Respiratory consultant emphasises the importance of personalised action plans to manage symptoms, while community care brings positive benefits for people with COPD, writes Michael McHale
Access to anti-inflammatory inhalers for everyone with Asthma remains an urgent need. That’s the message from the organisers of World Asthma Day, which took place on May 5.
The Global Initiative for Asthma (GINA) used the day to raise awareness of the need to ensure that all people with asthma can access inhaled medications that are essential for controlling the underlying disease and treating attacks.
Asthma is one of the most common chronic non-communicable diseases that affects over 260 million people.
However, despite the availability of medications to control the condition, asthma is responsible for over 450,000 deaths each year worldwide.
The vast majority of these deaths – 96 per cent – take place in low- and middle-income countries, where there is often a lack of availability or high cost associated with these medicines, especially inhaled corticosteroid-containing inhalers.
Even in high income countries, the cost of managing asthma can mean that many people with the condition have limited access to essential medicines, which can put their lives at risk.
An Irish survey of more than 500 parents of children with asthma recently uncovered how cost barriers are leaving many without these vital inhalers.
One-in-ten parents told the Asthma Society of Ireland that their child went without their asthma medication in the past three months because of financial constraints.
Furthermore, the survey found that more than one-third of children have been hospitalised in the past year because of their asthma, with 14 per cent hospitalised at least twice.
Inconsistent inhaler use and availability for children is a likely contributing factor to many of these outcomes. Findings from the survey released to Irish Medical Times showed that 42 per cent of parents do not have a personalised asthma action plan for their child.
A similar proportion of children – 43 per cent – have refused their medication at least occasionally when not symptomatic, with 17 per cent doing so always or often.
Asthma is one of the most common chronic non-communicable diseases that affects over 260 million people
Sadly for many, the condition appears to be impacting how their daily lives. Almost 30 per cent of parents said that their children always or often worry that sport or physical activity will trigger their asthma. Around one-in-four said their children always or often feel anxious about using their inhaler or spacer in public.
“When asthma is picked up early and managed well, children generally do extremely well. The right treatment plan, a personalised asthma action plan and regular reviews can make an enormous difference, not just now but for the rest of a child’s life,” said Prof Marcus Butler, consultant respiratory physician at UCD and St Vincent’s Hospital Group.
“If a child’s asthma is affecting sleep, school, sport or daily life, it may be uncontrolled and need to be reviewed. Any child hospitalised because of asthma should receive urgent follow-up care and a written asthma action plan so families know how to prevent flare-ups, manage symptoms and recognise when emergency help is needed.”
The survey also found that 61 per cent of parents said their child had been woken at night in the past three months by their asthma symptoms, including coughing, wheezing or breathlessness.
A further 41 per cent of children had missed at least one week of school in the past 12 months due to their asthma. Night-time waking and limited daily activity are clinical indicators of uncontrolled asthma in children.
On World Asthma Day the Asthma Society called on Minister for Health Jennifer Carroll Mac Neill to make maintenance and reliever therapy (MART) inhalers free for children aged 12-17.
“Children with asthma should be able to sleep well, go to school, play sports and thrive. But they also need access to the right treatment at the right time, and, for too many families across Ireland, cost is getting in the way,” said its CEO Eilís Ní Chaithnía.
“MART inhalers are the preferred treatment for asthma under national and international clinical guidelines, yet their cost remains prohibitive. Making these inhalers free for children aged 12 to 17 years would help prevent attacks, reduce hospital admissions, and allow more children to enjoy their childhood to the fullest.”
The GINA recommends that every person with asthma, including most pre-school children with asthma, should receive inhaled corticosteroids. Preferably, they say that a combination 2‑in‑1 inhaler containing both an inhaled corticosteroid and a quick-acting reliever should be widely available.
The call comes ahead of COPD Awareness Month, which takes place in November. According to national clinical guidelines published in 2021, chronic obstructive pulmonary disease is estimated to affect 500,000 people in Ireland, of whom more than 200,000 have moderate or severe illness, while just half are likely to be diagnosed.
Under the HSE’s Chronic Disease Management Programme, people with COPD who have a medical card or GP visit card can undergo a review of their condition twice a year. Each review consists of a practice nurse consultation and a GP consultation.
The HSE also advises people with COPD to use medicines, including inhalers, as prescribed.
Maintaining a healthy weight and exercising regularly can also improve symptoms and quality of life, while learning breathing techniques can be helpful in dealing with shortness of breath.
The National Clinical Programme for Respiratory supports access to respiratory services for patients living with COPD and asthma.
To move care away from acute hospitals and into communities, specialist respiratory teams have been established in Integrated Care Hubs around the country to treat COPD patients.
Other initiatives include the CARE virtual ward in Donegal which has changed how COPD is managed in the north west since its launch in 2023, empowering patients to manage their condition at home and delivering significant clinical and economic benefits.
The virtual ward has proven to reduce COPD admissions and improve patient outcomes. In its first two years it contributed to a 20 per cent drop in COPD admissions and a 50 per cent fall in readmissions, with 934 hospital bed days avoided.
COPD Support Ireland is the country’s only Ireland’s only national COPD support and advocacy body, bringing together local support groups from around the country, to help those living with, and caring for someone with, COPD.
Information on local COPD support groups can be found on www.copd.ie/map-of-membership/. 