Important change to how asthma is advised and treated
17 Sep 2025
Major change in asthma treatment advice for adults and adolescents
New guidance from the Australian Asthma Handbook advises GPs to move away from relying on short-acting beta2 agonists (SABA), commonly known as “blue puffers,” as the sole treatment for asthma in adults and adolescents.
The updated recommendations, launched by Federal Health and Ageing Minister Mark Butler at a health professional webinar, highlight the use of inhaled corticosteroids (ICS) for all patients with asthma.
Key changes in the handbook include:
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AIR therapy recommended: Adults and adolescents with asthma should start treatment with low-dose budesonide-formoterol (anti-inflammatory reliever, AIR-only therapy) as needed when symptoms occur. This combination reduces the risk of severe asthma attacks compared to using SABA alone.
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Shift to maintenance-and-reliever therapy (MART): For patients needing daily medication, MART is now the preferred pathway. It uses the same inhaler for both maintenance and relief, which is more effective than separate inhalers for ICS and SABA.
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Written asthma plans: Every patient on AIR or MART treatment should have a personalised asthma action plan.
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Specialist referrals: Patients with difficult-to-control asthma should be referred to a respiratory specialist earlier, particularly with the availability of new biologic therapies, which can help reduce the need for high-dose inhaled or repeated oral steroids.
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Diagnosis and monitoring: Spirometry remains important for diagnosis, though use has declined since COVID-19. The handbook also advises using fractional exhaled nitric oxide (FENO) testing to help distinguish asthma from other conditions.
Professor Nick Zwar, Chair of the NAC Guidelines Committee, said the updates reflect evidence showing that relying on SABA alone can increase the risk of severe attacks and result in poorer asthma control.
“Patients using only blue puffers are more at risk of severe exacerbations,” Professor Zwar told newsGP. “The new guidance recommends using a reliever that contains a corticosteroid and a beta-agonist together, which is safer and more effective.”
He also highlighted that GPs will now guide patients to use these combined inhalers, marking a “major change in practice.”
The handbook provides clear steps for starting treatment, stepping up to MART if needed, and safely stepping down therapy. It also emphasises preventing avoidable asthma complications and deaths.
Asthma affects about one in 10 Australians, with more than 56,000 emergency department visits each year, making effective management essential.
The updated Australian Asthma Handbook is now available online, along with a CPD-approved recording of the launch webinar.
Source: newsGP
