A group of respiratory physicians have proposed radical steps to curb excessive reliance on relievers, enhance preventer adherence, encourage asthma review, and provide specialised evaluation for complex patients.

Writing in a perspective article in the MJA Tunn Ren Tay from The Alfred Hospital in Melbourne and colleagues Michael Abramson and Mark Hew from Monash University said they were “disappointed and disquieted” at the results of an Australian asthma survey that found over a quarter of respondents were not using preventer inhalers despite having uncontrolled asthma.

The survey also showed that another 20% of respondents had uncontrolled symptoms despite regularly using preventers.

“If these figures are truly representative of the nation’s 2.3 million people with asthma, they suggest that about one million Australians have uncontrolled asthma,” the doctors wrote.

The findings suggested that patients preferred immediate symptom relief over long-term disease control.

And ironically, they said, the current dispensing system reinforced this behaviour.

“Relievers are readily available over the counter, but preventers require prescriptions, necessitating additional effort, time and expense.

“The logical solution to this problem is to re-design access to asthma medications… Preventers must be made more accessible.”

Another perhaps less palatable step to improving asthma control was to reduce the high volume dispensing of relievers without concomitant preventers.

“Such a move would require electronic coordination across pharmacies, with the ability to trigger referral for asthma review,” they said.

Another approach was to launch a combined short-acting reliever and steroid preventer in a single device, a move which according to the doctors would ensure that every dose of reliever was accompanied by a corresponding dose of preventer.

Other suggestions put forward by the doctors involved lengthening the time of an asthma consult in primary care by adjusting the rebate, as well as funding asthma educators.

The most challenging patients could also be seen at dedicated “difficult asthma centres” as evidence showed that dealing with these patients through comprehensive multidisciplinary assessment can improve quality of life as well as define  patient groups most likely to respond to “the expensive biological agents now entering clinical practice.”

“Asthma management in Australia has come a long way, but innovative strategies are needed to bridge the remaining gaps,” they concluded.