Health

Asthma: ‘It’s not taken seriously. This is killing people’

Emer Kelly was 47 when she died of an attack in January. Fatalities are on the increase

Emer Kelly, who died of an asthma attack, and her daughter, Ciara Kelly

Niamh Cahill
Sat Oct 6 2018 - 08:01

Ciara Kelly’s mother, Emer, suffered from asthma since childhood and was “always breathless”, Ciara recalls. Asthma attacks came “almost monthly” and Emer was hospitalised many times following severe attacks.

Despite the severity of her condition, however, Ciara felt healthcare professionals “weren’t sure how to treat it … There wasn’t a huge amount of help there to prevent attacks happening”.

Emer Kelly was 47 when she died in January following an asthma attack.

“My mother said goodnight to me and went to bed as normal. An hour later the noise of her nebuliser could be heard through the whole house. It was instant panic. I knew that she was always a worrier, which always made matters worse, so calming her down was my goal. Taking her hand and telling her to relax over and over, telling her she could breathe when all she could say to me was that she couldn’t.”

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“The sheer terror in her eyes told me that this was not a normal attack. She could not breathe. An ambulance was called immediately as her nebuliser did nothing. Her heart gave out and she sank to the floor. That entire night was a blur.”

Despite the high prevalence of asthma here, Ciara believes the condition is not taken seriously. “You see it in movies. You see the nerdy kid with asthma that takes his asthma inhaler and gets made fun out of, but the reality is that child has trouble breathing. It’s not something that’s taken seriously. Any amount of asthma is not good.”

“This is killing people. It’s ruining families and can happen completely out of the blue.”

Asthma Society of Ireland chief executive Sarah O'Connor says asthma attacks are "not normal and are an indication that asthma is uncontrolled". In Ireland one in five children has asthma.

Hard to manage

Severe asthma is often difficult for clinicians to manage. Nationally around 500 people suffer from severe asthma. New therapies are accessible but such drugs are expensive and often limited in terms of availability.

A HSE-led National Severe Asthma Network is currently under development to help improve patient access to new drugs.

Dr Dermot Nolan, Irish College of General Practitioners HSE integrated care lead for asthma, said the fact that asthma deaths were increasing "serves as a wake-up call for us all".

More than one-fifth of asthmatics continue to smoke, despite its negative effects on the airway, he said.

A previous study conducted by Dr Nolan found just six per cent of asthma patients had a self-management plan.

An audit of asthma deaths conducted in the UK identified an over-reliance on the blue, reliever inhaler. Using more than one reliever inhaler a year indicates uncontrolled asthma but 60 per cent of Irish asthmatics use their inhaler daily, Dr Nolan said.

The audit found optimal care was not being received and many had not seen their GP at least one year before death.

Michael Martin’s 19-year-old son, Chris, died on December 27th, 2015, following an asthma attack. Chris suffered from asthma since childhood, but Michael said it never stopped him doing what he wanted, including playing rugby.

Chris, from Gorey, Co Wexford, was studying environmental science at University College Cork and was "loving life", Michael says. The night before Chris died, he went out with friends and came home at 10pm. He "wasn't chesty at all", Michael recalled.

Chris Martin, who died on December 27th, 2015, aged 19, following an asthma attack

“There wasn’t a bother on him. He was having the craic and joking and laughing. He went to bed and woke up the next morning and then, bang, he couldn’t breathe. He got out of bed to put on his socks and just keeled over.”

Michael was suffering from cancer at the time and was on his way to Knock to pray for a cure. He got a phone call telling him Chris was having a bad asthma attack and rushed home, but Chris died before he got there.

“It seems only like yesterday,” Michael says. “There’s a void we can’t fill. Christmas will never be the same again. Not in a million years did we as a family think asthma could kill you.”

In transition year Chris travelled to Gambia as part of a fund-raising initiative for a project there. "It had big bearing on his life", Michael says.

Michael travelled to Gambia last February after organising a fund raiser for another project.

“They’re building a school in Gambia and naming it after Chris,” he says. “The sad thing was, where Chris was, I went. I followed in his footsteps. We had a Mass over there, and even the priest in the sermon was talking about Chris. It was an emotional trip.

“Chris was such a good kid. We don’t want his memory to die.”

Factors in fatalities

Dr Paul Carson at Allergy Ireland Slievemore Clinic said asthmatics should not die from the condition due to advancements in modern medicine.

He listed a number of factors, however, that could lead to a potentially fatal asthma attack. They include non-adherence to medication, going out without medication, sudden exposure to an allergy triggering an asthma attack, poor treatment of nasal and sinus allergies and medication interactions triggering an attack.

An allergy to pollen can trigger an attack, Dr Carson said. “At the moment all respiratory allergies are increasing worldwide. Hay fever affects 24 per cent of the population but scientists predict in 10 years this will jump to 50 per cent,” he says.

Dr Carson says it is unknown why this is happening, but there are suspicions atmospheric pollution, indirect pollution (chemical additives in food), “the hygiene hypothesis” – a lack of early childhood exposure to infectious agents – and genetics are possible causes.

Asthma Society of Ireland medical director Dr Marcus Butler says the majority of asthma is allergic and the rise in asthma and hay fever loosely correlates with increased exposure to perennial indoor allergens, chiefly the house dust mite and to a lesser extent moulds, Dr Butler said.

“This is to do with major changes in our own habitation, where we spend more time indoors in recent decades,” he says. “There are also theories of a link among asthma prevalence and the changes to a clean and chlorinated water supply in the past several decades in addition to increased use of broad spectrum antibiotics, the eradication of intestinal worms, the rise in inactivity relating to the arrival of television, alterations in diet, rising obesity rates and a variety of environmental toxicants.”

The reasons for asthma deaths are “poorly understood”, he said, but there are some risk factors in fatal and near-fatal asthma, such as admission to an intensive care unit, or numerous hospitalisations for asthma.

A recent history of poorly controlled asthma, where the patient might be waking at night, a change in pattern towards needing more frequent use of blue inhalers, and more variable readings on peak flow meters patients use to monitor their condition are other risk factors.

DOCTOR’S ORDERS: HOW TO HELP

Advice from Dr Butler on what should be done if you see someone having an asthma attack

Help the person to follow the Irish Asthma Society’s Five-Step Rule, which states that someone having an asthma attack should:

1. Stay calm. Sit up straight – do not lie down.

2. Take slow, steady breaths.

3. Take one puff of your reliever inhaler (usually blue) every minute.

Use a spacer if available.

People over six years can take up to 10 puffs in 10 minutes.

Children under six can take up to six puffs in 10 minutes.

4. Call 112 or 999 if your symptoms do not improve after 10 minutes.

5 Repeat step 3 if an ambulance has not arrived in 10 minutes.

Remember if someone is having an asthma attack, do not leave them on their own.

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