All Wales adult asthma management and prescribing guideline

Originally published in August 2020, this guideline aims to reduce variation in inhaler prescribing in the management of adult asthma. Since it’s original publication the guideline has received multiple updates: to encourage consideration of the decarbonisation agenda of NHS Wales; to present a new preferred regiment for mild asthma; and, in 2025 updated the guideline to reflect published NICE asthma guideline (NG254) (November 2024).

Patients with asthma need to be managed according to their disease severity. All patients with asthma should be treated with an inhaled corticosteroid and the practice of using short acting bronchodilator monotherapy is now outdated.

The current guidelines promote the use of anti-inflammatory reliever therapy or maintenance and reliever therapy regimes for all patients with asthma. This approach has been shown to reduce the risk of asthma exacerbations and unscheduled healthcare attendances.

 In those with well controlled symptoms appropriate management includes having their therapy stepped down. Given the evidence linking high inhaled steroid use to potentially severe adverse effects, in recent years there has been a concerted effort to increase patient safety and reduce the dose of inhaled corticosteroids used by patients on a daily basis in controlling their asthma.

(February 2024, updated August 2025)

Equality and Health Impact Assessment form

• All Wales Adult Asthma Management and Prescribing Guideline Equality and Health Impact Assessment form