Professor Christine Jenkins

There’s been a renewed call to reduce the availability of over-the-counter short-acting beta agonist (SABA) bronchodilators in order to nudge asthma management back into line with the evidence.

According to the Woolcock Institute of Medical Research, almost 40% of people with asthma in Australia still rely on SABA reliever medication alone yet guideline‐based asthma care recommends as‐needed inhaled anti‐inflammatory medication.

The current Global Initiative for Asthma (GINA) strategy for asthma management [link here] recommends in its Step 1, low dose-combination ICS-formoterol for adults and adolescents taken as needed for the relief of symptoms and if needed before exercise.

As an alternative, it also suggests an ICS should be taken whenever a SABA is taken.

Woolcock alumnus Professor Christine Jenkins said in a statement that SABA as the first treatment for asthma needs to give way to treating asthma in “a proactive, comprehensive way.”

Yet so many Australians appear locked into purchasing an over-the-counter SABA reliever at the pharmacy rather than visit a doctor for assessment of asthma triggers, diagnostic spirometry, individualised action plans, combined reliever/preventer medication and education on device use and adherence.

“Over-the-counter SABA availability is antiquated and harmful. Oral corticosteroids are overused which may lead to long-term cardiovascular and metabolic harms, newer treatments are under-used and we are not implementing simple evidence-based care that we know prevents symptoms and exacerbations,” she said.

Professor Jenkins and colleagues wrote in The MJA last month [link here] that over‐the‐counter availability of SABA medication was implemented over 30 years ago as a stop‐gap measure when asthma death rates were high and community awareness of asthma as a potentially life‐threatening disease was low.

Professor Carol Armour, the Woolcock’s Executive Director, said people need to know that the situation has changed.

“We need to move from a rescue culture in asthma which is reliant on relievers, to a prevention culture which is proven and has been recommended for more than a decade,” she said.

The MJA article said “…as matter of extreme urgency, Australia needs to re‐examine its approach to over‐the‐counter availability of short‐acting β2‐agonist (SABA) medications and the excessive number of inhalers available on prescription.”

It also included a list of the major challenges in asthma care, suggested strategies and expected outcomes.

Some of the other challenges include:

• High rates of asthma exacerbations and out-of-hours GP and ED visits.
• Underuse of spirometry leading to misdiagnosis
• Too few visits for asthma review
• Overuse and overprescription of oral corticosteroids

The authors said current models of care were failing people with asthma.

For example, the time pressures on GPs may limit their capacity to have a detailed discussion with patients about chronic diseases such as asthma and spirometry was underfunded given the time it takes and its complexity.