Asthma treatment still inadequate in Australia

The treatment of asthma in Australians remains inadequate, and could be improved by tailoring individuals’ asthma treatment and educating patients on inhaler technique, a leading asthma expert has warned.

Writing in the latest edition of Australian Prescriber, Associate Professor Helen Reddel, research leader at the Woolcock Institute of Medical Research says many people are prescribed higher doses than necessary. Most people do not use their inhalers correctly, leading to poor clinical outcomes and wasted medicines.

“Deaths from asthma have dramatically fallen in recent years, so it is often perceived as a commonplace and rarely serious condition. However, treatment of asthma in Australia is not optimal,” says Dr Reddel.

“Many patients are still under-treated. More than half of people with asthma aged 15–34 years are dispensed preventive medications only once in a year, which indicates many people are not taking enough of these medicines to reduce the risk of asthma flare-ups.”

“On the other hand, many patients are being over-treated. The majority of preventer prescriptions for asthma in Australian adults are for the highest potency combination of an inhaled corticosteroid and long-acting beta₂ agonist rather than a low-dose inhaled corticosteroid which alone should be sufficient for most patients. People with asthma should have their asthma control and risk factors reviewed once or twice a year, and have their treatment adjusted if necessary. Patients may also make short term adjustments for worsening asthma in accordance with their written action plan.”

Current guidelines are based on assessment of the patient’s level of asthma control - the extent to which the effects of asthma have been reduced or removed by treatment. The level of current control (how the patient’s asthma is at present) is determined by the frequency of symptoms, use of reliever inhalers and activity limitation over the last month, and spirometry. The patient’s future risk of adverse outcomes, particularly exacerbations and adverse drug reactions, should also be considered when deciding how to manage their asthma.

Dr Reddel, who is also Chair of the GINA (Global Initiative for Asthma) Science Committee, recommends that treatment should be stepped down when asthma is stable to minimise the (small) risk of adverse effects, such as osteoporosis and cataract, with treatment stepped up only after dealing with other factors contributing to poor control.

When symptoms are worse, other causes should be considered such as rhinitis, cardiac failure or vocal cord dysfunction. Inhaler technique should be reviewed by watching the patient demonstrate how they use it. Videos showing correct inhaler technique are available on the National Asthma Council website. Taking asthma medications as prescribed can be difficult, and Dr Reddel discusses ways to help. A second article by Dr Reddel on written asthma action plans will be published in the June issue of Australian Prescriber.

To read the full article and others visit www.australianprescriber.com

Individuals with questions about their medicine can call the Medicines Line (1300 MEDICINE or 1300 633 424), Monday to Friday 9am to 5pm AEST.