Australian doctors advised to stop prescribing blue puffer to treat asthma for some patients
Australia's most popular asthma treatment has been declared dangerous when used alone, forcing some patients to change their medication routine. See the new changes and what it means.
Australia has overhauled the way asthma is treated, with doctors advised to stop prescribing blue “reliever” puffers alone amid evidence they leave patients at greater risk of severe attacks.
The National Asthma Council Australia (NAC) released its updated Australian Asthma Handbook, launched by Health Minister Mark Butler, which marks a major shift in how the condition is managed.
The new guidelines urge health professionals to move away from short-acting beta2 agonists (SABA) – commonly known as blue puffers – as a stand-alone treatment for adults and adolescents over the age of 12.
Instead, they recommend inhalers that combine anti-inflammatory medication with a reliever effect.
An estimated 474 people died from asthma in Australia in 2023.
Overusing blue puffers — more than three inhalers a year — is linked to a higher risk of severe asthma attacks, while relying on 12 or more in a year significantly increases the risk of death.
Clinical Associate Professor Debbie Rigby, pharmacist and Clinical Executive Lead at NAC, said the evidence is clear that inhaled corticosteroids (ICS) should now form part of every treatment plan.
“The updated NAC Australian Asthma Handbook guidelines released state that all adults and adolescents with asthma need ICS as part of their treatment to reduce inflammation and prevent exacerbations,” she said.
“SABA-only treatment is associated with a higher risk of severe asthma exacerbations compared with AIR-only or with maintenance treatment with a low dose of ICS.
“For patients not using maintenance ICS-containing inhalers, low-dose budesonide-formoterol taken as needed markedly reduces the risk of severe exacerbations requiring oral corticosteroids, compared with SABA taken as needed.”
Minister Butler said the changes would affect millions of Australians.
“The 2.8 million Australians living with asthma all depend on their healthcare teams to make informed decisions – guided by the latest clinical advice and practical tools – to deliver the best care and treatment possible,” he said.
“It is latest part of a national push to improve how asthma and related respiratory conditions are managed, helping those living with asthma to breathe easier and live well.” Chair of the NAC Guidelines Committee Professor Nick Zwar said the key shift was prescribing anti-inflammatory treatment “from day one” rather than waiting for symptoms to worsen.
“The common approach was starting patients with mild asthma on SABA as needed however this did not treat the underlying inflammation. Starting patients on the new recommendation for low-dose budesonide-formoterol as needed offers a more evidence-based approach to asthma management and reflects the biology of the condition,” he said.
Dr Anita Muñoz, Chair of the RACGP’s Victoria Faculty, said the guidelines also addressed the widespread issue of self-medicating.
“Many Australians are managing their own asthma just with blue puffers that they buy over the counter at the pharmacy, but that is no longer recommended and encourages risky over-reliance,” she said.
“We encourage people with asthma to see their GP to discuss how the new recommendations may affect them and make sure they update their written asthma action plan.”
However, Professor Rigby said that while the updated guidelines discourage SABA-only treatment, blue puffers still remain available.
“Salbutamol inhalers continue to play an important role in acute asthma management,” she said.
“Salbutamol inhalers or ‘blue puffers’ can still be purchased in a community pharmacy with professional advice from a pharmacist.”
The NAC said every patient should now be given a Written Asthma Action Plan and carry their anti-inflammatory reliever at all times.
The revised 2025 edition of the Australian Asthma Handbook also includes changes for diagnosing and managing asthma in infants and children.
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Originally published as Australian doctors advised to stop prescribing blue puffer to treat asthma for some patients
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