Asthma

Swollen, twitchy airways that narrow, causing wheeze, cough, chest tightness and breathlessness. It affects over 2 million Australians, adults and children. With the right medicine, good inhaler technique and a written plan, it can usually be well controlled.

Asthma attack? Sit upright and stay calm. Give 4 separate puffs of a blue or grey reliever through a spacer, with 4 breaths after each puff. Wait 4 minutes. If no better, give 4 more puffs. Still not breathing normally? Call 000 and keep giving 4 puffs every 4 minutes until help arrives. If your action plan uses a different reliever, follow your plan.

Symptoms

• Wheeze (a whistling sound when breathing out), cough (often at night or early morning), a tight chest and breathlessness.
• Symptoms that come and go and are worse with colds, exercise, cold air, smoke, pollen, dust mites, pets or stress.
• In children: coughing at night, fast breathing, or the skin sucking in above the collarbone or between the ribs.
• Thunderstorms in pollen season can trigger sudden severe asthma, even in people with hay fever who’ve never had asthma.

Causes and risk factors

• A mix of genes and environment. It often runs in families.
• Allergies, hay fever and eczema make asthma more likely.
• Tobacco smoke exposure, including before birth and in childhood.
• Some jobs with dusts, fumes or chemicals can cause or worsen asthma.

How it’s diagnosed

• Your doctor asks about symptoms, triggers, allergies and family history and listens to your chest.
• In adults and older children, a breathing test (spirometry) before and after a reliever confirms it.
• In young children, it’s often diagnosed from the pattern of symptoms and a trial of asthma medicine.
• Wheezing in babies under 12 months is usually bronchiolitis, a viral chest infection, not asthma.

The asthma ladder

Everyone with asthma needs a reliever and a written action plan. Most people also need anti-inflammatory medicine. The aim: no night symptoms, no limits on activity and no attacks.

1. Step 1 · Self-careAction plan, technique and triggersA written asthma action plan from your GP, a spacer, a technique check at every visit, a yearly flu vaccine, and a smoke-free home.

   Works

   The foundation that makes every medicine work. Incorrect inhaler technique is very common, and only about 1 in 5 Australian adults with asthma has a written plan

   Cost

   Spacers about $10–20; plans and technique checks free with your GP or pharmacist

   How long

   Ongoing; review the plan yearly

   Watch for

   Share your child’s plan with school, childcare and family.

   A puffer that sprays the back of your throat is treating your tonsils.

2. Step 2 · PharmacyBlue reliever puffer (salbutamol)Opens the airways within minutes. Everyone with asthma should carry one, unless their plan uses an anti-inflammatory reliever instead.

   Works

   Fast symptom relief, but it doesn’t treat the swelling. Relying on it alone raises the risk of severe attacks

   Cost

   About $10–15 from a pharmacy

   How long

   As needed

   Watch for

   Needing it more than usual means your asthma isn’t controlled: see your GP. Shakiness and a fast heartbeat are common.

   Great fire extinguisher, no use as a smoke alarm.

3. Step 3 · PrescriptionAnti-inflammatory reliever (budesonide-formoterol)One inhaler with a steroid and a fast-acting opener, used only when you have symptoms. For mild asthma in people 12 and over.

   Works

   Cuts severe flare-ups by more than half compared with a blue reliever alone, and works as well as a daily preventer for mild asthma

   Cost

   Under the $25 PBS co-payment; $7.70 concession

   How long

   As needed, long term

   Watch for

   Hoarse voice or mouth thrush (rinse and spit after). Follow the maximum doses on your plan.

   The reliever that also treats the cause. Two jobs, one puffer.

4. Step 4 · PrescriptionDaily preventerAn inhaled steroid every day, sometimes combined with a long-acting opener. Used by children and adults with regular symptoms or flare-ups.

   Works

   In a year-long trial of mild asthma, a daily inhaled steroid meant about half as many flare-ups as a blue reliever alone, and better day-to-day control

   Cost

   Under the $25 PBS co-payment; $7.70 concession

   How long

   Daily, even when well; reviewed every few months

   Watch for

   Hoarse voice, mouth thrush: use a spacer and rinse after. Stopping when you feel well is the most common reason asthma comes back.

   It works best on the days you think you don’t need it.

5. Step 5 · SpecialistSevere asthma careFor the few with frequent attacks despite good technique and treatment. A respiratory specialist may add other inhalers, tablets or injections (biologics).

   Works

   Biologic injections reduce flare-ups and steroid tablet use in carefully selected people with severe asthma

   Cost

   $25 per script on the PBS ($7.70 concession) for those who meet strict criteria, plus specialist fees

   How long

   Long term, with regular review

   Watch for

   Bring your action plan, inhalers and a record of flare-ups.

   First check the basics. Most ‘severe’ asthma turns out to be technique or missed doses.

Costs are rough Australian prices in November 2026 and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

• Breathing techniques instead of medicineBreathing exercises may modestly improve quality of life, but they don’t replace preventers or relievers. Fine as an extra, never a swap.
• Relying on the blue reliever aloneIt eases symptoms but doesn’t treat the swelling, and relying on it raises the risk of severe attacks. Ask about an anti-inflammatory reliever or preventer.
• Stopping the preventer when you feel wellFeeling well is the preventer working. Talk to your GP about stepping down instead.

What you can do

• Get a written asthma action plan and keep a photo of it on your phone.
• Use a spacer with puffers, and ask for a technique check at every visit; children need a spacer (with a mask if very young).
• Have a yearly flu vaccine.
• Know your triggers; treat hay fever well and check thunderstorm asthma alerts in spring.
• Keep your home and car smoke-free; if you smoke, quitting helps your asthma and your family’s.
• Carry your reliever everywhere, and check it hasn’t expired or run out.

See your GP if

• You use your blue reliever more than usual, or wake at night with asthma
• Asthma stops you or your child exercising, playing or sleeping
• You’ve needed steroid tablets or an emergency visit in the past year
• You don’t have a written action plan, or it hasn’t been reviewed for a year

Call 000 (Australia) or your local emergency number if someone can’t speak a full sentence, has blue lips, is drowsy or confused, is gasping or collapsing, or their reliever isn’t helping. Also call if you’re not sure it’s asthma. If they have a known severe allergy, give their adrenaline autoinjector first, then the reliever. From a mobile, 112 works in most countries.

Helpful resources

• Asthma Australia: Asthma ToolkitAction plan downloads, first aid poster, Asthma Control Test and technique videos, plus 1800 ASTHMA (1800 278 462) to talk to an asthma educator. Australia.
• National Asthma Council: How-to videosShort videos showing correct technique for each type of inhaler and spacer, for adults and children. Australia.

Evidence and more information

• Better Health Channel: Asthma emergency first aid
• Healthdirect: Asthma in children
• National Asthma Council: Anti-inflammatory reliever therapy (2026)
• Novel START trial: as-needed budesonide-formoterol (NEJM, 2019)
• Asthma in Australia by the numbers
• Cochrane: Breathing exercises for adults with asthma

Reviewed 1 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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