The latest version of the Australian Asthma Handbook confirms the previously flagged changes away from an over-reliance on SABA-only relievers in mild asthma.

Version 2.1 of the Handbook outlines the Level 2 treatment option of as-needed low dose budesonide-formoterol for relief of symptoms in adults and adolescents over 12 years with mild asthma.

The National Asthma Council Australia said the new recommendation is supported by strong evidence from four randomised controlled trials totalling almost 10,000 adults and adolescents, that showed as-needed low dose budesonide-formoterol not only provided immediate symptom relief, but reduced the risk of severe flare ups by two-thirds compared with using short-acting relievers alone.

The reduction in risk of severe flare-ups was similar to, or better, than with a daily maintenance low-dose inhaled corticosteroid.

“This approach addressed the underlying lung inflammation and resulted in better health outcomes than with a short-acting reliever alone,” Chair of the Guidelines Committee Professor Amanda Barnard said.

“However, it’s important to note that short-acting relievers such as salbutamol remain an essential rescue medicine for their role in management of acute asthma and community first aid,” added Professor Barnard. “They still provide safe relief of symptoms when used with a regular daily inhaled corticosteroid preventer.”

In other additions to the Handbook, adults over 18 years with moderate-severe asthma requiring Level 3-4 asthma treatment options can now use beclometasone-formoterol combination in a single inhaler as a daily maintenance treatment, or as a maintenance-and-reliever therapy (with the latter not yet approved for PBS).

Other new treatment options in the Handbook include the use of dupilumab as an add-on therapy option for adults and adolescents with severe asthma and a new lower strength fluticasone furoate (50µg) for children, or for adults and adolescents whose inhaled corticosteroid dose has been tapered.