Asthma Treatment Online: Prescriptions and Management via Telehealth

Asthma affects approximately 2.8 million Australians, making it one of the most common chronic conditions in the country. For the majority with stable, established asthma, the primary ongoing healthcare requirement is prescription renewal for reliever and preventer inhalers. Telehealth is well-suited to this - experienced patients with a confirmed diagnosis, stable symptoms, and an established treatment plan often do not need to sit in a waiting room to get a repeat script.

This guide covers what telehealth can do for asthma management, what requires in-person care, and how to access prescriptions online without compromising your clinical safety.

Understanding the boundary matters. Telehealth is appropriate for some asthma care and not others.

**Appropriate for telehealth:**

• Repeat prescriptions for reliever inhalers (salbutamol, terbutaline)
• Repeat prescriptions for preventer inhalers (ICS, ICS/LABA combinations)
• Routine asthma management review for stable patients
• Medical certificates for asthma-related absence from work or study
• Referral letters for specialist review when needed

**Requires in-person assessment:**

• First-time asthma diagnosis (spirometry required)
• Significantly worsening asthma control
• Stepping up treatment to a higher tier (e.g., adding a LABA or LAMA)
• Oral corticosteroid prescribing for acute exacerbation
• Any features suggesting anaphylaxis, vocal cord dysfunction, or another diagnosis
• Children under 12 with asthma symptoms

The key principle: if your asthma is stable and your current treatment is working, a telehealth doctor can prescribe your existing medications. If things have changed - worse control, more frequent reliever use, new symptoms - an in-person review is the safer choice.

Reliever Inhalers (Short-Acting Beta-Agonists)

Reliever inhalers are used for immediate symptom relief. They work by relaxing the muscles around the airways, opening them quickly during an episode of wheeze, chest tightness, or breathlessness.

**Salbutamol (Ventolin, Asmol, Salamol):** The most commonly prescribed reliever in Australia. PBS-listed. Can be prescribed via telehealth for established asthma patients.

**Terbutaline (Bricanyl):** An alternative SABA, also PBS-listed and prescribable via telehealth.

If you are using your reliever inhaler more than twice per week (outside of exercise), your asthma is not optimally controlled. This warrants a medication review - telehealth can address this, though it may result in a recommendation to see your GP in person if stepping up preventer therapy is needed.

Preventer Inhalers (Inhaled Corticosteroids and Combinations)

Preventer inhalers reduce airway inflammation over time and are taken daily, regardless of symptoms. They are the cornerstone of moderate to severe asthma management under the National Asthma Council Australia guidelines.

**Inhaled corticosteroids (ICS):**

• Fluticasone propionate (Flixotide)
• Budesonide (Pulmicort)
• Beclometasone (Qvar)
• Ciclesonide (Alvesco)

**ICS/LABA combinations (preventer + long-acting reliever):**

• Fluticasone/salmeterol (Seretide)
• Budesonide/formoterol (Symbicort, Breyna)
• Fluticasone/vilanterol (Breo Ellipta)
• Fluticasone/formoterol (Flutiform)

All of these are PBS-listed for established asthma. For patients already stable on one of these medications, a telehealth repeat prescription is clinically appropriate.

Maintenance and Reliever Therapy (MART)

The MART approach uses a single ICS/LABA combination inhaler (specifically budesonide/formoterol formulations) as both the daily preventer and the as-needed reliever. This is a recommended strategy in current Australian asthma guidelines for eligible patients. Telehealth is appropriate for prescribing MART continuation in patients already established on this regimen.

A telehealth doctor prescribing asthma medication will assess:

**Asthma control:** How often you are using your reliever, whether symptoms are waking you at night, whether asthma is limiting your daily activities. Poorly controlled asthma generally requires an in-person medication review rather than a simple repeat script.

**Current treatment and adherence:** Which medications you are currently prescribed, whether you are taking them as directed, and whether your inhaler technique has been checked recently.

**Recent changes:** Any new symptoms, recent respiratory illnesses, changes in exercise tolerance, or new triggering factors.

**Prescription history:** How long you have been on the current regimen and whether the most recent prescription was from a treating GP who has your full clinical history.

**Red flags:** Any features suggesting the diagnosis is not straightforward asthma, or that something more significant is happening (e.g., significant unintentional weight loss, haemoptysis, cardiac symptoms).

If the assessment is straightforward, an eScript is issued and sent to your phone. If anything suggests a medication change is needed or that your asthma control is deteriorating, the doctor will recommend an in-person review rather than simply reissue an existing script.

All commonly prescribed asthma medications are PBS-listed in Australia. The co-payment you pay at the pharmacy:

| Patient type | PBS co-payment (2026) | |---|---| | General patient | Up to $31.60 per prescription | | Concession card holder | Up to $7.70 per prescription | | Safety Net (concession) | Free after $262.80/year | | Safety Net (general) | Concession rate after $1,563.50/year |

A combination preventer inhaler (Symbicort, Seretide) prescribed under the PBS costs the same co-payment as a generic reliever - the government subsidy covers the difference. Without Medicare, the same inhaler may cost $60-90 at full private price.

If asthma causes you to miss work or university, you are entitled to a medical certificate confirming your incapacity. A telehealth doctor can issue a medical certificate for asthma-related absence without requiring you to come into a clinic.

What the assessment covers: your symptom history, duration of incapacity, and whether the level of impairment is clinically consistent with your described symptoms. Certificates are legally valid under the Fair Work Act 2009 and accepted by employers, universities, and Centrelink.

For more detail on medical certificates for work: sick leave certificates online.

A written Asthma Action Plan tells you what to do when your asthma worsens - which medications to take, at what dose, and when to seek emergency care. The National Asthma Council recommends all people with asthma have an up-to-date written plan.

Your Asthma Action Plan should be reviewed whenever your treatment changes and at least annually. While a telehealth doctor can discuss your current plan and note any issues, a comprehensive plan review is best done with your regular GP who has your full history and can perform peak flow assessment in person.

Asthma can be life-threatening. Go to emergency immediately if:

• Your reliever inhaler is not improving symptoms after 4 puffs and 4 minutes
• You cannot complete a full sentence due to breathlessness
• Your lips, fingertips, or tongue are turning blue (cyanosis)
• You are working very hard to breathe (ribs visible during breathing)
• Your peak flow is below 50% of your personal best
• You feel unusually anxious, confused, or exhausted from breathing

None of these presentations are appropriate for telehealth. Call 000 or get to the nearest emergency department.

Telehealth works well for stable, established asthma requiring repeat prescriptions. It does not replace the specialist respiratory assessment, spirometry, or in-depth management review that in-person care provides. For most adults with well-controlled asthma who simply need a repeat script, an online consultation is a practical and appropriate option.

If your asthma is well-controlled on your current regimen and you need a prescription renewal, a repeat prescription request is the appropriate pathway. If your symptoms have changed, your control is worsening, or you have never been formally diagnosed, see your GP or a respiratory specialist in person.