Many patients remain strongly attached to short-acting beta agonist (SABA) inhalers, are sceptical of efforts to reduce their use and have concerns about inhaled corticosteroid (ICS)-containing treatments, potentially hindering uptake of newer guideline-recommended approaches, according to a UK online asthma forum.

Recent asthma guidelines recommend replacing SABA inhalers with ICS–formoterol-based treatments, based on evidence linking excessive SABA use to poorer asthma control, increased exacerbations and higher mortality risk. However, little is known about how patients perceive these changes outside clinical trial settings.

To explore this issue, researchers analysed discussions posted on a large UK online asthma forum and published their findings in the journal npj Primary Care Respiratory Medicine.

The qualitative study examined 323 forum posts from 206 adult users of the HealthUnlocked Asthma Community Forum between 2021 and 2025.

Using thematic analysis informed by the Necessity Concerns Framework, the investigators explored perceptions of SABA inhalers, ICS therapies, ICS–formoterol treatments and asthma care more broadly.

Strong attachment to SABA inhalers

A prominent finding was the strong emotional attachment many asthma patients had to their SABA inhalers. Users frequently described carrying them everywhere, maintaining spare supplies and viewing them as essential for managing symptoms.

Even among those prescribed ICS–formoterol regimens, some continued to regard SABA as their most effective treatment or a necessary ‘safety blanket’.

Although some participants recognised the risks associated with SABA overuse, many remained unconvinced by warnings and interpreted efforts to reduce prescribing as target-driven rather than patient-centred.

Several asthma patients felt clinicians focused too heavily on reducing SABA use without adequately investigating the reasons behind persistent symptoms. Some users also appeared unclear that reducing SABA use should be accompanied by the adoption of an anti-inflammatory reliever strategy.

ICS and ICS–formoterol therapy worries

Concerns regarding steroid-containing treatments were common. Participants frequently attributed side effects to ICS inhalers and, in some cases, reported reducing or discontinuing treatment because of these concerns.

Several contrasted the perceived harms of ICS with what they believed to be the relative safety of SABA inhalers.

Experiences with ICS–formoterol were mixed. Some users reported improved asthma control and reduced reliance on SABA, while others felt the newer treatment did not provide the same immediate symptom relief.

Difficulties using dry-powder inhaler devices, particularly during exacerbations, were also highlighted as a barrier to adherence.

Many participants reported concerns about side effects attributed to either the corticosteroid or formoterol component of combination inhalers. Others questioned why a reliever-containing inhaler should be taken regularly even when symptoms appeared controlled.

Communication and patient-centred asthma care

Across all themes, forum users expressed a desire for more, and better, communication and greater involvement in treatment decisions. Many felt that their concerns were not adequately acknowledged, that treatment changes were insufficiently explained and that recommendations did not always reflect their individual circumstances.

Some also reported medication reviews or treatment switches being implemented without meaningful discussion.

Several study limitations were noted, including the inability to verify diagnoses or prescribed treatments, limited demographic information and the possibility that forum users may not be representative of the wider asthma population. The qualitative design also meant that the prevalence of these beliefs could not be determined, the authors said.

Nevertheless, the findings highlighted important behavioural barriers to implementing contemporary asthma guidelines.

Successful adoption of ICS–formoterol-based treatment strategies will require better patient education, improved communication about the rationale for treatment changes and greater attention to individual concerns and beliefs, the authors concluded.

They also called for further research to identify effective ways of discussing guideline recommendations while supporting personalised asthma care.

Reference
Moon Z et al. Patient perspectives of asthma treatment and belief barriers to implementing new guidelines: a qualitative analysis of an online forum. npj Prim Care Respir Med 2026; May 15: doi: 10.1038/s41533-026-00483-9.