Professor Helen Reddel

Asthma control among Australian adults has worsened over the past decade despite years of national efforts to improve asthma management, according to a comparison of two national surveys.

A study published in the Medical Journal of Australia [link here] found more adults required urgent asthma-related healthcare in 2021 than in 2012, with researchers pointing to persistent reliance on blue puffers and slow uptake of anti-inflammatory reliever therapy as major contributors. Conducted before Australia’s revised asthma guidelines were introduced in September 2025, the survey provides an important baseline as clinicians begin implementing the new recommendations.

The repeat cross-sectional study compared responses from 5427 Australian adults with asthma surveyed in 2021 with 2686 adults surveyed using similar methods in 2012.

Key findings included:

• Well-controlled asthma fell from 54.4% in 2012 to 48.0% in 2021.
• Very poorly controlled asthma increased from 22.9% to 26.8%.
• Urgent asthma-related healthcare increased from 28.6% to 37.9%, with the adjusted odds of requiring urgent care 53% higher than in 2021.
• More adults reported asthma interfering with daily activities than a decade earlier.

Lead author Professor Helen Reddel, Research Leader at the Woolcock Institute of Medical Research and Macquarie University, said the findings, reported from patients themselves, reflected what many respiratory clinicians had been observing in practice.

They also provided an important national benchmark before implementation of Australia’s revised asthma guidelines.

“The results demonstrate that we’ve got a long way to go, but now that the new guidelines have been published, we can actually change this and turn it around,” she told the limbic.

“One of the messages from this study is not so much the negative that asthma outcomes have worsened, but that we now have the opportunity to improve outcomes.”

One finding offered an encouraging insight into where that change could occur.

Participants were more likely to report seeing their GP for a non-urgent asthma review than they had been a decade earlier. Professor Reddel said the survey could not determine what occurred during those consultations, but it showed more patients were discussing their asthma in general practice.

“They were there in the doctor’s office, asthma was mentioned, so they had the opportunity to improve their asthma management.”

By contrast, she said we need different approaches for patients who rely solely on over-the-counter short-acting beta-2 agonists who never discussed their asthma with a GP.

“The GP can’t do anything if they don’t actually see the patient, but pharmacists have the opportunity to talk to them about the change in asthma guidelines.”

One of the clearest signals from the survey emerged when researchers examined asthma control alongside preventer use.

The proportion of adults with uncontrolled asthma symptoms who reported taking little or no inhaled corticosteroid therapy increased from 25.6% in 2012 to 38.1% in 2021, making it the largest patient group identified in the survey.

Almost two-thirds of these patients required urgent asthma care during the previous year.

The survey also highlighted how slowly anti-inflammatory reliever therapy had been adopted before the revised Australian asthma guidelines were introduced.

Just 13.3% of participants reported using ICS-formoterol for symptom relief during the previous four weeks, while only 6.3% were using it without SABA.

Although these therapies had been PBS-subsidised for several years, she said there had been relatively little national attention to changing prescribing behaviour.

Professor Reddel said emergency departments also inadvertently reinforced longstanding reliance on salbutamol because their priority was treating the acute attack, with longer-term management generally left to general practice.

“On discharge, what we often hear is that patients are told to take six or more puffs every four or six hours and then gradually stretch it over a week,” she said.

“They’re usually given a course of oral corticosteroids, but changing their long-term management is something emergency departments often feel is more the role of the GP.”

She said that this approach was understandable given the realities of emergency medicine, where stabilising the patient understandably took precedence over reviewing long-term asthma management. However, work is underway to change discharge prescribing. 

The survey also documented persistent overuse of short-acting beta-2-agonists, with Professor Reddel describing Australia as one of the world’s highest users of blue puffers.

“Overuse of short-acting beta agonists is incredibly common in Australia,” she said. “It’s one of the highest in the world.”

Among adults using SABA:

• 56.3% reported obtaining three or more blue inhalers during the previous year, a frequency associated with increased risk of asthma exacerbations.
• 10.5% obtained 12 or more inhalers.
• More than half of those obtaining 12 or more inhalers required urgent asthma-related care.

Professor Reddel and colleagues suggested longstanding prescribing patterns with short-acting beta2-agonists had been reinforced by the inhalers’ low cost, over-the-counter availability and the ability to obtain up to 12 inhalers from a single unrestricted PBS prescription.

“Few clinicians or patients are aware that regular SABA use, even for 1–2 weeks, increases airway hyperresponsiveness and reduces bronchodilator effect, which can set up a vicious cycle encouraging SABA overuse,” they wrote.

Professor Reddel said that cycle could be unintentionally reinforced after an acute exacerbation.

“Someone goes home from the emergency department and is told to take regular SABA for the rest of the week,” she said.

“Because it’s not working as well as it did before, they take more. That’s how you get into a vicious cycle where people keep taking increasing amounts of SABA.”

Rather than explaining the underlying physiology to patients, Professor Reddel said she had found a simpler message was more likely to change behaviour.

“The more you take of the blue puffer, the less well it works.”

She said that single message often challenged one of the most deeply entrenched beliefs in asthma management.

“Most patients think of salbutamol as their lifesaver. They naturally assume that if a little works, then more must work even better.”

“So the concept that something which can save your life might actually be harmful if, long-term, you take too much of it is challenging – for patients and sometimes for clinicians.”

Professor Reddel said while over-the-counter availability contributed to Australia’s high SABA use, prescription use remained the main driver of overuse.

“They’re mainly older people on concession cards with other comorbidities, so to some extent it’s habitual use,” she said.

She said Australia’s prescribing arrangements also made excessive use easier.

“With an ordinary GP prescription, patients can receive two salbutamol inhalers with five repeats. That means they can obtain up to 12 inhalers before needing another review.”

The findings establish an important baseline before implementation of the revised Australian Asthma Handbook, which recommends anti-inflammatory reliever therapy or maintenance-and-reliever therapy with ICS-formoterol in place of SABA-only treatment for adults and adolescents.

Professor Reddel said general practice would play the central role in translating those recommendations into better outcomes.

She encouraged GPs to routinely assess three simple indicators that could quickly identify patients at increased risk of future exacerbations.

• What is the patient’s Asthma Control Test score?
• Have they had an asthma attack in the past 12 months?
• How often are they using their blue puffer?

“Any one of those three things would identify patients who are at higher risk of asthma attacks,” she said.

She said growing awareness of oral corticosteroid stewardship provided another reason to move patients away from reliever-only treatment.

“We now know that even a short course of prednisone once every couple of years significantly increases the risk of osteoporosis, diabetes, cataracts, glaucoma, obesity, depression, cardiac failure and a long list of other adverse effects.”

TSANZ has also published guidance promoting oral corticosteroid stewardship and reducing repeated prednisone exposure, including through earlier use of anti-inflammatory reliever therapy.