Using the blue inhaler alone to combat asthma is no longer recommended, even in mild asthma patients above the age of 12 years old.

This is because using the blue inhaler alone without the use of preventer therapy can worsen airway inflammation.

According to a joint statement by the Singapore National Asthma Program (SNAP), Asthma & Allergy Association (AAA) and National University Health System (NUHS), asthma patients must use both preventers and blue inhalers in order to reduce the severity of asthma attacks.

Singaporeans with asthma rely too much on blue inhalers for temporary relief

Asthma is a chronic inflammatory airway disease that affects five per cent of adults, and 20 per cent of children in Singapore.

While Singapore boasts a low asthma mortality rate, due to the widespread use of preventer therapy, asthma-related emergency department visits and hospitalisations are two to three times higher than other developed countries.

According to the joint statement, this is because many asthma patients rely excessively on blue inhalers for temporary symptom relief.

Using three or more canisters a year is strongly associated with severe asthma attacks, while using one or more canister a month is linked to life-threatening attacks resulting in deaths.

A SNAP audit found that 45 per cent of patients who were treated at National University Polyclinics (NUP) for severe asthma attacks were using their blue inhaler excessively, while 40 per cent of these patients had recurrent severe attacks, defined as two within a 12-month period.

Difference between preventer and blue inhaler

According to Lim Hui Fang, who is the director of SNAP, many patients remain reliant on the blue inhaler as the rapid relief is mistaken for adequate control.

Lim said that this is "a major misconception", likening the preventer to a fire extinguisher that puts out the airway inflammation.

On the other hand, the blue inhaler is merely blowing cool air so the asthma patient would feel less heat temporarily.

"Worse, if you continue to just take the blue inhaler alone, the fire gets bigger and that is when you get a severe asthma attack," said Lim.

According to Chiang Wen Chin, President of AAA, many in people with asthma in Singapore may be surprised that the blue inhaler is not the best way to manage their asthma, as patients have been relying on their blue inhalers to treat symptoms for the last 30 years.

She said that the combined use of a preventer and a reliever has been shown to be more effective than the blue inhaler alone in reducing the severity of asthma attacks and visits to the doctors and the hospitals.

Top image from peakpx.