Treatment & management

Treatment for asthma

In general, symptoms of asthma are easily controlled in most people by making lifestyle changes and using medications, so they can have normal lives. The main aims of asthma treatments are:

  • to stop asthma from interfering with school, work or play
  • to prevent flare-ups or ‘attacks’
  • to keep symptoms under control
  • to keep lungs as healthy as possible (National Asthma Council Australia 2020).

What medicines are used to treat asthma?

There are several medicines available to treat asthma. Different asthma medicines are used to achieve different 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.
  • Other medicines are used for management of difficult-to-treat asthma or as add-on options for management of severe asthma flare-ups.

Based on self-reported survey data, one-third (33%) of Australians with asthma had taken a respiratory medicine in the last 2 weeks in 2017–18 (ABS 2018). 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).

For more detailed information about medicines used to treat asthma, refer to Australian Asthma Handbook, Version 2.0. It provides Australia’s national guidelines for asthma management.

Management of asthma

As asthma is a chronic disease, it has to be cared for all the time, not just when symptoms are present. The four parts of managing asthma are:

  • Identify and minimise exposure to asthma triggers.
  • Understand and use medications as prescribed so as to have good asthma control.
  • Monitor asthma to recognise signs when it is getting worse.
  • Know what to do when asthma gets worse (Stanford Children’s Health 2020).

For more detailed information about management of asthma for different population groups, refer to the Australian Asthma Handbook, Version 2.0: Management for children, adolescents, and adults.

What role do GPs play in managing 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
  • review asthma with other possible co-morbidities
  • referral to a specialist and other health professionals.

In 2012, a survey of 2,686 Australians aged 16 and over with current asthma identified that 628 participants (23%) had visited a GP urgently about asthma at least once during the previous year, and 269 participants (10%) had attended a hospital or emergency department one or more times, with, in total, 769 participants (29%) reporting an urgent visit (urgent GP visit and/or hospital or emergency department visit) (Reddel et al. 2015).

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 (Britt et al. 2016). In the ten-year period from 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). It is worth noting that there is currently no nationally consistent primary health care data collection to monitor provision of care by GPs.

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

The line chart shows the general practice encounters for asthma fluctuated from 2006─07 to 2015─16. In 2015–16, the estimated rate of asthma management in general practice was 2.0 in 100 encounters, while this rate was 2.3 in 100 encounters in 2006–07.

Notes

  1. Asthma is classified according to International Classification of Primary Care, 2nd edition (ICPC-2) code R96.
  2. The Bettering the Evaluation and Care of Health (BEACH) year is from April to March.
  3. An encounter relates to a consultation between a patient and a GP.
  4. Statistics on general practice activities based on BEACH data are derived from a random sample survey of GPs and their encounters with patients, and should be interpreted with caution.

Source: Britt et al. 2016 (Data table).


An asthma action plan is a written self-management plan which is prepared for patients with asthma by a health care professional and can help people with asthma to manage their condition and reduce the severity of acute asthma flare-ups. There is no ‘standard’ asthma action plan, as everyone’s asthma is different. A patient’s plan needs to be developed to deal with his/her own triggers, signs and symptoms, and medication. Asthma action plans have formed part of the National Asthma Council Australia's guidelines for the management of asthma for 30 years (National Asthma Campaign 1990) and have been promoted in public education campaigns (including by the National Asthma Council Australia) on the basis that individualised written action plans improve asthma health outcomes (National Asthma Council Australia 2019).

Despite the Australian Asthma Handbook recommending all people with asthma have an asthma action plan, many people with asthma do not have a current written plan. In 2017–18, an estimated 839,000 (31%) people with asthma across all ages had a written asthma action plan (ABS 2018). Over two-thirds of children aged 0–14 had an asthma action plan (67%), however, this rate in people aged 15 and over was only about one-quarter (24%) (Figure 2). The results indicate that children aged 0–14 were the most likely to have a written asthma action plan compared with other age groups.

Figure 2: Proportion of people with asthma who have a written asthma action plan, by age group, 2017–18

The vertical bar chart shows the proportion of people with asthma who had a written asthma action plan in different age groups in 2017–18. One in three (67%25) children aged 0–14 with asthma were the most likely to have an asthma action plan compared with other age groups.

Note: Asthma refers to people who self-reported that they were diagnosed by a doctor or nurse as having asthma (current and long-term).

Source: ABS 2019 (Data table).

The National Asthma Strategy

The National Asthma Strategy 2018 (the Strategy) was launched in January 2018. The Strategy aims to outline Australia’s national response to asthma and inform how existing limited health care resources can be better coordinated and targeted across all levels of government (Department of Health 2017). The Strategy identifies the most effective and appropriate interventions to reduce the impact of asthma in the community and continue to be an international leader in asthma prevention, management and research (Department of Health 2017). In 2019, the AIHW reported on the 10 national asthma indicators to monitor the outcome measures associated with the Strategy. For more information, see National Asthma Strategy 2018, and National asthma indicators – an interactive overview.

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 2017–18, there were 38,792 hospitalisations where asthma was the principal diagnosis. The rate of hospitalisations for asthma was 158 per 100,000 population. The rate among children aged 0–14 (363 per 100,000 population) was markedly higher than the rate among people aged 15 and over (106 per 100,000 population).

During the last decade, the age-standardised rate of hospitalisations for asthma for children aged 0–14 decreased overall, falling from 542 per 100,000 population in 2009–10 to 363 per 100,000 population in 2017–18. Over the same period, the age-standardised rate of hospitalisations for asthma for those aged 15 and over fluctuated between 87 and 112 per 100,000 population.

Hospitalisation rates differ by sex and age (Figure 3). In 2017–18, boys aged 0–14 were 1.6 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 2.3 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 boys than girls for those under 15, and generally more common in females than in males for those over 25. See Prevalence by age and sex.

Figure 3: Age-standardised hospitalisation rate due to asthma, by sex and broad age group, 2008–09 to 2017–18

The line chart shows hospitalisation rates for asthma among children and adults from 2008–09 to 2017–18. During the last decade, the age-standardised rate of hospitalisations for asthma for children aged 0–14 decreased overall, falling from 542 per 100,000 population in 2009–10 to 363 per 100,000 population in 2017–18. Over the same period, the age-standardised rate of hospitalisations for asthma for those aged 15 and over fluctuated between 87 and 112 per 100,000 population.

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Seasonal variation in hospitalisations for asthma

Among children, the peaks for asthma hospitalisations 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 4). This coincides with the annual winter ‘flu’ season and may reflect the rise in respiratory infections observed then.

Figure 4: Weekly variation in hospitalisations due to asthma, by age group, 2017

The line chart shows weekly variation in hospitalisation rates for asthma in all age groups in 2017. For children aged 2–4 years, the peak for asthma hospitalisations (by admission period) occurred in February, while for children aged 5–14 years, the peaks occurred in February and May.

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Age profile of hospitalisations for asthma compared with hospitalisations for all causes

While most hospitalisations for all causes in 2017–18 were for older people, 44% of the 39,000 hospitalisations for asthma in Australia were for children aged 0–14 (Figure 5). The age profile of hospitalisations for asthma was much younger compared with hospitalisations for all causes in the same year.

Figure 5: Hospitalisations due to asthma and hospitalisations due to all causes, by age group, 2017–18

The bar chart shows hospitalisations for asthma and for all causes for different age groups in 2017–18. Most asthma hospitalisations were children aged 0–14 years (44%), whereas, most hospitalisations for all causes were for people aged 65 years and over (42%).

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