The PBS-approved indication for budesonide/formoterol (Symbicort Turbuhaler 200/6 and Rapihaler 100/3) has now been extended to include as-needed management of patients 12 years and over with mild asthma.
The change is in line with an early update to the Australian Asthma Handbook – yet to be endorsed by the TSANZ or the RACGP – and follows increasing evidence of the importance of inhaled corticosteroids even in mild asthma.
Last year’s GINA report – reported here in the limbic – said SABA-only treatment was no longer recommended for the treatment of asthma in adolescents and adults.
Instead, patients with asthma should receive symptom-driven (for mild asthma) or daily ICS-containing controller treatment to reduce the risk of asthma exacerbations and asthma-related deaths.
Professor Amanda Barnard, chair of the guidelines committee for the National Asthma Council, told the limbic that Australia’s interpretation of the evidence was slightly different.
“We’ve said in a very few patients – with symptoms less than twice a month and no risk factors for flare ups – then it’s probably okay to have Ventolin. This is where we differ from GINA guidelines. They are saying nobody should ever have just Ventolin.”
Professor Barnard said most asthma patients in primary care should be taking an ICS.
“The evidence is that a lot of people who are prescribed regular low-dose inhaled corticosteroids don’t take them for a whole host of reasons. So in those patients who find it difficult to take something every day, this [as-needed] will be fantastic for them because they are getting relief but they are also getting much-needed inhaled corticosteroids.”
Other patients, who were well maintained on regular low-dose ICS and very rarely needed their SABA, should stay with their current management plan, she said.
“One of the challenges for primary care is those patients still need to be taking it regularly – they are not the people for an ‘as-needed’ approach. It’s the same medication, it looks the same … some people need to take it as regular maintenance, some people can take it as PRN – we need to be clear about the difference.”
Professor Barnard added that having salbutamol available OTC certainly complicated the picture and allowed some people to slide under the radar with their asthma when they really should be seeing a doctor for some form of ICS.