Pulse ·

Australia's asthma control is still slipping — and the data says why

By Dr HB Lo, FACRRM 4 min read
Verdict Yes — worth knowing about

A Medical Journal of Australia comparison of 2012 and 2021 asthma data found urgent care visits climbed from 29% to 38% of adults with asthma — while 52% still have uncontrolled symptoms and 56% obtained three or more short-acting reliever inhalers in a year. Only 13% were using the now-preferred ICS-formoterol combination therapy.

The 2025 Australian Asthma Handbook recommends a shift away from SABA-only treatment toward anti-inflammatory reliever therapy for most adults. GPs are identified as the key intervention point — through proactive review of patients whose relievers are being used more frequently than the guidelines recommend.

What just happened

A study published this week in the Medical Journal of Australia compared asthma management data from two national surveys — 2012 and 2021 — and found the headline numbers moving in the wrong direction. Urgent asthma-related healthcare visits climbed from 29% to 38% of adults with asthma over that decade. Twenty-eight per cent of adults reported asthma interfering with daily activities in 2021, up from 20.5% in 2012. More than half — 52% — still have uncontrolled symptoms.

What makes this finding uncomfortable is that it happened during a decade when asthma treatments genuinely improved. The 2025 Australian Asthma Handbook now recommends ICS-formoterol combination therapy as the preferred reliever for most adults — a significant shift from the previous standard of relying on short-acting beta-agonist (SABA) inhalers alone. The treatments got better. The population-level outcomes got worse.

For anyone who has managed asthma for years with a familiar blue puffer — and found it works well enough, most of the time — this gap between available treatment and actual outcomes is worth sitting with.

The both-and

”If the guidelines updated, why hasn’t the prescribing changed?”

Because guidelines change on paper faster than they change in consulting rooms, and for reasons that are not straightforward to fix. Only 13% of the 2021 cohort were using ICS-formoterol combination therapy — the now-preferred approach. Fifty-six per cent obtained three or more SABA inhalers in a 12-month period, a threshold the guidelines explicitly flag as a signal of undertreatment.

The study identifies the friction points directly. Cost is real: SABA relievers are cheaper and more accessible than ICS-formoterol combination inhalers. Familiarity matters: patients know what a blue puffer does in the acute moment, and switching requires a new technique, a new prescription, and trust in something unfamiliar at exactly the moment asthma matters most. GP workforce pressures and consultation time constraints create structural barriers to the kind of proactive review the updated guidance recommends.

None of these are failures of individual GPs or individual patients. They are the predictable gap between what an evidence update says and what a healthcare system under pressure can deliver quickly. The data makes that gap visible. Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, was direct in calling for general practice to take a more proactive role — not because GPs have been negligent, but because the system has not been set up to prompt review without the patient initiating it.

”But surely well-controlled asthma on a SABA doesn’t need changing?”

This is precisely the right question, and it deserves a direct answer: the study’s concern is not with people who genuinely have well-controlled asthma. It is with the substantial proportion who appear to have controlled symptoms because a SABA provides fast relief — while underlying airway inflammation remains inadequately managed.

The clinical signals that matter are frequency of use. Needing a reliever more than twice a week is a flag. Waking at night with symptoms more than twice a month is a flag. Getting through three or more SABA inhalers in a year is a flag. These are not automatic reasons to change treatment — they are reasons to have a proper review rather than assuming the current regimen is sufficient.

The other structural issue worth naming: cost. Even when a GP recommends ICS-formoterol, some patients cannot absorb the higher cost of the combination inhaler. This is not a minor footnote — it is a documented reason why the guideline-to-practice gap is not simply solved by more awareness.

2 cents

Asthma is the kind of condition that becomes invisible background noise in a person’s life. You get a puffer. You use it when things get tight. You mostly get on with everything else. The problem the MJA study is pointing to is not dramatic — it is the quiet accumulation of under-managed inflammation that shows up later as the unexpected emergency department visit, the antibiotic course for a chest infection that felt disproportionate, the sick day that probably did not need to happen.

The call for proactive review from general practice is not about finding problems where there are none. It is about recognising that the current model waits for patients to bring symptoms forward — and symptoms are often the last signal to change when asthma is under-treated. A structured asthma review looks at reliever use frequency, whether a written action plan exists, and whether inhaler technique is still correct. It is a brief appointment. The data suggests it is what is mostly missing.

If you have asthma and have not had a structured review in the past year — or if you are getting through more than two reliever inhalers annually — that is a reasonable reason to make a general practice appointment. Not urgently. Just soon.

Verdict: yes — the data is AU-primary, the 2025 guideline shift is real, and the question of whether your current asthma management is optimised is worth putting to your GP.

Sources cited

  1. RACGP newsGP — GP intervention call to tackle drop in asthma control. https://www1.racgp.org.au/newsgp/clinical/gp-intervention-call-to-tackle-drop-in-asthma-cont
  2. Medical Journal of Australia — Asthma management study 2012 vs 2021. https://onlinelibrary.wiley.com/doi/10.5694/mja2.70221
  3. Australian Asthma Handbook 2025 — National Asthma Council Australia. https://www.asthmahandbook.org.au

Frequently asked questions

  • How do I know if my asthma is 'uncontrolled'?

    The Australian Asthma Handbook flags these warning signs: needing your reliever inhaler more than twice a week, waking at night with asthma symptoms more than twice a month, or having asthma limit your physical activity. Getting through three or more SABA inhalers in a year is also a clinical red flag. If any of these apply, it's worth booking a review with your GP — ideally one that includes a written asthma action plan.

  • My GP gave me a blue puffer years ago and it seems to work — do I need to change?

    That's exactly the conversation to have with your GP rather than assume either way. The guidelines have shifted, but whether a change makes sense for you depends on how often you're using your reliever, whether your symptoms are genuinely controlled, and your own preferences. The concern in the data is not people with well-controlled asthma — it's the significant proportion using SABA frequently enough to signal under-treatment of underlying airway inflammation.