Core Revision
Revision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.
The Asthma Reasoner
Asthma was rewritten in 2024, and inhalers are a perennial AKT and MSRA trap. Instead of memorising a table, you’ll build the mental model — what each inhaler class does and why the pathway now leads with an anti-inflammatory reliever — then walk the step-up ladder and reason an exam-style case. The tool records how you do on each step and inhaler, on this device. Revision aid, not clinical advice.
Understand mode: the mental model — what the inhaler classes mean and why the 2024 pathway leads with an anti-inflammatory reliever. Tap a card to see why.
The one idea · a reliever should carry a steroid
Old asthma treatment gave a steroid-free blue reliever (a SABA) for symptoms and a separate brown preventer (an ICS) to take every day. The flaw: people leaned on the blue inhaler and under-used the steroid, so inflammation ran unchecked. The 2024 fix is simple — for people aged 12 and over starting or stepping up treatment, NG245 makes the reliever an inhaler that contains a steroid (an ICS/formoterol inhaler), so every rescue puff also delivers an anti-inflammatory. That single move is what AIR and MART are built on.
Four letters do most of the work in asthma. Tap a card to see what the class is, what it’s for, and where it sits in the 2024 pathway.
What changed in 2024
The single most examinable thing about asthma right now is how much the guideline moved. Tap a card to flip it over for the detail — the big shift is first.
The 2024 step-up ladder as a stepper. Tap any step for what it is, why you step up, and what comes next. Switch on Test me to predict the next step yourself — instant feedback and a running score. The adult/young-person and 5–11 pathways diverge in important ways, so switch between them.
Inhaler identifier
Pick an inhaler to see its drug, class, typical device and — most importantly — what it’s for. Switch to Test me to quiz yourself on each one’s role, with instant feedback and a running score.
Walk an exam-style case. You’re given a fictional patient’s current treatment and how well they’re controlled — predict the next move, commit your answer, then see the reasoning. This is thinking through the case, not looking it up.
AKT pattern · how they catch you out
Inhaler questions reward two things: knowing the 2024 change, and knowing which combination inhalers can double as relievers. Watch for:
- A newly diagnosed adult who’d once have been handed “a blue inhaler” — the 2024 answer is an as-needed ICS/formoterol (AIR), not a SABA alone.
- Choosing a MART inhaler: Fostair (adults only) and Symbicort work (formoterol is fast-onset); Seretide and Relvar do not (salmeterol/vilanterol are too slow to be relievers).
- A child aged 5–11 — they still start on ICS + SABA, so don’t apply the adult rule.
- An inhaler named only by colour — the safe answer is to check the drug, never the colour.
Lose the “blue inhaler for everyone” reflex
If you take one thing from the 2024 guideline into the exam, make it this: in NG245, for people aged 12 and over starting or stepping up treatment, the reliever is now an ICS/formoterol inhaler, so every rescue puff carries an anti-inflammatory. Once that clicks, AIR and MART stop feeling like new jargon and start looking like the obvious fix for the old problem of patients over-using a steroid-free blue inhaler.
Save your progress — and go further
Your progress in this tool is saved on this device. Create a free account to explore more of Core Revision — the tool stays free either way.
Take this further
This tool is free. If you are preparing for the MRCGP AKT, the full course puts the same reasoning into exam-style questions: a question bank with Core Lens and Deep Dive explanations, a Core Calendar revision plan built around your exam date, and Core Compass to show you which topics need you next.
Questions? Email admin@corerevision.com
Based on NICE/BTS/SIGN NG245 (published 27 November 2024, last updated November 2025). A revision aid only — verify independently against the current guideline.
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Core Revision Ltd is an independent educational platform and is not affiliated with the RCGP.
Written by practising UK GPs for exam revision. Sources are cited on this page and corrections are logged. Education only — always confirm against current guidance. Core Revision is an independent revision resource.