What can GPs do to reform asthma management?

GPs must implement best-practice asthma management, or ‘someone else will’, warns one of the authors of a landmark reform blueprint for the management and treatment of the disease.
 
Chair of RACGP Specific Interests Respiratory Medicine, Dr Kerry Hancock, is one of five members of the Future of Asthma group, and among authors of its newly launched A Bold Blueprint for Asthma Reform.
 
The document says Australia is ‘failing’ its 2.8 million asthma sufferers, with a near 40-year stagnation in management and treatment of the disease, and has called for ‘urgent, system wide reform’.
 
‘Critically, the blueprint argues that a life without asthma symptoms, including remission, is now achievable for many Australians, but only if the system changes,’ the authors wrote.
 
In 2023, 480 Australians lost their lives to asthma. In 2023–24 it caused 32,000 hospitalisations, with more than 90% of these considered potentially preventable with better community care.
 
Its impact on Aboriginal and Torres Strait Islanders is more severe, with emergency department rates 2.7 times higher and death rates 3.4 times higher than non-Indigenous Australians.
 
Yet also in 2023–24, asthma-related health system expenditure was $1.3 billion, or 0.7% of total health system spending.
 
Of this, primary care accounted for 61% – more than double the average across diseases.
 
Dr Hancock said little has changed in asthma management since the 1980s when, following high death rates, it became classified as a priority health area, and key initiatives were introduced such as the first guidelines for the disease’s management.
 
Advances have been made since, but many have gone unused or underutilised because ‘people think we’ve solved the asthma problem’, Dr Hancock told newsGP.
 
‘There have been some really amazing changes that have happened in the last 15 years, like the biologics for asthma, which have been life-changing for some people, but because … death rates came down, people in the community become complacent.’
 
‘People deserve to have their asthma reviewed properly, more fully and comprehensively. That’s been in the guidelines for 20 years.’
 
She believes there is complacency from both GPs and their patients with asthma, with only one in four people with asthma having a written asthma action plan.
 
‘GPs have become complacent because people are not dying from asthma like they were – it came down from 1000 to 400 [annually], but has stayed at 400 for ages,’ she said.
 
‘And patients with asthma don’t demand things. They just cruise along and think, “well, I’m on my asthma medication. If I flare up, I flare up, I’ll sort that out when it happens”. They just plod along.
 
‘Both the health professionals and the people with asthma need to take it more seriously. They need to demand. People with ADHD are demanding to be seen and to be assessed as to whether they should go on to medication. People with obesity are demanding to be assessed and offered medication.’
 
The blueprint lists five main areas for reform, such as prioritising research and improving medicine use, but key to GPs is the fourth area – ‘implementing the optimal asthma consultation within primary care’ – which is authored by Dr Hancock.
 
While she supports the RACGP’s call for higher Medicare rebates, which will enable longer consultations for more complex cases, Dr Hancock suggests GPs can also implement new practice systems, such as a nurse-led asthma clinic to administer the comprehensive reviews of all patients with asthma, with GP oversight.
 
‘That’s going to be different for different practices, but a strategy can be to use the other members of the practice team, like the practice nurse and the specialist pharmacist that does the home medicines review,’ she said.
 
‘How practices are set up would be helped by policy changes around funding. It can happen without the funding, but it would be helped by better funding.’
 
Dr Hancock is concerned that if GPs do not implement best-practice asthma care, ‘then somebody else will take it away from them,’ she said.
 
At present, Queensland and Western Australia are both running pilot programs that enable pharmacists to manage and treat asthma.
 
‘What concerns me, is if GPs do not implement best-practice asthma care, there are other health professionals outside general practice who will potentially take that away from them, and be funded to do it,’ Dr Hancock said.
 
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