Online Asthma Slide Rule

The asthma slide rule helps to start a conversation with your patients and colleagues around how much short-acting beta2 agonist is acceptable before a review is necessary.

Asthma Right Care (ARC) is a global initiative led by the International Primary Care Respiratory Group (IPCRG) to explore how to use social movement approaches to create a sense of discomfort and dissatisfaction with the status quo in the management of asthma. 

The asthma slide rule supports implementation of the 2024 BTS/NICE/SIGN asthma guideline, greener respiratory healthcare and is a gateway to establishing short-acting beta2-agonist (SABA) free treatment pathways. It should be used:

  • to identify patients on SABA (alone) treatment pathways,
  • for SABA over-reliance discussions and what good control looks like, and
  • to identify those exact patients you want to switch onto SABA free treatment pathways*. 

See PCRS's First Steps to Implement the new BTS/NICE/SIGN Asthma Guideline resource for further support in this area. 

* Licensed inhaled corticosteroid (ICS)/Formoterol reliever therapy is safer as it contains anti-inflammatory treatment (which helps treat the symptoms and the cause). 

Disclaimer - No newly diagnosed patients should be initiated on a SABA alone treatment pathway. Offer either anti-inflammatory reliever (AIR) or maintenance and reliever therapy (MART) for newly diagnosed patients. For more information about appropriate use of SABA and/or SABA free pathways please see the 2024 BTS/NICE/SIGN asthma guideline and PCRS implementing the new asthma guideline resource linked to above. 

Please see the MRHA drug safety update on SABA use and indications of poor asthma control and the need for asthma reviews. Studies show a link between 3 or more SABA prescriptions over the 1-year study period and experiencing severe asthma exacerbations. 

A set of guidance notes have been produced to support use of the 2025 Asthma Slide Rule. Please access these below:

Asthma Slide Rule

1. Questions for prescriber to ask themselves and a person with asthma

Using this slide rule, how much short-acting beta2 agonist (SABA) also known as reliever/rescue/'blue' inhaler would they think was acceptable for a person with asthma to take in a year, week or day before they thought a review was necessary? What made them choose that?

Suggestion

Try asking a person with asthma the following question before asking question 1:
'In the past 4 weeks, how often have you used your reliever/blue inhaler each day?'

Number of SABA inhalers Rx per year
1
Puffs of SABA used per year*
200
Puffs of SABA used per week
4
Puffs of SABA used per day
-1
Increasing SABA use
Symptoms
*Some devices do not contain 200 puffs. Check the number in the devices you prescribe/dispense or use, and modify these messages accordingly

2. Questions for prescriber to ask themselves and a person with asthma

Reflecting on their answer to question 1, and using the number scale 0-10 below, slide to the number that reflects:

For your patient

  • How confident they feel moving to A)SABA free treatment option* or B) reducing SABA use if conventional method is preferred*. What made them select [number]? What would have made it a higher number (e.g. 8) and help them feel more confident about this?

*Any changes should be part of a shared decision.

For your colleague

  • How important is it that they organise a review? What made them select [number]? What would have made it a higher number (e.g. 8)?
  • How confident do they feel to have a conversation about poor asthma control and suggesting SABA free treatment pathways as an alternative? Or, if their patient wishes to stick to a SABA treatment pathway, discussing keeping SABA puffs to less than 3 times a week (note that 1 dose of SABA = 1-2 puffs). What made them select [number]? What would have made it a higher number (e.g. 8)?

Note: The 2024 BTS/NICE/SIGN asthma guideline advises that 'Uncontrolled asthma: Any exacerbation requiring oral steroids or frequent regular symptoms (such as using reliever inhaler 3 or more days a week or nighttime waking 1 or more times a week.'

This resource has been produced as part of the PCRS Asthma Right Care (ARC) initiative, which is part of a wider global social movement initiated by the IPCRG; AstraZeneca Ltd has sponsored the production of this resource, the sponsor has had no input into the resource content.

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