Treatment & management

What role do GPs play in treating asthma?

General practitioners (GPs) play a central role in the management of asthma in the community.

This role includes assessment, diagnosis, prescription of regular medications, education, provision of written action plans, and regular review as well as managing asthma flare-ups. Asthma-related visits to GPs may occur for a variety of reasons, including:

  • the acute or reactive management of asthma symptoms
  • a review during or following a flare-up
  • a review or initiation of a written action plan
  • a visit for maintenance activities, such as monitoring and prescription of regular medications
  • referral to other health professionals.

A survey in 2012 of 2,686 Australians aged 16 and older with current asthma identified that 29% had needed urgent health care for asthma in the previous year [1]. Of these, 23% had urgent need to see their GP, 10% their emergency department or hospital, with 4% needing one or more nights in hospital because of their asthma.

According to the Bettering the Evaluation and Care of Health (BEACH) survey, asthma was one of the most frequently managed chronic problems in the decade up to 2015–16 [2].

In the ten year period 2006–07 to 2015–16, the estimated rate of asthma management in general practice declined from 2.3 in 100 encounters to 2.0 in 100 encounters (Figure 1). The BEACH survey gathers information from a random sample of GPs in Australia. An 'encounter' is a consultation between a patient and a GP.

There is currently no nationally consistent primary health care data collection to monitor provision of care by GPs. Note that statistics on general practice activities based on BEACH data are derived from a sample survey of GPs and their encounters with patients, and need to be interpreted with some caution.

Figure 1: General practice encounters for asthma, all ages, 2006–07 to 2015–16

The horizontal line chart shows that between 2006–07 and 2015–16, the estimated rate of general practice encounters for asthma declined slightly from 2.3 to 2.0 per 100 encounters.

Notes

  1. The Bettering the Evaluation and Care of Health (BEACH) year is April to March.
  2. Asthma is classified according to International Classification of Primary Care, 2nd edition (ICPC-2) code R96.

Source: [2] (Data table).

How many people have an asthma action plan?

Many people with asthma do not have a current written asthma action plan although it is recommended in national guidelines.

A written asthma action plan, prepared for patients with asthma by a health care professional, can help people with asthma to manage their condition and reduce the severity of acute asthma flare-ups.

Asthma action plans have formed part of the National Asthma Council Australia's guidelines for the management of asthma for 28 years [3] and have been promoted in public education campaigns (including by the National Asthma Council Australia) on the basis that individualised written action plans reduce the risk of dying of asthma and improve asthma health outcomes [4].

In 2014─15 only 21% of people aged 15 and over, and 57% of children aged 0–14 [5], with asthma had an asthma action plan (Figure 2), despite recommendations that every person with asthma have an asthma action plan (for more information see the recommendations here: Australian Asthma Handbook - action plans).

Across all ages, in 2014–15, an estimated 699,000 people, that is 28% of people with asthma [5] reported having a written asthma action plan, an increase from 24% in 2011─12 [6], 21% in 2007─08 [7] and 16% in 2004─05 [8].

Among people with asthma, adults aged 25─34 were the least likely to have a written action plan (16%) [5]. This percentage is similar to that recorded in 2011─12 for this age group [6]. Children aged 0─14 were the most likely to have a written asthma plan (57%) [5], an increase from 41% in 2011─12 [6], 48% in 2007─08 [7] and 26% in 2004─05 [8].

Figure 2: Proportion of people with asthma who have a written asthma action plan, by age, 2014─15

The vertical bar chart shows that in 2014–15, written asthma action plans were less common among adults aged 25–44 (17%2525). Children aged 0–14 were the most likely to have a plan (41%2525).

Notes:

  1. Self-reported doctor-diagnosed current and long-term asthma.
  2. The 75+ age group proportion has a margin of error > 10 percentage points which should be considered when interpreting this information.

Source: National Health Survey: Health Service Usage and Health Related Actions, 2014–15. ABS cat. no. 4364.055.002. Canberra: ABS (Data table).

What medicines are used to treat asthma?

Use of medicines is the mainstay of asthma management.

In 2014─15 based on self-reported survey data, 35% of Australians with asthma had taken a respiratory medicine in the last 2 weeks [5], a decrease from 43% in 2011─12 [6]. These medicines may have been used to treat asthma or another respiratory condition, as most of the medicines used for asthma are also used for patients with other chronic lung diseases, in particular chronic obstructive pulmonary disease (COPD).

The overall goals of using medications to treat asthma are to:

  • improve the quality of life
  • minimise symptoms, such as breathlessness and wheezing
  • minimise the risk of adverse outcomes due to asthma, such as flare-ups.

Different asthma medicines are used to achieve these goals, as follows:

  • Relievers are medicines used for the rapid relief of asthma symptoms when they occur. They can also be used before exercise, to prevent exercise-induced bronchoconstriction (constriction of the airways).
  • Preventers are medicines used every day in asthma control to minimise symptoms and reduce the likelihood of episodes or flare-ups. Inhaled corticosteroids are the most commonly used preventers. Some asthma medicines include both a preventer and a long-acting reliever in a single inhaler.
  • Other medicines are occasionally used to manage asthma in specific circumstances, for example for management of difficult-to-treat asthma or as add-on options for management of severe asthma flare-ups.

There are clinical guidelines to help doctors and patients to best manage asthma. These guidelines include recommendations for effective use of medications.

For more detailed information about medicines used to treat asthma, refer to the Australian Asthma Handbook, Version 1.3, which provides Australia’s national guidelines for asthma management [4], Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD [9], and Asthma in Australia 2011 [10].

What role do hospitals play in treating asthma?

