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 almost a quarter of participants (23%) had visited a general practitioner urgently about asthma at least once during the previous year, and 10% had attended a hospital or emergency department one or more times, with, in total, 29% reporting an urgent visit [1].

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). 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. The Bettering the Evaluation and Care of Health (BEACH) year is April to March.
  2. An encounter relates to a consultation between a patient and a GP.
  3. Asthma is classified according to International Classification of Primary Care, 2nd edition (ICPC-2) code R96.
  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: [2] (Data table).

How many people have an asthma action plan?

Many people with asthma do not have a current written asthma action plan. 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 29 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 improve asthma health outcomes [4].

In 2017–18, an estimated 839,000 (31%) people with asthma across all ages had a written asthma action plan [5] despite the recommendations that every person with asthma have an asthma action plan (for more information see Australian Asthma Handbook – written asthma action plans). Twenty four per cent of people aged 15 years and over with asthma had an asthma action plan, while 67% of children aged 0–14 with asthma had an asthma action plan (Figure 2). Compared with the other age groups, children aged 0–14 were the most likely to have a written asthma action plan.

Figure 2: Proportion of people with asthma who have a written asthma action plan, by age, 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. Children aged 0–14 with asthma were the most likely to have an asthma action plan (67%25) compared with the other age groups.

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

Source: AIHW analysis of ABS 2019 [6] (Data table).

What medicines are used to treat asthma?

Use of medicines is the mainstay of asthma management. In 2017–18, based on self-reported survey data, 33% of Australians with asthma had taken a respiratory medicine in the last 2 weeks [5]. 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 2.0, which provides Australia’s national guidelines for asthma management [4], Respiratory medication use in Australia 2003–2013: treatment of asthma and COPD [7], and Asthma in Australia 2011 [8].

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 2016–17, there were 41,871 hospitalisations where asthma was the principal diagnosis. The rate of hospitalisations for asthma was 174 per 100,000 population. The rate among children aged 0–14 (416 per 100,000 population) was markedly higher than the rate among people aged 15 and over (112 per 100,000 population).

Over the 10 years to 2016–17, the age-standardised rate of hospitalisations for asthma for children aged 0–14 decreased overall, falling from 519 to 416 per 100,000 population. 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. The rate of 112 per 100,000 population is the highest for this age group over the previous 10 years.

Hospitalisation rates differ by sex and age (Figure 3). In 2016–17, 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 2.3 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: Hospitalisation rates for asthma, by sex and broad age group, 2007–08 to 2016–17

The line chart shows hospitalisation rates for asthma among children and adults from 2007─8 to 2016─17. The age-standardised hospitalisation rate for asthma among adults aged 15 and over fluctuated between 51 and 67 per 100,000 population in men, and between 120 and 154 per 100,000 population in women during last decade. However, this rate decreased from 671 per 100,000 population in 2009–10 to 515 per 100,000 population in 2016–17 among boys and from 373 per 100,000 population in 2011–12 to 311 per 100,000 population in 2016–17 among girls.Note: 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 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), 2016

The line chart shows weekly variation in hospitalisation rates for asthma in all age groups in 2016. 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.

Note: Data reported by period of admission. Hospitalisations per week for 2016. Only full weeks are shown.

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

Figure 5: Weekly variation in hospitalisations for asthma, adults aged 15 and over, 2016

The line chart shows weekly variation in asthma hospitalisation rates for adults aged 15 and over in 2016. For people aged 15–64 years, the peak for asthma hospitalisations (by admission period) occurred in November, however, for people aged 65 years and over, the peak occurred in August.

Note: Data reported by period of admission. Hospitalisations per week for 2016. 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 2016–17 were for older people, 47% of the 41,871 hospitalisations for asthma in Australia were for children aged 0–14 (Figure 6). The age profile was much younger compared to all hospitalisations in the same year.

Figure 6: Hospitalisations for asthma and all causes, by age group, 2016–17

The bar chart shows hospitalisations for asthma and for all causes for different age groups in 2016–17. Most asthma hospitalisations were children aged 0–14 years (47%25), however, most hospitalisations for all causes were for older people aged 65 years and over (42%25).

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 2019. Australian Asthma Handbook, Version 2.0. Melbourne: National Asthma Council Australia. Viewed 1 May 2019.
  5. ABS (Australian Bureau of Statistics) 2018. National Health Survey: First results, 2017─18. ABS cat. no. 4364.0.55.001. Canberra: ABS.
  6. ABS 2019. Microdata: National Health Survey, 2017–18, detailed microdata, DataLab. ABS cat. no. 4324.0.55.001. Canberra: ABS. Findings based on AIHW analysis of ABS microdata.
  7. AIHW (Australian Institute of Health and Welfare): 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.
  8. ACAM (Australian Centre for Airways disease Monitoring) 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