Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population

Helen K Reddel, Susan M Sawyer, Peter W Everett, Paul V Flood and Matthew J Peters
Med J Aust 2015; 202 (9): 492-496. || doi: 10.5694/mja14.01564


Objective: To identify patterns of asthma control and treatment in Australian adults with asthma.

Design: Cross-sectional web-based survey, conducted 1–27 November 2012.

Participants: Adults with current asthma, at least 16 years of age, drawn randomly from a web-based panel and weighted to reflect national population proportions for people with asthma.

Main outcome measures: Asthma Control Test (ACT) scores; health care utilisation; medication use.

Results: 2686 participants completed the survey (57.1% female; median age group, 40-49 years). Mean ACT score was 19.2 (95% CI, 18.9–19.3), with asthma classified as “well controlled” for 54.4% of participants, “not well controlled” for 22.7% and “very poorly controlled” for 23.0%. 60.8% reported using preventer medication (mostly combined inhaled corticosteroid/long-acting β2-agonist) during the previous year. 23.4% had made at least one urgent visit to a general practitioner concerning their asthma, 10.0% at least one emergency department visit. Urgent consultations were more common for “very poorly controlled” than “well controlled” asthma (adjusted odds ratio, urgent GP visits 5.98 [95% CI, 4.75–7.54] and emergency department visits 2.59 [95% CI, 1.91–3.53] respectively).

Participants were classified according to asthma symptom control and frequency of preventer medication usage: Those with “well controlled” asthma included Group A (40.0% of participants) who used preventer medication infrequently (less than 5 days a week) or not at all, consistent with mild asthma, and Group B (14.7%), who used it at least 5 days a week. Uncontrolled asthma symptoms were reported by Group C (19.7%) despite regular preventer use, and by Group D (25.7%), who used none or little.

Conclusions: This study provides the first data about asthma control and its relationship with treatment in a large representative Australian population. The findings highlight significant preventable asthma morbidity in Australia.

Please login with your free MJA account to view this article in full

  • Helen K Reddel1
  • Susan M Sawyer2,0,3,0,4
  • Peter W Everett5
  • Paul V Flood5,0,0,6
  • Matthew J Peters7

  • 1 Woolcock Institute of Medical Research, University of Sydney, NSW.
  • 2 Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC.
  • 3 University of Melbourne, Melbourne, VIC.
  • 4 Murdoch Childrens Research Institute, Melbourne, VIC.
  • 5 InSync Surveys, Melbourne, VIC.
  • 6 Frontrow Research, Melbourne, VIC.
  • 7 Concord Repatriation General Hospital, Sydney, NSW.


The survey, statistical analysis and logistical support for investigator meetings were funded by AstraZeneca. The survey was hosted and data analysed by Ultrafeedback/InSync Surveys. The investigators were independently responsible for the final methods, questionnaire design, analysis plan and interpretation. We had full access to all study data, including statistical reports and tables. The manuscript was drafted by Helen Reddel, and all authors contributed to the discussion and editing of the final version. We acknowledge the contribution of Anne Mulham (deceased), Susan Miller and Ellen Vasiliauskas who were instrumental in the conception and execution of the background qualitative research and in this survey. We acknowledge the assistance of John Lipscomb of InSync Surveys for additional statistical analysis.

Competing interests:

Helen Reddel and Matthew Peters have received honoraria for their memberships of committees and the provision of independent medical education for several companies that manufacture asthma medications, and Helen Reddel has also received unrestricted research grants from AstraZeneca and GlaxoSmithKline.

