Managing asthma: ‘I never felt like my symptoms could ever improve’

Sarah Darcy has had asthma since childhood, though she was only diagnosed as a teenager.

“I was always seen as being ‘chesty’ as a kid as I was known for terrible coughs,” Darcy says.

“But it wasn’t till I was a teenager that I was diagnosed with asthma. I remember my chest being very tight and I felt like I was struggling to breathe.

[ ‘I don’t feel my asthma is properly managed. It has a real hold over me’ ]

“I think my Mam might have thought I was trying to get out of a test in school, which could have been true, to be fair, but she brought me to the doctor, who diagnosed asthma – and I’m not sure which one of us was more surprised.

Mary Hannigan: Ireland are competing but they’re nowhere close thus far to pointing

---

Ken Early: Effortlessly elegant Ancelotti deservedly considered among the world’s best

---

Dublin constituency: Left-wing candidates face dog fight for the last seat

---

Netflix, Prime Video, Disney+, Apple TV+: 10 of the best new shows to watch in June

---

“After that and throughout my teens and 20s, my asthma was always in the background – but I could never be accused of being sporty, so I can’t really say that asthma caused issues there.

“However, I would have had coughing fits if I talked for a long time, or laughed, or was trying to shout over music and background noise on a night out.

“I know now that all of those things meant that my asthma wasn’t well controlled.”

The 44-year-old company director says that, although her medication changed over the years, she never really felt “on top” of the condition. For years she was able to “get by”, but in 2017 she had a very serious episode, which saw her seeking help from the Asthma Society and getting advice on how to better manage the disease.

“Over time I went from having just a blue reliever inhaler, to a reliever and a preventer and then went on to a stronger preventer inhaler (a powder inhaler),” Darcy says.

Controller inhalers

Asthma is a disease characterised by inflammation of the airways. “Controller inhalers are anti-inflammatory medicines prescribed to prevent the symptoms of asthma from occurring, by reducing the inflammation over time and lowering the risk of an asthma attack,” a spokesperson for the Asthma Society says.

“It does not provide any instant relief of symptoms, but builds up protection and reduces symptoms over a longer period.

“Controller inhalers are now considered to be the cornerstone of asthma treatment, according to clinicians and the GINA – international best practice guidelines – on asthma management, while reliever inhalers are prescribed for use when asthma symptoms flare. These work quickly by opening the airways wider and making it easier to breathe again, by relaxing the muscles which tighten when asthma symptoms worsen.

“The majority of people with asthma are prescribed a daily controller inhaler to protect against an asthma attack and a reliever inhaler to use when symptoms occur,” the spokesperson says.

“The controller medication should be taken every day, as prescribed and even when asthma symptoms are not present.”

Oral steroids

Darcy always felt like the medications she took “were just to keep me at the symptom level I was at – and I never felt like my asthma symptoms could ever improve”.

In Darcy’s case, there was a very slow build up of symptoms, and several courses of oral steroids in a year would not have been unusual for her.

“In 2015, I was referred for testing for the first time, this resulted in me being put on new medication, but I don’t remember much follow-up beyond checking whether I needed new prescriptions and I continued to have that slow build-up of symptoms – like the cliche of the frog in hot water, I didn’t notice how much worse it was getting,” Darcy explains.

“Then in 2017, I had a significant asthma attack with constant coughing and blue lips – and I attended the emergency department with it for the first time.

“Since then, I’ve attended A&E a few times with asthma attacks, but fortunately, I have never had to be admitted to hospital.

“Even more fortunate, when I presented to hospital that first time, the senior registrar had a special interest in respiratory illnesses and recognised that my asthma was poorly controlled.

[  ‘I had an asthma attack so severe that it actually burst a hole in my lung’ ]

“He referred me to the respiratory clinic in Connolly Hospital and suggested contacting the Asthma Society advice line – and it’s not an exaggeration to say that this was life-changing.”

The Dublin woman says that following this vital intervention, her asthma is now well controlled and she has been able to reduce the amount of medication she is taking.

“Knowing my triggers and knowing what good asthma control looks like for me means I can breathe without wheezing all the time,” she says.

“At the moment, my job involves some public speaking, where I give presentations to groups of staff for our clients, and present training to groups of administrators.

“This means speaking for anywhere between an hour to over three hours to groups of different sizes, both online and in-person – and there is no way I could manage this if my asthma wasn’t well controlled.

“Also, now I can run for the bus without coughing and I’ve noticed that other people don’t comment about being able to hear me breathe from across the room any more.

“I can sing along to the radio as well – although not sure other people would agree that’s a good thing – but my sleep quality is better too, which makes a huge difference to pretty much everything.

[ Q&A: What is asthma and how is it diagnosed in children? ]

“During the initial call [to the advice line] and the follow-up calls from specialist nurses, we spoke about good inhaler technique, having an asthma management plan, peak flow readings, and how to recognise an asthma attack and this was all so helpful,” Darcy says.

“There are great videos on the Asthma Society website too and knowing how to recognise an asthma attack and the five-step plan for [what to do during] an asthma attack have been so beneficial both to me and my family as it gave all of us a set of guidelines for what to watch out for and helped my family to know what to do in an emergency situation.

“One of the most important things for me is that I now feel like I am better able to advocate for myself when discussing my asthma with healthcare professionals.

“I am armed with more information and a better understanding of my medications. It helps me feel like managing my asthma is a partnership, rather than something which is just happening to me.”

About Asthma

• Asthma is an inflammatory disease of varying severity that affects the airways.
• Ireland has among the highest rates of asthma in the world.
• Findings of 2019 research suggest a one-in-five (890,000 people) have a lifetime prevalence rate, a one-in-13 (380,000) annual prevalence rate in adults and a one-in-10 annual prevalence rate in children.
• CSO figures suggest a fall in death rates since 2015, with 61 deaths in 2016 and 57 deaths in 2017, though these figures remain unacceptably high, in light of asthma being a largely manageable disease.
• People with asthma have airways which are extra sensitive to substances (or triggers), which irritate them.
• Air pollution can severely impact their quality of life by triggering asthma symptoms while studies have shown that air pollution can cause asthma in young children.
• According to recent research, reducing air pollution can save lives and better the quality of life for someone with asthma.
• Common symptoms include coughing, wheezing, shortness of breath, and chest tightness.
• If anyone has any concerns they should seek advice from their GP.
• Asthma Awareness Week takes place from May 1st-7th. The Asthma Society in Ireland is hosting a virtual informational conference on the topic of Asthma Care for All on Thursday, May 4th (see asthma.ie)