Healthcare professionals’ perspectives and experiences of relief treatment for mild asthma in UK primary care settings

Abstract In 2024, the UK British Thoracic Society/National Institute for Health and Care Excellence/Scottish Intercollegiate Guidelines Network (BTS/NICE/SIGN) guidelines introduced a major change in asthma management, recommending inhaled corticosteroid (ICS)/formoterol combination inhaler therapy as Anti-Inflammatory Reliever (AIR) or Maintenance and Reliever Therapy (MART) as the preferred treatment in patients with mild asthma over maintenance inhaled corticosteroids (ICS) with a short-acting beta-agonist (SABA) reliever. This qualitative study was conducted within the RELIEF pragmatic randomised controlled trial to explore healthcare professionals’ (HCPs) experiences of prescribing ICS plus ICS/formoterol reliever (intervention) compared to ICS plus a short-acting beta-agonist (SABA) reliever (control; treatment as usual) in patients with mild asthma. This study aimed to assess the acceptability and feasibility of switching patients’ current SABA reliever inhalers to ICS/formoterol reliever inhalers from a HCP perspective. Semi-Structured interviews were conducted with 30 HCPs across 28 primary care practices in the United Kingdom. Using thematic analysis, five overarching themes were constructed that provide insight into the barriers and facilitators to adopting changes in mild asthma management: mild asthma as a low-priority condition; medication beliefs and steroid-related concerns as barriers to implementation; acceptability and usability of combined inhalers in real-world practice; health literacy, education and persistent knowledge gaps; and patient-centred, flexible models of care as key implementation facilitators. Findings suggest that coordinated strategies encompassing patient and HCP education, prescribing support tools and structured review processes could mitigate behavioural, cultural and organisational barriers to new asthma guideline adherence.