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.
Important 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,” says lead researcher and asthma specialist Professor Helen Reddel. “This suggests that for some Australian patients, their extra spending may not be paying off.”
More than two million Australians have asthma, a chronic lung condition that inflames and narrows the airways, causing wheezing, shortness of breath, chest tightness and coughing. The causes are still not well understood, but in patients with asthma, the triggers for symptoms are known to include viral infections, exercise, and exposure to allergens and irritants. 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 says. “However, we discovered that in both countries, almost half of the people prescribed any type of preventer medications are not taking them regularly.”
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 story becomes even more interesting when we look at how often patients said they were taking their preventer inhaler - in both countries combined, the combination inhalers were more likely to be taken regularly than simple preventer inhalers (61 per cent vs 47 per cent), but more New Zealanders than Australians were taking a preventer inhaler regularly (43 per cent vs 34 per cent).
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 says. “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.”
Explaining the trans-Tasman differences, Professor Reddel says New Zealanders pay less for their asthma medication than Australians, but until recently, access to combination therapies (which are more expensive for government) was more tightly regulated in New Zealand than Australia. “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.”
She called on doctors and pharmacists to make patients aware that choices are available for preventer medications. “In Australia, almost all of the basic asthma preventer inhalers are more affordable for patients than are combination inhalers, but there is little awareness of this,” the specialist says. “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.”
Given the high rates of poorly-controlled asthma in both countries, urgent work is also needed to boost use of preventer medications in general, she says. “Used daily and used correctly, a preventer inhaler is the very best tool a person with asthma has to ensure their condition is well controlled and reduce their risk of a flare-up,” Professor Reddel says. “Most people only need a low dose to get the full benefit, and yet so many people aren’t taking it regularly.”
“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.”