Patients' lives could be put at risk if pharmaceutical companies stray away from the widely recognised colour coding of inhalers used to treat asthma.
That's according to UK Inhaler Group (UKIG), which has published the findings of its survey of 3,000 health care professionals and patients. The survey sought to determine the importance of coloured labelling on inhalers used in the treatment of asthma and COPD*.
Now the group is calling for an official colour-code system for inhalers to prevent possible confusion over which inhaler to use in emergencies, which it says could put patients' lives at risk.
The survey of 2,127 patients with asthma and COPD and 596 healthcare professionals, is published in npj Primary Care Respiratory Medicine.
'Reliever' inhalers, the ones used in an emergency for instant relief, are traditionally coloured blue. The survey revealed 89 per cent of patients and 95 per cent of healthcare professionals frequently refer to the colour when discussing reliever medication.
However, this remains an unofficial colour-coding system. With the increase in inhaler types available, there is concern that blue may be used for inhalers not designed for emergency relief, and other colours used for quick relief medications. UKIG is concerned this could mean patients reach for the wrong inhaler in an emergency. Comments from patients who took part in the survey included:
"My seven year old knows the blue one is for when I am having an attack. It's useful to tell people I need the blue one and quicker therefore to get the medicine I need."
"I am visually impaired and rely very much on the colour of my inhalers. It's also great to be able to say to my kids please fetch my blue inhaler for example and know they get the right one."
Lead Author Monica Fletcher, CEO of UK charity Education for Health and Chair of the UKIG, said: "In an acute emergency, inhalers that work rapidly to open up the airways are lifesaving, particularly for asthma.
"With a range of inhalers and new treatments available, it is vitally important for not only patients but their families and carers such as schoolteachers to know which one to use in an emergency. Our survey revealed that it is important to know what medications people take, but definition by colour is by far the preferred way to do this and could save lives."
Over the last two years two pharmaceutical companies that had planned to change the proposed colour of new inhalers and break this 'unofficial convention' decided not to after considerable lobbying from the group. UKIG is calling for all interested parties to agree a formal industry-wide approach to colour coding so that in the future it would not be possible for a blue inhaler to obtain a licence unless it is a reliever and inhalers not for rapid symptom relief will not be licensed if they are blue.
Fletcher added: "These results highlight the importance of colour and add to the debate about the need to formalise the colour coding of inhaled therapies. In particular, they show the need for using the colour blue for inhalers for rapid relief of symptoms.
"We believe this survey should provide the impetus for all interested parties to discuss and agree a formal industry-wide approach to colour coding of inhaled therapies for the benefit of patients, carers and healthcare professionals."
Dr Duncan Keeley, GP in Thame and policy lead for the Primary Care Respiratory Society UK, said clear communication is important if clinicians and patients are going to work together to ensure the patient's lung condition is as well controlled as possible.
He explained: "With so many different compounds in inhalers, and patients often having more than one inhaler, referring to inhalers by their colour is obviously very helpful. And it also helps the people around the patient to know that the blue inhaler is the one that needs to be used in an emergency. So this is about safety - in a real emergency, when someone is struggling for breath, it is important that there is no room for confusion about which inhaler will have a rapid effect to relieve symptoms."
Toby Capstick, Lead Respiratory Pharmacist at Leeds Teaching Hospitals NHS Trust said: "There are a wide range of inhalers available for the treatment of asthma and COPD. Our survey has shown that patients rely on the colour of their inhalers to identify them rather than their names, which may be difficult to remember or pronounce.
"There was a strong opinion across patients and healthcare professionals that the blue colour is important to identify reliever inhalers, so that they and friends or family can retrieve them in an emergency. However, there are also concerns that if blue colouring is used for preventer inhalers, which are taken regularly to control asthma and COPD, that this could cause patients to accidentally overuse their preventer inhalers potentially resulting in significant side effects."
Asthma UK comment
Sonia Munde, Clinical Nurse Manager and Head of Asthma UK helpline, said: "The term 'blue inhaler' has been synonymous with the reliever inhaler for years and is commonly referred to this way by clinicians and patients. It is so important to have consistent simple health messaging between people with asthma, their carers and healthcare professionals. This is particularly the case during a life-threatening asthma attack when clear coherent instructions can save lives. For example, a 999 call operator may tell someone to take a number of puffs from their blue inhaler, while that person is waiting for an ambulance during an asthma attack. And our nurses will often refer to the 'blue inhaler' when they are giving advice on Asthma UK's helpline. The research from the UK Inhaler Group supports the fact that colour coding of potentially life-saving reliever therapy is an important safety feature."
Article: Is the 'blue' colour convention for inhaled reliever medications important? A UK-based survey of healthcare professionals and patients with airways disease, Monica Fletcher, Jane Scullion, John White, Bronwen Thompson & Toby Capstick, npj Primary Care Respiratory Medicine, doi:10.1038/npjpcrm.2016.81, published online 3 November 2016.