Asthma control

Analysis of PBS data shows that in 2022-2023, 27% of people aged 40 and under (and dispensed at least one reliever during the year) were considered to have poor asthma control based on their use of reliver medication (dispensed reliever medicine 3 or more times in a year) – progress compared to 29% in 2017-2018. It was:
– 31% in people aged 35-40, higher than for all other age groups
– 29% in males vs 26% in females
Rates have remained similar since 2017-2018 apart from spikes in 2019-2020 and 2020-2021 related to bushfires and COVID-19 pandemic.

Note: since previous reporting by AIHW, the scope of reliever medication has expanded to include SABA and also budesonide-formoterol 50-200mcg, resulting in data changes across all years. Budesonide-formoterol can also be used as a preventer.

Analysis of PBS data indicates that:

• 18% of people 40 and under being dispensed a reliever were dispensed at least 3 relievers within 12 months (overuse) in 2021-2022, compared to 19% in 2020-2021, 18% in 2019-2020, 16% in 2018-2019 and 17% in 2017-2018, and has therefore remained quite stable since 2017-2018 despite a spike in 2020-2021 that may be related to COVID-19 panic buying and bushfires in 2019-2020.
• by age groups, the proportion of reliever overuse (3 or more reliever dispensed within a year) in 2021-2022 was: 10.1% in 0-14 yo; 18.3% in 15-24 yo; 22.3% in 25-34 yo and 26.3% in 35-40 yo

Fig.11:Proportion of people aged 40 and under dispensed at least one reliever, who were dispensed relievers 3 or more times within 12 months, by age and sex, 2017–18 to 2021–22

According to a cross-sectional survey of 6048 adult Australians with current asthma in the community (conducted in Feb-March 2021 during Covid measures), 21.7% of adults with asthma had difficult-to-treat asthma (DTTA) in 2021, of which:
– 50.4% had very poorly controlled asthma
– 36.2% were current smokers
– 85.4% had at least 1 additional chronic condition
61.4% of those with DTTA had at least 1 urgent GP visit in the last 12 months (compared to 27.5% in non-DTTA people; 4.8 times more likely).
41.9% of those with DTTA had at least 1 ED visit in the last 12 months (compared to 17.9% in non-DTTA; 3.8 times more likely).

The prevalence of DTTA was higher is areas of greater socioeconomic disadvantage, where participants were also less likely to have received biologic therapy in the previous three months.

DTTA was defined as severe asthma and/or poor asthma control and/or urgent asthma healthcare in previous 12 months despite medium-high dose ICS/LABA.
Note: the survey was conducted during COVID measures which may have impacted healthcare utilisation.

A survey of 412 people from Oct 2017 to Oct 2018, who bought a SABA inhaler over the counter from a retail pharmacy found that 289 (70%) were overusers, as defined by inhaler use more than twice per week in the past four weeks.

Other issues of concern from the snapshot of asthma inhaler purchasers in NSW community pharmacies in 2017-2018 include the finding that 74% of SABA inhaler users reporting not using a preventer daily.

A 2012 survey of nearly 2,700 Australians aged 16 years and older with current asthma found:
– Asthma was not well-controlled in 45% of people with current asthma. 34% of these people did not use any preventer, and 23% used it less than 5 days/week.
– Nearly 40% only used a blue reliever puffer, treating their symptoms but not the cause. 1 in 4 of these people needed urgent treatment for their condition in the previous year.
– Only half (50.5%) of the participants saw their general practitioner for a non-urgent asthma review during the previous year
– 29% of participants needed urgent health care (GP or emergency department) for their asthma during the previous year
– preventer adherence was poor: overall, 43% of preventer medication users reported taking it less than 5 days a week, and 31% used it less than weekly.