Patient perspectives of asthma treatment and belief barriers to implementing new guidelines: a qualitative analysis of an online forum

For the last 40 years, the first line of asthma treatment has been short-acting beta2 agonists (SABA) used as symptom relief alongside daily inhaled corticosteroids (ICS) as preventers. New guidelines recommend replacing SABA relievers with ICS-based relievers (ICS-formoterol) because of clear risks from excess and sole use of SABA. This study aimed to explore patient perceptions of SABA, ICS and ICS-formoterol, with a focus on identifying barriers to adherence to new recommended treatments. A qualitative study was carried out investigating UK asthma online community forum posts using keyword searches between July 2021 and March 2025. Inductive thematic analysis was used to analyze the data, informed by the Necessity Concerns Framework. 326 posts were identified across 206 adults with asthma. Thematic analysis highlighted that many people remained attached to their SABA and viewed it as a key element of their treatment. They appeared unconvinced by warnings around SABA over-use and were dissatisfied with the quality of advice from health care professionals (HCPs). In contrast, they raised a range of concerns about ICS and ICS-formoterol, and had reservations about replacing SABA with these treatments. A common objection to replacing SABA was that ICS-formoterol does not provide the same symptom relief. Results highlight a perceived lack of individualized care from HCPs and insufficient explanation and justification of treatment changes. This analysis highlights several potential barriers to adherence to recommended asthma treatment. Strategies to support the implementation of asthma treatment guidelines should include addressing patients’ treatment beliefs and educating clinicians to better communicate treatment changes.