  • 1. Australian Centre for Asthma Monitoring. Asthma in Australia 2011. Canberra: Australian Institute of Health and Welfare, 2011. (AIHW Cat. No. ACM 22; Asthma Series No. 4.) (accessed Nov 2014).
  • 2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163-2196.
  • 3. National Asthma Council Australia. Australian asthma handbook, version 1.0 [website]. Melbourne: National Asthma Council Australia, 2014. (accessed Nov 2014).
  • 4. Global Initiative for Asthma. Global strategy for asthma management and prevention. Revised 2014. Vancouver: GINA, 2014. (accessed Nov 2014).
  • 5. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: Asthma control and exacerbations: Standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009; 180: 59-99.
  • 6. Australian Centre for Asthma Monitoring. Refining national asthma indicators: Delphi survey and correlation analysis. Canberra: Australian Institute of Health and Welfare, 2009. (Cat. No. ACM 15.) (accessed Nov 2014).
  • 7. Reddel HK, Cooper S, Guevara-Rattray E, et al. Asthma control in Australia 1990-2011. 21 years since the introduction of asthma management guidelines — where are we now? Sydney: Woolcock Institute of Medical Research, 2013. (accessed Oct 2014).
  • 8. Australian Institute of Health and Welfare. How much is spent on asthma? [website] (accessed Mar 2015).
  • 9. Poulos LM, Ampon RD, Marks GB, Reddel HK. Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study. Prim Care Respir J 2013; 22: 201-208.
  • 10. Toelle BG, Xuan W, Bird TE, et al. Respiratory symptoms and illness in older Australians: the Burden of Obstructive Lung Disease (BOLD) study. Med J Aust 2013; 198: 144-148. <MJA full text>
  • 11. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004; 6: e34.
  • 12. Australian Bureau of Statistics. Australian Health Survey: First results, 2011-12. Canberra: Australian Bureau of Statistics, 2012. (ABS Cat. No. 4364.0.55.001). (accessed Nov 2014).
  • 13. Schatz M, Sorkness CA, Li JT, et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 2006; 117: 549-556.
  • 14. Wallace LS, Rogers ES, Roskos SE, et al. Brief report: screening items to identify patients with limited health literacy skills. J Gen Intern Med 2006; 21: 874-877.
  • 15. Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) —-technical paper. Canberra: ABS, 2006. (ABS Cat. No. 2039.0.55.001). (accessed Jan 2009).
  • 16. Sinclair M, O'Toole J, Malawaraarachchi M, Leder K. Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches. BMC Med Res Methodol 2012; 12: 132.
  • 17. Australian Bureau of Statistics. Household use of information technology, Australia, 2012-13. Canberra: ABS, 2014. (ABS Cat. No. 8146.0). (accessed Nov 2014).
  • 18. Bambrick H, Fear J, Denniss R. What does $50,000 buy in a population survey? Characteristics of internet survey participants compared with a random telephone sample. Canberra: The Australia Institute, 2009. (Technical Brief No.4). (accessed Nov 2014).
  • 19. Chang L, Krosnick JA. National surveys via RDD telephone interviewing versus the internet: comparing sample representativeness and response quality. Public Opin Q 2009; 73: 641-678.
  • 20. Armour CL, Lemay K, Saini B, et al. Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control. J Asthma 2011; 48: 914-922.
  • 21. Foster JM, Smith L, Bosnic-Anticevich SZ, et al. Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma. Intern Med J 2012; 42: e136-e144.
  • 22. Reddel H, Bosnic-Anticevich S, Toelle B, et al. Identifying the needs of people with asthma in New South Wales. St Leonards (NSW): Asthma Foundation NSW, 2007. (accessed Nov 2014).
  • 23. Bateman ED, Clark TJH, Frith L, et al. Rate of response of individual asthma control measures varies and may overestimate asthma control: an analysis of the GOAL study. J Asthma 2007; 44: 667-673.
  • 24. Marks GB, Abramson MJ, Jenkins CR, et al. Asthma management and outcomes in Australia: a nation-wide telephone interview survey. Respirology 2007; 12: 212-219.
  • 25. Fuhlbrigge A, Reed ML, Stempel DA, et al. The status of asthma control in the U. S. adult population. Allergy Asthma Proc 2009; 30: 529-533.
  • 26. Demoly P, Paggiaro P, Plaza V, et al. Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK. Eur Respir Rev 2009; 18: 105-112.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.