Right Asthma Image Campaign

23 September 2021

What a year! My continuing journey to transform asthma services in London for children and young people

By Sara Nelson RGN, BSc (Hons), MSc, Queens Nurse, Programme Lead, Children and Young People’s Transformation Programme NHS England (London Region)


They say that time flies when you are having fun, but I really can’t believe it’s five years since I started #AskAboutAsthma and this year it’s going national, so we are all very excited.

I am very proud of all that our partners across London have achieved in the last 5 years and even more so this year.  Despite the difficulties of COVID-19, 2021 has been a good one for raising the profile of children and young people’s asthma.  We now have a clear national focus and the up and coming National Asthma Bundle of Care (based on British Thoracic Society and NICE guidance and our London Asthma Standards). Various teams have won or been shortlisted for a variety of awards and only last month one of our local teams from Tower Hamlets and Barts Health won an HSJ award for their Tower Hamlets Together: Born Well, Growing Well Asthma and Wheeze Project.

Our friend and parent advocate Rosamund Kissi-Debrah won her landmark case, ruling that air pollution was a contributory factor in her daughter Ella’s death and her grassroots campaign continues to try to change the law.  It has been a privilege over the last 5 years to work alongside her. Preventative measures are essential and exposure to pollutants can impact on children and young people’s current and future health, as strong evidence suggests it impairs lung growth in children. We look forward to continuing to work with NHS England, the Greater London Authority and other partners to improve the air quality in London

We were also able to launch our #RightAsthmaInhalerImage campaign following my frustration about the poor images used by mainstream and medical media frequently portraying incorrect/inappropriate inhaler use. The wrong images continually re-enforce poor health messages to people with asthma or other respiratory disease, and to health professionals who are not experienced in respiratory care.

This frustration was shared by a number of leading clinicians across the country so myself and Viv Marsh, Nurse Lead for Dudley Respiratory Group, convened a group of expert respiratory healthcare professionals and patient representatives from across the UK who united to address their concerns with the aim of improving the quality of inhaler images. We believe this will improve information for patients, healthcare professionals and the public about the use of inhalers. The importance of each child and young person with asthma being able to use their inhalers effectively is one of the 3 key planks of our #AskAboutAsthma campaign so it’s important to share this message.

Images promoting incorrect inhaler could negatively impact asthma control, leading to potential asthma attacks and worsening quality of life.  Frequently, inhaler images depict the use of a blue reliever (rescue) medication, rather than a preventer inhaler (often brown), which is the most important part of asthma treatment. There are concerns that the use of blue inhalers could be linked to overreliance on reliever medication, identified as one of the key themes associated with avoidable asthma deaths in the National Review of Asthma Deaths (2014), rather than encouraging use of a preventer inhaler alongside a spacer device.

Sadly asthma is sometimes not taken seriously because of its episodic nature. The regular use of rescue inhalers, more than 2-3 times a week, should be regarded as a loss of asthma control and not ignored; it needs to be seen as an alarm bell that a medical review is needed.

Inhalers are not always easy to use, and correct technique is important to ensure the medicine is deposited in the lungs where it is needed. Spacer devices make pressurised Metered Dose Inhalers (pMDI) much easier to use and help medicine deposition. Images need to reflect this. If we can normalise spacer use in the media, this may also tackle some of the embarrassment and stigma issues expressed by children and young people. Please do share the message about using the right inhaler image, depicting the right person, right preventative treatment, in the right way, with the right technique, at the right time, in the right place.


I have been very fortunate to have worked with some fantastic, highly skilled clinicians, managers, children and young people and parents over the last five years and thank our London Asthma Leadership and Implementation Group for their incredible support.

The momentum is starting to build through this campaign and our more general social movement for change that we have been creating.  The tools that we have put in place such as the London Ambitions and London Asthma Toolkit are helping build a foundation of awareness and information to pave the way for improved asthma care in the UK.

However, too many children are still dying. We need to continue to put in place a legacy for the children in London who have succumbed to the disease and take action to prevent future deaths.  There are a number of actions that we can take as a health and social care system to make improvements in the way that children and young people with asthma are cared for and the simplest of which is to keep raising awareness. Therefore, I urge you all to keep sharing these messages #AAASharethemessage.


Nelson S, (2021) Let’s improve media portrayal of inhalers Journal of Community Nursing June p12-13

Guilmant-Farry, Nelson S  (2021) Asthma’s image problem.  Community Practitioner Vol 94 | No 03 May/June 26-27


See more from #AskAboutAsthma 2021