How nurses can support patients through inhaler changes

Switching inhalers for asthma patients requires the right level of support to ensure better condition control. Three nurses outline the essential factors in making inhaler changes work, from addressing ingrained habits to arranging proactive follow-up.

Increasing numbers of patients will need to switch inhalers given that national guidance now shifts away from short-acting beta agonist (SABA)-only treatment, and pushes towards combination inhalers and anti-inflammatory reliever (AIR) and maintenance and reliever therapy (MART) for better, more sustainable asthma control.

However, effective inhaler changes depend on more than just a new prescription. Patient education, shared decision-making, hands-on technique demonstration and structured follow-up all play a part in ensuring a smooth transition.

Despite this, a recent Asthma + Lung UK report shows these fundamentals are often missing. More than a third of patients report worse condition control after switching inhalers, while many receive no appointment, no technique guidance, or no follow-up.

So what’s going wrong, and how could it be fixed?

For Aleksandra Gawlik-Lipinski, independent respiratory nurse consultant and honorary advanced nurse practitioner at University Hospitals of Leicester NHS Trust, the challenges identified in the report point to how inhaler use can become embedded over time.

She explains: ‘Inhaler switching can be challenging, particularly when patients have become accustomed to a specific device and have developed strong health beliefs around it.

‘Often, this relates to reliance on a salbutamol inhaler, which provides immediate symptom relief but does not address the underlying airway inflammation that characterises asthma.’

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Ms Gawlik-Lipinski says that without addressing this gap in understanding, switching can feel unsettling rather than supportive.

‘Patients need to understand asthma as an inflammatory condition, the role of inhaled corticosteroids, and why preventer treatment is essential for long-term control.’

She adds that the difficulty is not simply technical. ‘Switching inhalers frequently means changing a long-established, sometimes lifelong, behaviour, and this can understandably be difficult.’

When discussing MART with patients, Ms Gawlik-Lipinski frames it as ‘an upgrade in quality of care’. She highlights the ‘strong evidence’ that it reduces exacerbations and hospital admissions compared with conventional treatment.

‘I also emphasise the practical benefit of using a single inhaler,’ she adds.

Maria Eurton, respiratory nurse specialist and non-medical prescriber at Living Well Partnership PCN in Southampton, also stresses the importance of thorough assessment.

‘Inhaler switching is more than a change of device – it is a clinical decision that requires careful judgement,’ she says.

In her experience, switches that work well are usually grounded in a review of what is driving symptoms.

‘Nurses often lead this work, exploring whether the patient is open to switching to a device that delivers the same drugs, and whether issues such as poor adherence or poor inhaler technique are driving symptoms rather than the inhaler itself,’ she explains.

Ms Eurton highlights that timing and context matter. ‘Equally important is recognising when not to switch – particularly during an acute asthma exacerbation, or when symptoms suggest an alternative cause.’

The report found that some patients were unclear about the reason for their inhaler being changed, while others believed the decision was driven in part by cost or environmental considerations.

Ms Eurton believes that communication plays a decisive role here, observing: ‘When patients are unclear about dosing, device use, or the reason for the change, they can lose confidence very quickly.’

Without planned follow-up, she adds, ‘these issues can escalate, leaving patients to deal with side effects or worsening symptoms alone’.

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For Marieke Strange, lead nurse at Whiteladies Medical Group in Bristol, patient feedback following a switch often centres on familiarity and sensation.

‘The biggest issue or complaint I hear is that patients feel it doesn’t work as well because they cannot feel the “hit” that they feel taking their pressurised metered-dose inhaler (pMDI) incorrectly.’ According to Ms Strange, this reaction is common when patients move to a dry powder inhaler (DPI), and requires full explanation.

Setting expectations early can help patients persevere, she adds. ‘I do always tell patients that if they would respond to one DPI, they don’t necessarily respond to a different one as well.’

Ms Strange also reassures patients about adjustment. ‘Sometimes the body just has to get used to the new type of inhaler and side effects settle after a couple of weeks.’

The importance of follow-up is a recurring theme. Ms Eurton describes it as an opportunity to reinforce understanding as well as review technique and control. ‘The most effective follow-up is timely, responsive, and holistic,’ she stresses, but adds that support should not stop there. ‘Most importantly, good follow-up is not a single event.’

Ms Gawlik-Lipinski emphasises that time and reassurance are part of effective switching, requiring proactive follow-up systems. In her previous practice, she set up automated messages to prompt patients to book a review, alongside electronic alerts to flag follow-up when patient records were opened.

‘Patients should feel confident about reaching out if they experience difficulties and be signposted to appropriate resources,’ she adds.

For Ms Strange, follow-up also strengthens the relationship between clinician and patient. ‘They always appreciate the follow-up call. They want to tell you how they are doing with your change.’

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She also notes that flexibility can be necessary. What matters most, she says, is whether the inhaler is actually used. ‘In all honesty, the worst inhaler for the environment and asthma care is the one that they don’t take and ends up in a drawer.’

Ms Gawlik-Lipinski is emphatic about what represents bad practice. ‘Blanket inhaler switching is a poor practice and should be avoided,’ she says. ‘It risks patient disengagement and worsening asthma control.’

Taken together, the nurses’ experiences and advice confirm what the report concludes: that inhaler switching requires education, shared decision-making, demonstration and follow-up.

What remains clear is that nurses are central to supporting patients before and after prescription changes, helping to translate guidance into care that patients can understand, trust and use.