asthma in the UK?
Since November 2024, UK guidance (NICE, BTS and SIGN, NG245) recommends that adults and young people aged 12 and over who are newly diagnosed start on a combination inhaler containing a low-dose steroid and formoterol, used only when they have symptoms. This is called AIR therapy. People with frequent symptoms or a severe attack start on low-dose MART instead. A blue reliever on its own is no longer recommended for anyone with asthma.
What is MART therapy?
MART (maintenance and reliever therapy) uses one combination inhaler, containing an inhaled steroid and formoterol, for both a regular daily dose and extra doses when you have symptoms. Formoterol works within minutes, so it can replace a separate blue reliever, and every extra dose also gives more steroid. UK guidance recommends MART for adults whose asthma isn’t controlled on AIR therapy. Only some inhalers and strengths are licensed for it.
Do I need to take my inhaler every day?
It depends on the inhaler and how it’s been prescribed. A preventer, a combination inhaler used for maintenance or MART, and a LAMA need to be taken every day, even when you feel well, because they work by keeping inflammation down. A blue reliever, or a combination inhaler prescribed as AIR, is only used when you have symptoms. Your asthma action plan should say which applies to you.
What if my asthma is not controlled on Step 1 or 2?
UK guidance no longer uses numbered steps for adults. If your asthma isn’t controlled, your GP or asthma nurse should first check your inhaler technique, whether you’re taking it as prescribed, and your triggers. Then treatment usually moves from AIR to low-dose MART, then moderate-dose MART. If it’s still not controlled, they’ll check FeNO and a blood eosinophil count and either refer you to a specialist or try adding montelukast or a LAMA. Our guide to advanced asthma treatments covers these.
What colour are asthma inhalers?
Relievers are usually blue. Preventers are often brown (such as Clenil Modulite), and combination inhalers come in other colours, such as purple (Seretide), red (Symbicort) and pink (Fostair). There’s no UK standard, though, and the same medicine can come in different colours from different makers. Always go by the name and strength on the label, not the colour.
What are the different types of asthma inhalers?
There are three main types: relievers (usually blue), which open the airways quickly; preventers, which contain an inhaled steroid taken every day to reduce inflammation; and combination inhalers, which contain a steroid and a long-acting bronchodilator. Some combination inhalers are used as a reliever too (AIR or MART). Less common types include LAMA inhalers such as Spiriva, used as an add-on in severe asthma. Each comes in different devices: aerosol, dry powder, breath-actuated or soft mist.
What is AIR therapy?
AIR stands for anti-inflammatory reliever. Instead of a blue reliever, you use a combination inhaler containing a low-dose steroid and formoterol, such as Symbicort 200/6, only when you have symptoms. Each dose relieves symptoms within minutes and gives steroid to treat the inflammation. UK guidance recommends AIR for adults newly diagnosed with asthma. Use your inhaler this way only if your GP or asthma nurse has set it up.
For symptoms, triggers and how asthma is diagnosed, see our asthma guide.
References
- NICE, BTS and SIGN. Asthma: diagnosis, monitoring and chronic asthma management (NG245), November 2024. nice.org.uk
- NICE, BTS and SIGN. Pharmacological management of asthma in people aged 12 and over (NG245 algorithm), November 2024. sign.ac.uk
- NICE, BTS and SIGN. Asthma: inhaled corticosteroid doses for people aged 12 and over (NG245 dose tables), November 2025. sign.ac.uk
- MHRA Drug Safety Update. Short-acting beta-2 agonists (SABA): reminder of the risks from overuse in asthma and changes in the SABA prescribing guidelines, April 2025. gov.uk
- Electronic Medicines Compendium. Fostair 100/6 micrograms pressurised inhalation solution: Summary of Product Characteristics. medicines.org.uk
- Electronic Medicines Compendium. Ventolin Evohaler 100 micrograms: Summary of Product Characteristics. medicines.org.uk
- NHS. Asthma: treatment. nhs.uk
- The Pharmaceutical Journal. Industry-wide standard on inhaler colour needed, say experts. pharmaceutical-journal.com
- Usmani OS et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respiratory Research, 2018.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.