Asthmatics no better off on more costly drug

Australians are relying on expensive asthma medication despite new research showing many New Zealanders with asthma fare just the same on a more affordable inhaler.


New research from the Woolcock Institute of Medical Research in Sydney has confirmed high rates of poor asthma control in Australia and across the ditch. The study, published today in the international journal Respirology, shows 45 per cent of Australians and 41 per cent New Zealanders live with poorly controlled asthma symptoms.


Further, almost 30 per cent of people with asthma in both countries required urgent health care for asthma in the past year.


“Interestingly we found that most Australians with asthma are prescribed a combination preventer medication while New Zealand achieved the same asthma results overall with more use of a basic preventer inhaler that, in Australia, is more affordable for patients,” said lead researcher and asthma specialist Professor Helen Reddel.


“This suggests that for some Australian patients, their extra spending may not be paying off.” 


Preventer inhalers markedly reduce the risk and symptoms of asthma if they are taken regularly, but many patients fail to use them regularly, instead relying on a quick-relief inhaler that doesn’t treat the asthma itself, the ambulance-at-the-bottom-of-the-cliff solution.


Professor Reddel and her colleagues from Melbourne, Christchurch and Wellington set out to investigate whether use of the combination preventer medication was linked to better asthma results for patients.


The study involved more than 3000 randomly-selected Australians and New Zealanders with asthma who completed an online survey focused on asthma symptom control, medication use, and doctors’ visits over the period of one year.


“Guidelines in both countries recommend that most people with asthma should be taking a simple daily asthma preventer inhaler to reduce symptoms and reduce the risk of serious flare-ups,” Professor Reddel said.


Guidelines in both countries also recommend that asthma treatment should start with a basic preventer inhaler, with the combination inhalers prescribed if asthma is still not well-controlled despite the medication being taken correctly and regularly.


In Australia, the simple preventer inhaler is more affordable for patients than the combination preventer, but in New Zealand, the cost to patients is the same.


Despite this, out of those using a preventer in Australia, 82 per cent were taking a combination preventer inhaler, compared with just 44 per cent in New Zealand. Kiwis were more likely to use a basic (single medication) preventer inhaler.


The most important statistic – rates of uncontrolled asthma that leave patients at risk of asthma attacks – were equally poor in both countries. “Despite the greater use of combination inhalers in Australia, Australia’s results are no better,” Professor Reddel said.


“This suggests that some Australian patients could be better off if they considered moving to the more affordable basic preventer therapy, as long as they made sure to take it every day.”


Also, in Australia, reliever inhalers are available over-the-counter without a prescription, so many patients with uncontrolled asthma in Australia rely on quick relief medications that don’t actually treat their asthma, without seeing their GP.


Professor Reddel called on doctors and pharmacists to make patients aware that choices are available for preventer medications.


“Since cost is often an important factor for patient decisions about medications, it would be good to make patients and doctors in Australia aware that there are more affordable options available, that for many patients would work just as well,” Professor Reddel said.


“My advice is please use your preventer inhaler, and have someone check that you are using it correctly. It will help protect you, keep you out of hospital and it may even save your life.”


Reference: Is higher population-level use of ICS/LABA combination associated with better asthma outcomes? Cross-sectional surveys of nationally representative populations in New Zealand and Australia, Respirology,


10 August 2017.