Revised 2025 edition of Australian Asthma Handbook now available

The revised 2025 edition of the National Asthma Council’s (NAC) Australian Asthma Handbook is now available. Providing the national guidelines for asthma management in Australia and leading the provision of evidence-based, practical advice for asthma management in primary care, the revised 2025 edition also includes changes for improved diagnosis and management of asthma in infants and children.

Included in the 2025 revised edition are recommendations that encourage health professionals to stop prescribing or advising treatment with as-needed short-acting beta2 agonists (SABA) alone to manage asthma in adults and adolescents. The revised NAC Australian Asthma Handbook now recommends anti-inflammatory reliever (AIR)-only therapy and maintenance-and-reliever therapy (MART) for adults and adolescents (aged over 12).

“The updated NAC Australian Asthma Handbook guidelines released today state that all adults and adolescents with asthma need ICS as part of their treatment to reduce inflammation and prevent exacerbations,” said Clinical Associate Professor Debbie Rigby, pharmacist and Clinical Executive Lead, NAC. “SABA-only treatment is associated with a higher risk of severe asthma exacerbations compared with AIR-only or with maintenance treatment with a low dose of ICS.

“For patients not using maintenance ICS-containing inhalers, low-dose budesonide-formoterol taken as needed markedly reduces the risk of severe exacerbations requiring oral corticosteroids, compared with SABA taken as needed,” Rigby added.

Australia’s Minister for Health and Ageing, Mark Butler, launched the updated guidelines on 16 September, saying: "The updated Australian Asthma Handbook will support primary health professionals to better diagnose, treat and manage their patients with the condition.

“It is the latest part of a national push to improve how asthma and related respiratory conditions are managed, helping those living with asthma to breathe easier and live well,” Butler added.

Extensive research and review of national and international evidence led by a multidisciplinary network of expert primary care and specialist contributors on the NAC’s Guidelines Committee preceded the release of the revised edition.

According to NAC Guidelines Committee Chair Professor Nick Zwar, that health professionals prescribe anti-inflammatory treatment from day one when it comes to asthma in adults and adolescents is the critical take-home message.

“The common approach was starting patients with mild asthma on SABA as needed; however, this did not treat the underlying inflammation,” Zwar said. “Starting patients on the new recommendation for low-dose budesonide-formoterol as needed offers a more evidence-based approach to asthma management and reflects the biology of the condition.

“Patients sometimes initially think that an anti-inflammatory reliever doesn’t work as well as their SABA puffer, and we need to help them understand that it is working — the quick action of the long-acting beta-agonist gives relief from symptoms, and also, they are getting an anti-inflammatory effect from the low-dose corticosteroid.

“The new recommendations give a patient just as good a response and treatment effect in terms of reducing the risk of having future exacerbations and needing to use oral prednisolone and they are very similar in terms of day to day symptom control.

When prescribing AIR or MART treatment, Zwar added that every patient should be given a Written Asthma Action Plan.

“This clearly outlines what the person is supposed to do and how much medication they should be using and when they should be concerned.

“If the patient takes action early and they are using a low dose anti-inflammatory medication, it means that the asthma attack is controlled more quickly and they are using less reliever medication.

“We also encourage all health professionals to advise patients to carry their anti-inflammatory reliever at all times and use it when they experience difficulty breathing, or before exercise, if needed,” Zwar said.

Summary of key changes

NAC provided the following summary of key changes for adults and adolescents with asthma:

Initial treatment for most (AIR-only)

• Treatment in adults and adolescents should be started with inhaled low-dose budesonide-formoterol (anti-inflammatory reliever (AIR)-only therapy), taken as needed when symptoms occur.
• Low-dose budesonide-formoterol as needed reduces the risk of severe exacerbations requiring oral corticosteroids, compared with SABA taken as needed.
• The older treatment, maintenance treatment with low-dose ICS (plus salbutamol as needed), is the alternative treatment option for patients with a new diagnosis of asthma.
• Maintenance treatment is generally not necessary for adults and adolescents with infrequent symptoms and no specific indications for maintenance ICS treatment.
• For patients using maintenance low-dose ICS plus SABA as needed (alternative Level 1 option), consider switching to budesonide-formoterol as needed (recommended Level 1 treatment) as a strategy to reduce exacerbation risk.

MART (maintenance-and-reliever therapy)

• Start treatment at a higher level (low-dose MART or medium-dose MART) if the patient has frequent symptoms, a recent severe asthma exacerbation that required treatment with systemic corticosteroids, or known risk factors for severe exacerbations.
• MART reduces the rate of exacerbations, compared with fixed-dose maintenance ICS-LABA regimens (with SABA as needed) at the same or a higher ICS dose.
• Low-dose MART using budesonide-formoterol can easily be stepped down to as-needed budesonide-formoterol, without the need for a new inhaler.
• For patients using maintenance ICS-LABA plus SABA as needed, consider switching to MART before considering a dose increase.
   

Images: Supplied. Top image caption: Anti-inflammatory reliever with spacer.