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Compared with 2012, fewer participants had well\u2010controlled symptoms (ACT\u2009\u2265\u200920: 2021, 48.0%; 2012, 54.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and more had very poorly controlled symptoms (ACT\u00a05\u201315: 2021, 26.8%; 2012, 22.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37\u20131.69];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Fewer participants had good symptom control while taking little\/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little\/no ICS (2021, 38.1%; 2012, 25.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12\u2009months. Overuse of short\u2010acting beta\n                      <jats:sub>2<\/jats:sub>\n                      \u2010agonists was common: 56.3% adults obtained \u2265\u20093 inhalers in the previous year, and 10.5% obtained \u2265\u200912 inhalers. For symptom relief in the previous 4\u2009weeks, only 13.3% adults reported using an anti\u2010inflammatory reliever (ICS\u2013formoterol).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system\u2010wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ACTRN12620000977976p<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70221","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:06:29Z","timestamp":1782281189000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021"],"prefix":"10.5694","volume":"224","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-6350","authenticated-orcid":false,"given":"Helen K.","family":"Reddel","sequence":"first","affiliation":[{"name":"Australian Centre for Airways Disease Monitoring (ACAM) Woolcock Institute of Medical Research  Sydney New South Wales Australia"},{"name":"Macquarie Medical School, Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria R.","family":"Ampon","sequence":"additional","affiliation":[{"name":"Australian Centre for Airways Disease Monitoring (ACAM) Woolcock Institute of Medical Research  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne M.","family":"Poulos","sequence":"additional","affiliation":[{"name":"Australian Centre for Airways Disease Monitoring (ACAM) Woolcock Institute of Medical Research  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon R.","family":"Davis","sequence":"additional","affiliation":[{"name":"Australian Centre for Airways Disease Monitoring (ACAM) Woolcock Institute of Medical Research  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett G.","family":"Toelle","sequence":"additional","affiliation":[{"name":"Respiratory and Environmental Epidemiology Woolcock Institute of Medical Research  Sydney New South Wales Australia"},{"name":"Department of Health Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy B.","family":"Marks","sequence":"additional","affiliation":[{"name":"Respiratory and Environmental Epidemiology Woolcock Institute of Medical Research  Sydney New South Wales Australia"},{"name":"Lung Health Burnet Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taehoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Australian Centre for Airways Disease Monitoring (ACAM) Woolcock Institute of Medical Research  Sydney New South Wales Australia"},{"name":"Division of Respiratory and Critical Care Medicine, Department of Internal Medicine Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan  Ulsan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Chronic Respiratory Conditions","author":"Australian Government, Australian Institute of Health and Welfare","year":"2024"},{"key":"e_1_2_13_3_1","volume-title":"Mortality From Asthma and COPD in Australia. 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