3 September 2020

The National Asthma Council Australia has launched the Australian Asthma Handbook V2.1 which outlines important new recommendations that could affect many of the 2.7 million Australians with asthma.

Key to the new update is a focus on avoiding the underuse of preventer medicines by people with asthma and the corresponding over-reliance on reliever medications.

Australian Asthma Handbook V2.1 outlines a new treatment option for adults and adolescents (aged over 12 years) with mild asthma, with Level 2 treatment now including as-needed low dose budesonide-formoterol, taken for relief of symptoms, as an alternative to a daily maintenance low-dose inhaled corticosteroid preventer.

The new recommendation is supported by strong evidence from four randomised controlled trials totalling almost 10,000 adults and adolescents, that showed as-needed low dose budesonide-formoterol not only provided immediate symptom relief, but reduced 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.

In other additions, adults over 18 years with moderate-severe asthma requiring Level 3-4 asthma treatment options can now 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).

Further new treatment options include the use of dupilumab, a new biological add-on therapy option for adults and adolescents with severe asthma and also a new lower strength fluticasone furoate 50 microg for children, or for adults and adolescents whose inhaled corticosteroid dose has been tapered.

The Australian Asthma Handbook, published by the National Asthma Council, provides the national guidelines for asthma management in Australia.

“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.

“This approach addressed the underlying lung inflammation and resulted in better health outcomes than with a short-acting reliever alone,” said Professor Amanda Barnard, Chair of the Guidelines Committee.

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

Ms 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.

“We are proud that V2.1 of the Handbook presents a significant update on asthma management for adults and adolescents. The review has been conducted by a multidisciplinary team of leading health professionals dedicated to asthma, including primary care clinicians and respiratory specialists.

“The rigorous development included a comprehensive review of evidence from recent clinical trials, consideration of the Australian health system context and deliberation on how recommendations would be implemented in primary care,” said Ms Cleveland.

As part of the review process, the National Asthma Council Australia consulted with and has received endorsement from stakeholder groups such as the RACGP, APNA, and PSA on the latest update. Importantly, they also sought feedback on the implementation of the update from people with asthma.

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.

Refer to the Australian Asthma Handbook for full details. 

With the National Asthma Council Australia.

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