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New edition of National Asthma Handbook is launched

The National Asthma Council Australia has today (26 August) launched the latest edition of the Australian Asthma Handbook V2.1  – which outlines major new recommendations.

The handbook provides the national guidelines for asthma management in Australia. 

A key focus in the new edition is avoiding the underuse of preventer medicines by people with asthma and the corresponding over-reliance on reliever medications.

The new handbook also outlines a new treatment option for adults and adolescents (aged over 12 years) with mild asthma, the Council said.

As-needed low-dose budesonide-formoterol, taken for relief of symptoms, is now a Level 2 treatment alternative to a daily maintenance low-dose inhaled corticosteroid preventer. 

The Council says the new recommendation is supported by “strong evidence” from four randomised controlled trials showing as-needed low dose budesonide-formoterol not only provides immediate symptom relief, but also reduces 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.

Other new treatment options include:

  • Adults over 18 years, with moderate-severe asthma requiring Level 3-4 asthma treatment options, can use beclometasone-formoterol combination in single inhaler as a daily maintenance treatment, or as a maintenance-and-reliever therapy (with the latter not yet approved for PBS).
  • The use of dupilumab, a new biological add-on therapy option for adults and adolescents with severe asthma
  • A new, lower strength, fluticasone furoate 50 microg for children, or for adults and adolescents whose inhaled corticosteroid dose has been tapered.

“In patients with mild asthma for whom guidelines recommended daily low dose inhaled corticosteroid treatment, the clinical trials found that as-needed low-dose budesonide-formoterol, taken when the patient experienced asthma symptoms, reduced the risk of severe flare-ups to a similar extent as maintenance inhaled corticosteroids, without the need for daily treatment,” said Professor Amanda Barnard, Chair of the Guidelines Committee.

“This approach addressed the underlying lung inflammation and resulted in better health outcomes than with a short-acting reliever alone.” 

“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,” she said.

“They still provide safe relief of symptoms when used with a regular daily inhaled corticosteroid preventer.”

As part of the review process, the National Asthma Council Australia consulted with, and received endorsement from, stakeholder groups such as the RACGP, APNA, and PSA on the latest update.

Rhonda Cleveland, Acting CEO of the National Asthma Council, said “The Handbook continues to set the standard for evidence-based, practical advice for asthma management in primary care”.

The handbook’s development included a comprehensive review of evidence from recent clinical trials – conducted by a multidisciplinary team “dedicated to asthma, including primary care clinicians and respiratory specialists”.

It also considered deliberation on how recommendations would be implemented in primary care, said Ms Cleveland.

“We are proud that V2.1 of the Handbook presents a significant update on asthma management for adults and adolescents”.

The full Handbook update also includes detailed guidance for implementation, practice tips and other updates as well as health professional education to help in the implementation of the new guidelines. 

Go to the dedicated handbook website for more information

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