The GP Show #227 Asthma - Moving beyond the blue puffer with Dr Brett Montgomery
Oct 8, 2026
Dr Brett Montgomery, a University of Western Australia GP and chair of the Australian Asthma Handbook committee, unpacks major changes in asthma care. The conversation covers FeNO testing, preschool wheeze, acute attacks, and why salbutamol alone is no longer recommended. They explore MART inhalers, montelukast, treatment escalation, inhaler technique, and greener options for respiratory care.
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FeNO Helps Resolve Uncertain Asthma Diagnoses
- Fractional exhaled nitric oxide detects airway inflammation and can support asthma diagnosis when spirometry is nondiagnostic.
- It is a tie-breaker for patients with a convincing history but variable or inconclusive spirometry, not a mandatory primary-care investment.
Use Carefully Interpreted Steroid Trials In Preschoolers
- For preschool children with recurrent respiratory symptoms, assess history and examination, observe salbutamol response, then consider an 8–12-week inhaled corticosteroid trial.
- Interpret improvement cautiously because viral recovery or seasonal change may explain an apparent response.
Repeated Steroid Bursts Signal Poor Prevention
- Prescribe oral corticosteroids when acute asthma requires them, but treat repeated courses as a warning to improve long-term prevention.
- Around 1,000 milligrams lifetime prednisolone-equivalent is associated with metabolic effects, hypertension, diabetes, obesity, fractures, and low bone density.