#Over the counter asthma inhaler update

Patients should use the low-dose budesonide–formoterol inhaler in the same way as a salbutamol inhaler. 7 To mitigate these risks, clinicians from the Global Initiative for Asthma (GINA) initiated clinical trials that have culminated in evidence-based changes to global, and now Australian, treatment options for mild asthma. In the past, an occasional course of oral corticosteroids was considered acceptable, but as few as four or five lifetime courses of oral corticosteroids are associated with an increased risk of adverse effects such as osteoporosis, pneumonia, cataracts and diabetes. However, patients are rarely adherent with this therapy, and poor adherence is associated with an increased risk of severe flare-ups requiring oral corticosteroids. There is no evidence of adverse effects at these doses. The risk of a severe flare-up can be reduced by half (or more) with daily low-dose ICS, for example fluticasone propionate ≤200 microgram/day or budesonide ≤400 microgram/day. 4 Approximately 15% of asthma deaths occur in patients with apparently mild asthma. This is associated with a doubling of the risk of emergency department presentation 3 and an increased risk of asthma death. Overuse is generally defined as dispensing of three or more canisters of salbutamol in a year (an average of 1.6 or more puffs per day). However, patients with mild asthma are still at risk of severe exacerbations, particularly if they overuse SABAs. In the past, it was thought that mild asthma was of little concern, and that treating it with as-needed SABAs for symptom relief and an occasional course of oral corticosteroids was a simple and inexpensive therapeutic strategy. Almost half of these usually bought relievers over-the-counter. In a large Australian population survey, 39% of asthma patients (aged ≥16 years) had not used a preventer inhaler in the previous year. These patients may not even seek medical advice since in Australia salbutamol inhalers can be purchased over-the-counter. From the perspective of patients and clinicians, asthma is usually regarded as mild if symptoms are infrequent or quickly relieved by a salbutamol inhaler, with little interference on their day-to-day life. Asthma is classified as mild if it can be well controlled with a short-acting beta 2 agonist (SABA) such as salbutamol, or a low-dose inhaled corticosteroid (ICS). Many adults and adolescents with asthma (50–70%) have mild disease, that is an estimated 1.1–1.6 million Australians. Key changes have been made around the rationale and evidence for management options, and the factors to consider in shared decision making.

The 2020 updates focus on expanded options for the treatment of mild asthma in adults and adolescents. 1 It provides evidence-based, practical online guidance for health professionals, particularly in primary care.

#Over the counter asthma inhaler update

A recent update to Australian asthma guidelines was launched in September 2020 (version 2.1).