Non-pharmacological management of adult asthma in Australia: cross-sectional analysis of a population-based cohort study

Aim: To identify the level of non-pharmacological care received by middle-aged adults with current asthma in Australia and to identify its association with clinical measures.

Methods: The Tasmanian Longitudinal Health Study (TAHS) is a population-based cohort first studied in 1968 (n = 8583). In 2010, when participants were aged 49 years, a stratified sample enriched for asthma and bronchitis underwent clinical assessments including respiratory questionnaires and lung function testing (n = 836). Current asthma was defined as self-reported asthma symptoms and/or healthcare utilization in the last 12 months. Multivariable linear regression and log-binomial models were used to assess the relevant associations.

Results: Of the entire TAHS cohort, 15.6% (95% CI 13.4–18.2%) had current asthma. Of these, 37.9% (95% CI 30.5–45.9%) had seen a general practitioner for their asthma and 16.5% (95% CI 11.5–23.1%) had discussed their asthma with a pharmacist in the last 12 months. Written asthma action plans (AAPs) were reported by 17.9% (95% CI 12.9–23.2%), verbal AAPs by 53.8% (95% CI 45.9–61.6%) and doctor-assessments of inhaler technique by 42.7% (95% CI 35.2–50.5%). Adults with asthma of greater severity were more likely to have received verbal AAPs (p-trend =0.02). In contrast, adults with lower spirometry were more likely to have received verbal AAPs (p = 0.04), written AAPs (p = 0.001) and education on inhaler technique (p = 0.04).

Conclusion: Despite an established evidence base and recommendations in local and international guidelines, non-pharmacological asthma management remains sub-optimal in the middle-aged adult asthma population.