A million Australian asthmatics live with wheezing, breathlessness and flare-ups despite the availability of effective preventer inhalers, new research has found.
The country’s first nationally representative study on asthma control has revealed the true state of the respiratory disease for the 2.3 million Australians who have asthma.
The AirSupply study, led by a collaboration of researchers and survey experts, unveils four important groups of people with asthma, and shows that 25% have uncontrolled asthma and use preventative medication infrequently or never.
A further 20% have uncontrolled symptoms despite regularly using their medication, possibly due to incorrect inhaler technique.
The remaining two groups are those who have well-controlled asthma without regular medication (40%) and those who control it well with preventer medications (15%).
“We’ve been able to paint for the first time a clear picture of asthma control overall and the results are not encouraging,” says Helen Reddel, Woolcock researcher and lead author of the study published today in the Medical Journal of Australia.
“We found that almost half of Australians with asthma – 45% – have more symptoms than they need to put up with. Apart from the unnecessary burden on their life, this flags them as being at higher risk of dangerous asthma flare-ups.”
There were also substantial problems with the prescribing and use of asthma medications.
“Put these things together and it becomes clear that a substantial part of Australia’s problem with asthma symptoms and flare-ups may be preventable,” Prof Reddel says.
The web-based study questioned 2686 adults with asthma in detail about their condition and how they manage it. Participants were recruited from an online panel of almost a quarter of a million Australians to ensure a broad range of people were included. The work investigates the complex relationship between inhaler use and asthma control.
Results also showed that in the past year only half of patients had had a non-urgent GP review of their asthma and just 20% had discussed their asthma with a pharmacist.
This lack of consultation had a concerning flow-on effect. Of those with asthma, 29 per cent had needed urgent health care for their asthma during the previous year.
“This is the ambulance at the bottom of the cliff analogy. People are seeking out the help only when the situation is urgent,” Prof Reddel says.
The study also revealed some serious concerns around inhaler use. Over half of those with frequent asthma symptoms were not using a preventer, or not using it regularly.
“These patients are at high risk of flare-ups that could be avoided if only they were using a preventer puffer – using it correctly, and regularly,” the researcher said.
The findings add to the report from the Australian Centre for Airways Disease Monitoring (ACAM) published last week that found just 16 per cent of people with asthma aged 35 to 64 who were prescribed inhaled preventer medication used the medication regularly over the course of a year.
Prof Reddel, who was also an author on the ACAM report, says the AirSupply study offers a more complete profile of actual medication use, rather than only dispensing rates, and shows whether the treatment a person was taking was controlling symptoms and flare-ups as it should.
She says the findings challenge the common assumption that asthma is a ‘solved’ problem in Australia.
“Because deaths from asthma have dropped by 70% in the past 30 years many people believe asthma is no longer an issue,” the researcher explains.
“But sadly, as these results show, that’s not the case. Fewer people might be dying but still we have tens of thousands of Australians living with unnecessarily uncomfortable symptoms and risk of dangerous flare-ups, at a high cost to themselves and the community.”
The researchers are quick to point out that while the results might be disappointing, the knowledge can be used for good purpose.
“Asthma isn’t one size fits all, and different people with asthma need different approaches to their treatment,” the researcher says. “Now we have valuable information about the four groups of asthma we’re able to offer up some clear, practical messages to improve care for all.”
There is a good reason for all people with asthma, regardless of which of the four groups they fall into, to see their GP annually for a condition review, Prof Reddel says.
Four asthma groups
The AirSupply study identifies four groups of people with asthma:
- Well controlled asthma with little or no preventer use – 40% – Need annual GP review, written asthma action plan;
- Well controlled asthma with regular preventer use – 15% Need to ask their GP to consider lowering the dose;
- Uncontrolled symptoms despite regular preventer use – 20% – GPs should check technique and adherence, treat other health problems; and
- Uncontrolled symptoms with little or no preventer use – 25% – Need to start regular preventer use or take it more regularly.