People with asthma require admission to hospital when flare-ups or 'attacks' are potentially life-threatening or when they cannot be managed at home or by a GP.

Data from the AIHW National Hospital Morbidity Database (NHMD) show that in 2015–16, there were 39,448 hospitalisations where asthma was the principal diagnosis. The rate of hospitalisations for asthma was 169 per 100,000 population. The rate among children aged 0–14 (442 per 100,000 population) was markedly higher than the rate among people aged 15 and over (98 per 100,000 population).

Over the 10 years to 2015–16, the age-standardised rate of hospitalisations for asthma for children aged 0–14 decreased overall, falling from 539 to 442 per 100,000 population. Over the same period, the age-standardised rate of hospitalisations for asthma for those aged 15 and over fluctuated between 88 and 102 per 100,000 population. However, for the past two years the rate has remained steady at 98 per 100,000.

Hospitalisation rates differ by sex and age (Figure 3). In 2015–16, boys aged 0–14 were 1.7 times as likely as girls of the same age to be admitted to hospital for asthma; conversely, of those aged 15 and over, females were 2.4 times as likely as males to be admitted to hospital for asthma. These differences in hospitalisation by sex and age reflect in part the difference in the prevalence of asthma—which is more common in males than females for those under 15, and more common in females than in males for those over 15. See Prevalence by age and sex.

Figure 3: Hospitalisation rates for asthma, by sex and broad age group, 2005–06 to 2015–16

The horizontal line chart shows that hospitalisation rates for asthma remained relatively steady for both males and females aged 15 and over between 2005–06 and 2015–16. Among children aged 14 and under, rates declined slightly for both males and females.

Note:

  1. Age-standardised to the 2001 Australian Standard Population.

Source: AIHW National Hospital Morbidity Database (Data table).

Seasonal variation in hospitalisations for asthma

Among children, the peaks for asthma hospitalisations (by admission period) occur in late summer (February) and autumn (May) (Figure 4). The peak in February is likely related to respiratory infections associated with returns to school and childcare after the summer break. This has been found during similar peaks in September in Northern Hemisphere countries; lower use of preventer medication during holidays may also contribute.

Among adults, hospitalisations for asthma are highest in winter and early spring (June through to September), particularly in people aged 65 years and older (Figure 5). This coincides with the annual winter 'flu' season and may reflect the rise in respiratory infections observed then.

Figure 4: Weekly variation in hospitalisation rates for asthma, by age-group (all ages comparison), 2015

The horizontal line chart shows that the weekly hospitalisation rate for asthma in children aged 14 and under peaks in late summer / early autumn, and is consistently higher than the rates for adults aged 15 and over.

Note:

  1. Data reported by period of admission. Hospitalisations per week for 2015. Only full weeks are shown.

Source: AIHW National Hospital Morbidity Database (Data table).

Figure 5: Weekly variation in hospitalisations for asthma, adults (15 and over) 2015

The horizontal line chart shows that the peak seasons for asthma hospitalisations for those aged 15 and over are late winter and early spring, and this peak is highest for those aged over 65.

Note:

  1. Data reported by period of admission. Hospitalisations per week for 2015. Only full weeks are shown.

Source: AIHW National Hospital Morbidity Database (Data table).

Hospitalisations for asthma and all causes by age group

While most hospitalisations (all causes) in 2015–16 were for older people, half (51%) of the 39,448 hospitalisations for asthma in Australia were for children aged 0–14 (Figure 6). This age group was much younger compared to all hospitalisations in the same year.

Figure 6: Hospitalisations for asthma and all causes, by age group, 2015–16

The vertical bar chart shows that in 2015–16, the most asthma hospitalisations were for children aged 0-4 (nearly 30%25). By comparison, the majority of hospitalisations for all causes were in adults aged 35–64 and 65 and over (38%25 and 41%25, respectively).

Source: AIHW National Hospital Morbidity Database (Data table).

References

  1. Reddel HK, Sawyer SM, Everett PW, Flood PV, Peters MJ 2015. Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population. Medical Journal of Australia; 202:492–7.
  2. Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C, et al. 2016. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 41. Sydney: Sydney University Press.
  3. National Asthma Campaign 1990. Asthma Management Plan. Melbourne: National Asthma Campaign. 
  4. National Asthma Council Australia 2016. Australian Asthma Handbook, Version 1.3. Melbourne: National Asthma Council Australia.
  5. Australian Bureau of Statistics (ABS) 2017. Australian Health Survey: Health Service Usage and Health Related Actions, 2014─15. Table 7. Asthma: Actions and medications taken. ABS cat. No. 4364.0.55.002. Canberra: ABS.
  6. ABS 2013. Australian Health Survey: Health Service Usage and Health Related Actions, 2011-12. Table 7: Asthma: Actions and medications taken. ABS Cat. no. 4364.0.55.002 Canberra: ABS.
  7. ABS 2009. National Health Survey: Summary of Results, 2007–08 (Reissue) . ABS cat. no. 4364.0. Canberra: ABS.
  8. ABS 2006. Asthma in Australia: A Snapshot 2004–05. ABS Cat. no. 4819.0.55.001. Canberra: ABS.
  9. Australian Institute of Health and Welfare (AIHW): Correll PK, Poulos LM, Ampon R, Reddel HK & Marks GB 2015. Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD. Cat. no. ACM 31. Canberra: AIHW.
  10. Australian Centre for Airways disease Monitoring (ACAM) 2011. Asthma in Australia 2011: with a focus chapter on chronic obstructive pulmonary disease. AIHW Asthma Series no. 4. Cat. no. ACM 22. Canberra: AIHW.