How do I know if my asthma is well-controlled?

Australian guidelines define well-controlled asthma as: daytime symptoms two days per week or fewer, no limitation of activities, no night-time waking due to asthma, reliever inhaler use two days per week or fewer, and no asthma attacks in the past year. If any of these are exceeded regularly, your asthma management may need review. The most practical first step is booking an asthma review with your GP, requesting spirometry (a simple breathing test), and having your inhaler technique assessed by a pharmacist or practice nurse. Most people using their reliever frequently are either under-treated or using poor technique with their preventer.

What does reliever inhaler overuse mean and why does it matter?

Short-acting reliever inhalers — Ventolin and its equivalents — relieve acute symptoms but do nothing to address the underlying airway inflammation that drives asthma. Obtaining three or more of these inhalers per year is a recognised marker of poorly controlled asthma in Australian and international guidelines. Overuse is associated with increased risk of severe attacks, hospitalisation, and in some data, mortality. Updated 2025 Australian guidelines recommend that people on step 2 or above use a combination low-dose inhaled corticosteroid and reliever device (such as Symbicort or Trelegy) rather than a standalone Ventolin — reducing reliance on SABA alone. If you are going through reliever inhalers regularly, speak with your GP about whether a preventer is appropriate for your situation.

Australian asthma control is getting worse — MJA nine-year comparison

What just happened

The current issue of the Medical Journal of Australia (Volume 224, Issue 6, June 2026) has published a national comparison that should be uncomfortable reading for anyone involved in asthma care. Researchers compared two large stratified web surveys of Australian adults with asthma: the first from 2012 (n = 2,686) and the second from 2021 (n = 5,427), both designed to represent the adult population by age, gender, and location.

The headline finding: well-controlled asthma declined from 54.4 per cent in 2012 to 48.0 per cent in 2021. Very poorly controlled asthma rose from 22.9 to 26.8 per cent. Urgent care presentations — emergency department or after-hours visits driven by asthma symptoms — rose from 28.6 to 37.9 per cent. In the subset of people who were undertreated or receiving no treatment at all, urgent care visits jumped from 41.2 to 63.5 per cent.

These are not marginal shifts. They document a decade during which asthma outcomes in Australia moved in the wrong direction, even as the clinical evidence base for effective asthma management improved substantially and new guideline versions were issued.

Two specific patterns were flagged as drivers. First, reliever inhaler overuse: 56.3 per cent of people in the 2021 survey were obtaining three or more short-acting beta-agonist (SABA) inhalers — Ventolin and equivalents — per year. The threshold of three or more per year has been identified in Australian and international guidelines as a marker of inadequately controlled asthma and a signal of elevated risk for severe attacks. Second, inhaler technique: only 42 per cent of people using inhaled corticosteroid preventers had their technique checked by a health professional in the past year. A preventer used with poor technique delivers a fraction of the intended dose.

The both-and

What nine years of worsening outcomes actually tells us

The study’s comparison period runs from 2012 to 2021 — which captures the full roll-out of the previous generation of updated Australian asthma guidelines, a substantial investment in public asthma awareness campaigns, and the introduction of new preventer devices to the Australian market. The worsening outcomes despite that context is the finding that requires explanation.

The study does not identify a single cause, and several explanations are plausible. Diagnostic drift is one — the population of adults captured under “asthma” in 2021 may include more people with mild or atypical presentations who were missed in earlier surveys, pulling down the percentage with well-controlled disease. A second explanation is that the era of proactive SABA-overuse messaging, which became prominent in the 2019 GINA global guidelines and is embedded in the 2025 Australian update, had not yet translated into changed prescribing or patient behaviour by the time the 2021 survey data was collected. The 2025 Australian guidelines formally recommend combination inhaled corticosteroid-formoterol therapy as the preferred reliever for adults on step 2 or above — a significant departure from the Ventolin-first approach that was standard for decades.

A third possibility is structural: patient access to scheduled asthma reviews in general practice, inhaler technique education from practice nurses or pharmacists, and written asthma action plans has not been consistently available across the decade. There is evidence across multiple chronic conditions in Australia that the minimum viable care many people can access in general practice has not kept pace with guideline evolution. The study authors call for “urgent implementation of the updated 2025 Australian guidelines” — framing that places the problem at system level as much as individual behaviour.

Why inhaler technique matters more than most people realise

An inhaled corticosteroid preventer is only as effective as its delivery to the airways. Studies across inhaler device types consistently show that correct technique is not achieved by many patients without formal instruction and checking. For pressurised metered-dose inhalers, coordinating actuation with inhalation at the right breath depth is the most common failure point. For dry-powder inhalers, flow rate during inhalation is the critical variable — too slow and insufficient drug reaches the bronchioles.

The practical implication is direct: if you have been on a preventer for months and your asthma does not feel well-controlled, the first question worth asking — before escalating the dose or adding another medication — is whether your inhaler is actually delivering medicine to your airways. A pharmacist can assess this quickly and demonstrate the correct technique for your specific device. That check is often the highest-value fifteen minutes in asthma management.

The asthma picture at midlife for women

Adult-onset asthma — or asthma that was mild in youth and worsens in adult life — peaks in women during the perimenopausal years, driven in part by the immunological and hormonal shifts of that period. Women at 45 who develop new wheeze, persistent cough, or unexplained breathlessness that is worse at night or on exercise deserve asthma as a working hypothesis, not only reflux, anxiety, or deconditioning. Lung Foundation Australia notes that hormonal changes across the menstrual cycle and at menopause can affect airway responsiveness.

The MJA data does not disaggregate by age and sex, but the demographic most likely to be under-treated with preventive therapy is the adult who developed mild asthma in their 30s or 40s and has been managing on a “just-in-case” reliever ever since — a pattern the data clearly identifies as widespread.

2 cents

If you have a Ventolin — or any short-acting reliever — in your bag that you use more than twice a week, or have gone through more than two of these inhalers in the past twelve months: book an asthma review with your GP. Not because something is catastrophically wrong — but because the evidence is clear that frequent reliever use is a signal that airway inflammation is not adequately controlled, and that pattern over time carries real risk.

At that review, three things are worth asking for: first, a check of whether your current preventer regimen matches the 2025 guidelines; second, a spirometry test if you have never had one or have not had one in several years; third, a pharmacist or nurse check of your inhaler technique. These are not heroic interventions — they are routine care that this data tells us many people are not receiving.

Asthma in Australia affects roughly one in nine adults. This research says the gap between what is clinically achievable with current treatments and what the average person is actually experiencing has been widening. Most of that gap is bridgeable through better access to routine preventive care in general practice.

Verdict: yes — worth knowing about.

Sources cited

Medical Journal of Australia — Worsening of key asthma indicators: a comparison of stratified sample surveys. June 2026; 224(6). https://www.mja.com.au/journal/2026/224/6/worsening-asthma-outcomes-australian-adults-comparison-stratified-sample-surveys
RACGP — Clinical guidelines. https://www.racgp.org.au/clinical-resources/clinical-guidelines
Lung Foundation Australia — Asthma. https://lungfoundation.com.au/patients-carers/living-with-a-lung-disease/asthma/