Managing Asthma Well and Sustainably - Patient Perspectives Explored

Asthma affects 300 million people worldwide. The widespread use of short-acting beta₂-agonist (SABA) relievers, commonly delivered via pressurised metered dose inhalers (pMDIs), is contrary to evidence-based guidelines. SABA overuse is associated with poor asthma control and high carbon emissions. Reducing reliance presents a dual opportunity to improve patient outcomes while decreasing environmental impact, yet patient perspectives remain unclear.

The aim of this study was to explore the perspectives, understanding, and preferences of a sample of Australians living with asthma regarding inhaler types, medication options, self-management, and environmental impact.

We conducted in-depth interviews with adults who regularly used inhalers to manage their asthma (n = 23), recruited via consumer health networks. Participants completed an online pre-interview survey on demographics, asthma history and inhaler use. Interviews were semi-structured, following a guide developed with advice from the consumer panel. Data were analysed thematically using an inductive framework. Survey data were summarised descriptively.

Predominantly female (91%) participants had limited awareness of different device types and their environmental impact, with many surprised by pMDI emissions. While most valued environmental sustainability, they prioritised access to fast-acting SABA pMDIs, perceived to be the most effective emergency treatment by many. Familiarity, psychological comfort, and concern about reliable relief during acute asthma attacks were key barriers to switching device types. Health professional recommendation strongly influenced choice of inhaler, with most participants relying on clinician advice and expressing limited involvement in decision-making. Barriers to accessing care and information, such as cost, time and rurality, contributed to knowledge gaps and potential overreliance on SABAs. Positive experiences with asthma care nurses and pharmacists highlighted opportunities for multi-disciplinary care teams to improve support.

Environmental concern is important to patients but, alone, is insufficient to drive change in asthma management. Treatment is shaped by familiarity, habit and fear of exacerbations, with strong reliance on clinician expertise.

A consumer panel of asthma patients provided lived-experience insights during study conception, helped shape interview materials, and reviewed our findings and conclusions. Asthma Australia (Australia's peak asthma consumer advocacy body) and the Health Care Consumers' Association were engaged in this project since inception of the study idea, collaborated in co-designing the funding proposal, recruiting participants and their representatives contributed to the research as co-authors. Their involvement ensures our research reflects real-world experiences and perspectives.