The Woolcock Institute of Medical Research

News & Articles
Beyond the blue puffer

Beyond the blue puffer

Tuesday, May 07, 2024

The idea that asthma is a “trivial” disease, easily treated by a blue puffer (reliever inhaler) when someone gets a bit wheezy or breathless is leaving many people to fall through the cracks.

The results of a population survey released today, World Asthma Day, and led by Woolcock researchers including Professor Helen Reddel reveal some startling statistics when it comes to people who have difficult-to-treat or severe asthma in Australia.

Difficult-to-treat asthma (DTTA) is defined as asthma that is uncontrolled despite prescription and treatment with a medium or high dose of combination therapy (inhaled corticosteroids and long-acting beta agonists). There can be a number of contributory factors including misdiagnosis, poor adherence, incorrect inhaler technique and lack of treatment for comorbidities.

While 11 percent of Australian adults have asthma, more than one in five of those in the survey satisfied DTTA criteria. Of those, more than two-thirds were obese or overweight, 85 percent had at least one additional chronic condition, 57 percent had two or more additional chronic conditions, 36 percent were current smokers and almost 45 percent suffered from anxiety or depression. The survey was conducted in January-February 2021 and, at that time, more than half of adults with asthma reported feeling more anxious since the start of the COVID pandemic.


A number of studies, conducted both in Australia and overseas, have shown that a large majority of people living with asthma could, with proper management, be living fuller, better, more active lives.

So why, with all the treatments we have available for asthma, are so many people living with symptoms like breathlessness, the stress of having flare-ups or attacks and feeling hopeless?

“It's partly because asthma management in Australia is subpar,” says report author Professor Helen Reddel. “Asthma is often regarded as fairly trivial and most attention is given to severe asthma, which is only around five percent of the asthma population. This focus is partly because patients with severe asthma can have spectacular improvement with addition of biologic therapies, but you can get similarly striking responses if you manage non-severe asthma well.”

“There are a lot of barriers to good asthma care in Australia. The strongest of those, and the most difficult to address, is the reliance on blue puffers (salbutamol inhalers) for asthma treatment. There has been an assumption for 50 years that these inhalers are the main treatment for asthma, and in Australia, this is reinforced by their over-the-counter availability. It's very difficult to change something that's so deeply embedded in the health system, in public awareness, in patient awareness, in health professional awareness.”

Want to stay up to date with our research on sleep and respiratory conditions?
Sign up to our monthly newsletter


How do you “sell” the paradox that a medicine that can save your life might actually do you harm if it’s all you take or if you use it too much?

“There's no simple fix. We have strong evidence that new strategies for asthma management recommended by the Global Initiative for Asthma (GINA) and by the Australian asthma guidelines reduce the risk of someone with mild asthma needing to go to the emergency department or be hospitalised by two thirds, but we have an implementation gap.”

“Part of the problem is that people often don't actually talk to their GP about their asthma. In addition, GPs may not be aware of the new asthma treatment strategy and may not have some of the skills and resources that will help to improve asthma management. This sometimes requires a coordinated multi-disciplinary approach, which is time-consuming. In my clinic, I repeatedly see people with uncontrolled asthma symptoms and frequent attacks, and in most cases, these patients can experience really substantial improvements. We need to encourage people, if their asthma is like this, to ask for a specialist referral to assist their GP.”


Professor Reddel believes that having processes and simple checks that can be done routinely in a GP’s office, would make a big difference to asthma management in Australia.

“We need to start by encouraging patients to recognise if their asthma isn't well controlled, meaning they have symptoms more than a couple of days a week, have more than one attack requiring medical attention in a year, or it interferes with their ability to do normal activities. They need to talk to their GP about their asthma and have some basic checks – things like inhaler technique, adherence, comorbidities, weight, diet. These things can make a huge difference.”

Translating to better lives for patients and huge savings to our health system.

Find out more

Share online

Register your interest as a research participant for research studies

We Need Volunteers for our research

Our Affiliations