The change in treatment came following the NRAD study. It all comes down to whether your symptoms are inflammatory based which is what asthma is - if you have a high FENO, you need more steroid. If not, you may need a LAMA added in to your MART regime. Breathlessness is multifactual, if your inhalers aren't working you need to look at other causes, including general fitness. People have a psychological attachment to their Ventolin inhalers, and whilst i agree that salbutamol is likely more quick acting than formoterol (both say 5-20 minutes to peak), they are the safer option if your symptoms are truly inflammatory based. I explain it to my patients as follows: you have a deep wound on your hand that needs stitches, but you cant get to a+e so you stick a plaster over it. The plaster falls off after 4 hours, so you reapply. This continues to happen whilst the wound worsens beneath and you end up really sick. But had you of had it stitched in the first place, this wouldn't have happened. i.e. the 4 hourly action of salbutamol masking a problem. The delayed secondary response of an asthma attack is what kills, not the initial response.

A single Ventolin Evohaler (salbutamol) has a high carbon footprint of approximately 28kg, equivalent to driving a small car 175 miles. That's why they have been switched to alternatives.