September is a wicked month for children with asthma

Returning to a musty school and exposure to children with viruses and bacteria can make it a stressful time

Tue, Aug 26, 2014, 01:00

Orla Dunne has had her share of “scary moments” with her son Max, who suffered uncontrollable bouts of coughing from about the age of two.

Even just running across the road would leave him spluttering and out of breath. Although Orla had some experience of asthma, she hadn’t seen this form before and didn’t make the link.

At times, particularly during the night, it got so bad. “Max couldn’t catch his breath, it was that severe, and he would go blue on us. It was quite scary at the time.”

Their GP prescribed a reliever inhaler to be used with an aerochamber, but he was young for a diagnosis of asthma, so he wasn’t given preventative medication and they had to wait a year to see a respiratory consultant in Tallaght hospital.

The Dunnes thought the inhaler device wasn’t working. Then they brought it along to an open day hosted by the Asthma Society of Ireland (ASI) and found out they weren’t using it properly. A nurse sat them down to work out an asthma management plan, and demonstrated how to use the inhaler.

“The main thing for us was maintaining it until we got the diagnosis and he was put on the preventative [medication],” says Orla. And the support of the ASI was invaluable during that time of limbo.

The consultant was great, once “you got your foot in the door”, she says, and Max saw him every three months initially but now, three years later, he needs only an annual check-up.

Takes time

It takes time for the preventative medication to kick in and doses were raised and lowered in an effort to find the right balance for Max. There were occasions when Orla would “sit by the bedside, afraid to turn away in case he would stop breathing on us”.

Max had to be brought to the emergency department at Tallaght hospital a number of times. There he would go on a nebuliser and be given steroids. That was “until the age of four; until we got it completely managed,” says Orla.

Now that he is six, the difference in Max is “fantastic”. “We don’t actually have to use the Ventolin [reliever] inhaler that often anymore.”

But he uses the preventative inhaler twice daily, which controls everything, she says. He races up and down the road outside their house in Tallaght with no problem, and can jump on the trampoline in their back garden without sparking a coughing fit after a couple of bounces.

They used to have to ensure Max was indoors early because damp air in the evenings was a trigger. “This summer he has had a ball and been able to stay out.”

Cold air and dust are among the more common triggers for asthma, a condition in which the airways become oversensitive to such things. (Smoke, mould, pets, pollen, colds and flu are also likely to affect those who are susceptible.)

Muscles around the airway tighten up, making it more difficult for the air to flow in and out. A longer-term effect is swelling of the airway, and accumulation of mucus.

No direct cause has been identified but it is understood to be an inter-reaction between genetics and the environment; having cleaner homes is thought to be a factor in the rise of cases in developed countries. Ireland has the fourth-highest rate of asthma in the world, with an estimated 470,000 adults and children affected.

Although Max missed quite a bit of school when he started in junior infants at Scoil Maelruain Junior, Orla has no worries about him now that he is going into first class. “He still goes in with his aerochamber and inhaler just in case, but rarely needs it,” she says.

Back to school

Many other children are not so fortunate. While September is most associated in families’ minds with back to school, it is also the time for a significant jump in hospital admissions of children with asthma; and the two are not unconnected.

The link is due to several factors, says asthma nurse specialist Frances Guiney. These include the fact that parents may have discontinued medication over the summer, when the child didn’t seem to need it; children are in a different environment and air quality may be an issue if the school building has been closed; they’re exposed to more bacteria and viruses in mixing with fellow pupils, and the new school year is a stressful time.

According to the most recent figures available, hospital admissions for children aged five to 14 years suffering with asthma rose from 41 in August 2012 to 143 in September 2012: an increase of 249 per cent. In the same year, the average length of hospital stays for children’s asthma increased by 51 per cent: from 1.41 days in August to 2.14 days in September.

Yet emergency cases, with one life lost every day in Ireland due to asthma, are only part of the story. It is the most common chronic illness and affects one in five children.

“Children will go downhill academically if their condition isn’t controlled,” says Guiney.

Not only do they miss on average 10 days of school a year, their concentration and energy levels may also be poor, due to disturbed nights and lethargy. Having to sit out for PE or other physical activities does nothing for their morale, either.

An estimated 60 per cent of asthma sufferers do not have their condition under control. “People with asthma should be like people without asthma in 95 per cent of cases,” says Guiney, who works with ASI. This can be achieved through appropriate medication and reducing contact with known triggers where possible.

To help parents and schools cope with what is a “red flag” time, the society is hosting free clinics in primary schools and towns around the country from September 15th to 26th to advise about the management of the condition.

Bad asthma attacks do not usually come as bolts out of the blue: generally there is a build-up of symptoms, she explains.

“I feel strongly that people with asthma should have some form of management plan. Once they recognise something out of sync with their condition, they know what to do, where to go and when to get help.”

Plan templates are available from ASI and they are “generally completed by the patient and their healthcare professional”, she says. “It outlines what medication to take on a daily basis, how to take them how to recognise your asthma is deteriorating and what to do about it and, if you get an attack, what to do and when to get help.”

The ASI is also very keen to advise schools. “We can provide best-practice guidelines but we can’t tell schools what to do,” she adds. “But they should have some form of policy, to know which children have asthma.”

Improved 100 per cent

Gary and Aoife Doyle first got in touch with the ASI after a pharmacy had given them what turned out to be the wrong spacer device for their son Noah, who had been diagnosed with asthma by their GP just after he turned four. They had noticed he had a really bad cough and seemed run down.

“The ASI gave me loads of advice and sent me out an aerochamber,” says Gary. “As soon as Noah got that, he improved 100 per cent; it was an instant response.

Although Gary has asthma himself, he is the first to say that he “didn’t have all the answers”, so has found the ASI advice helpline really useful.

“It was tough at the start and we were really struggling with Noah. The practical advice they can give is really valuable to parents.”

They had already opted for wooden floors instead of carpets at their home in Gorey, Co Wexford, but it hadn’t occurred to them to cut down on cuddly toys too.

They were having difficulty with getting Noah to take the preventative inhaler every morning before Aoife left with him for Dublin, dropping him off at his granny’s house in Ashford, Co Wicklow. When an ASI adviser pointed out that it really wasn’t going to work because Noah was tired and had just woken up, they realised that they would be better off letting his granny do it with him instead, before she took him to his preschool.

Noah will be starting “big” school in Ashford next month and the Doyles will tell the teacher about his condition, although they are happy it is being managed properly now. However, there may be times when he needs to take his blue inhaler at school. As with Gary, the condition seems to be triggered by a lot of sport or a change in the weather.

“Hopefully it will be something he will eventually grow out of. But I didn’t,” Gary says.

Asthma is a very different condition for everybody, Guiney stresses – and it can change within the same person.

“If you don’t treat the stage you’re at, it is going to get worse. If you don’t treat the inflammation in the airways, it is likely to worsen.”

The contrary is true as well, she says. It can get better. But she would never say somebody has “grown out of it”, preferring to call it a “remission”.

For more information and for details of the back-to-school clinics, see asthma.ie. Asthma nurse specialists are available on the ASI helpline, 1850-445464, Monday to Friday, from 10am to 1pm.

swayman@irishtimes.com

Back-to-school checklist

Have your child’s asthma reviewed by a GP before school starts.

Inform the school of your child’s condition and inquire if the school has an asthma policy. Guidelines are available on asthma.ie.

The Asthma Society of Ireland provides a school card that can be used to record essential details about your child’s health and treatment.

Make sure your child carries a reliever (blue) inhaler at all times and that there is a spare, labelled one left in school.

Keep your child at home if they are not well enough to attend.

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