31 OCTOBER 2025 6 NEWS ausdoc. com. au
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31 OCTOBER 2025 6 NEWS ausdoc. com. au
Asthma guidelines updated
Professor Nick Zwar.
Jamie Thannoo EVERY adult and adolescent with asthma should be treated with inhaled corticosteroids, new Australian guidelines say.
The cohort of patients recommended solely to use short-acting beta 2 agonists( SABAs) had been shrinking over recent years as doctors moved towards maintenance-and-reliever therapy( MART) or anti-inflammatory reliever treatment.
Juvenile arthritis is one of the most common chronic diseases affecting young Australians. 3
Early diagnosis is crucial for preventing life-long pain and disability. 1, 2 You can change a child’ s life.
Learn more at jafa. org. au / hcphub
In September, the National Asthma Council( NAC) handbook finally declared that SABA-only treatment was“ now considered inadequate treatment” for all adults and adolescents.
It reflected international consensus that asthma treatment should address underlying inflammation, said GP Professor Nick Zwar, chair of the NAC Guidelines Committee.
“ We know there is evidence that people on SABA alone, even though they might
‘ It might take a bit of getting used to.’
have mild asthma, can sometimes flare up, leading them to the hospital and to need oral
DON ' T MISS THE SIGNS
STIFF I SWOLLEN I SORE
RECOGNISE AND REFER 1, 2 steroids,” Professor Zwar told Australian Doctor.
“ There is increasing evidence that recurrent repeated use of oral steroids has implications for bone health— more than we realised in the past.” The updated handbook recommends that newly diagnosed adolescents and adults start on a low-dose combined budesonide – formoterol inhaler, taken when symptoms occur.
This will lower the risk of exacerbations compared with as-needed SABAs, including for patients with infrequent symptoms, it says.
MART with budesonide – formoterol is recommended for initial treatment of more severe asthma.
The guidelines point out that these patients, if they step down treatment, will merely switch from regular to as-needed treatment using the same inhaler.
An option remains of initial maintenance treatment using low-dose inhaled corticosteroid and salbutamol as needed, but the guidelines say patients struggle with the daily habit.
Professor Zwar said patients relying on OTC SABAs should now be told by pharmacists to see a GP for a budesonide – formoterol script.
“ There will be conversations explaining to them the anti-inflammatory reliever idea, that it will work as well as SABA, that it might take a bit of getting used to, but it will reduce the risk of asthma and of having to take a course of steroids,” he said.
With spirometry declining since the COVID-19 pandemic, the guidelines explain when to use fractional exhaled nitric oxide as an alternative, Professor Zwar added.
The guidelines also include new advice on biologics, such as benralizumab and dupilumab, for treating severe asthma and persistent type 2 inflammation, with monoclonal antibody therapy labelled the“ most effective add-on treatment”.
“ These newer medicines, which are only available through respiratory specialists, are something to think about because there is increasing evidence about how effective they can be,” Professor Zwar said.
The new guidelines would also, if followed, reduce greenhouse gas emissions from inhalers, he said.
“ The advantage of the suggested approach is that more people will be able to use a dry powder inhaler, and they are preferable for having a lower greenhouse gas impact, for patients who can manage that.” NAC: Australian Asthma Handbook: asthmahandbook. org. au or scan code to visit the resource hub
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References: 1. Juvenile Arthritis Foundation Australia. About juvenile arthritis. Available at: www. jafa. org. au / about / juvenile-arthritis / [ Accessed August 2025 ]. 2. Healthdirect. Arthritis in children Available at: https:// www. healthdirect. gov. au / arthritis-and-children-juvenile-arthritis [ Accessed August 2025 ]. 3. Australian Institute of Health and Welfare. Chronic musculoskeletal conditions: Juvenile arthritis. Available at: https:// www. aihw. gov. au / reports / chronic-musculoskeletal-conditions / juvenile-arthritis # Livingwitharthritis [ Accessed August 2025 ].
Juvenile arthritis – HCP’ s program received grant funding from the Australian Government.
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