REAL WORLD: Deirdre Dowling is determined that her six-year-old son's asthma will not  have a negative effect on his life, she tells Fiona Murdoch

Six-year-old Matthew Dowling desperately wants to be the same as his classmates. He plays with the same toys, wears the same kinds of clothes - and he makes valiant attempts to run about as much as they do.

But no matter how hard he tries to keep up during break-time at Rathfarnham Educate Together National School in Dublin, he is invariably the first to run out of steam. After about 10 minutes, he is completely breathless and needs to take a rest.

Although he knows a puff from his inhaler would help, he refuses to use it - after all, none of the other kids have an inhaler. And so Matthew's remains firmly out of sight at the bottom of his schoolbag.

It is not that he minds taking his medication - he takes it at home without any fuss - but, whatever happens, his friends must not find out about his asthma.

"He hates being different - he wants to be the same as everyone else," explains his mum, Deirdre. "He seems to feel there is a stigma attached to asthma."

Deirdre - also an asthmatic - does not agree, though she admits that when she was younger she, too, hid her condition from her friends.

Asthma runs in the family - Deirdre's father was an asthmatic and her brother suffered as a child: "When Matthew asks me why he has asthma, I tell him that it is in the family. I feel guilty for passing it on."

An attack may be caused by any of a wide variety of factors. It may be exercise-induced or it may have its roots in an allergy, virus, bacteria or even an emotion.

"Sometimes just laughing can set it off," says Deirdre. "But most of the time, I can't pin Matthew's attacks down to any particular cause - they just come on for no apparent reason."

An asthma attack is, of course, terrifying for Matthew and distressing for his mum to witness: "It is horrible watching your own child suffer - Matthew becomes very frightened and he can't vocalise how he feels. But I try not to panic. When he comes out of hospital, he'll say to me: 'I'm never going back to the hospital'."

The fact that Deirdre is a nurse goes some way towards helping matters: "I am more aware of the need for preventative medicine and of when it is necessary to bring him to the GP or to casualty. When an attack gets worse, the chest becomes silent - some parents might think their child is getting better at that point."

Matthew, who was diagnosed after his first attack at the age of two, is a moderate sufferer - severe asthmatics always have breathing difficulties; in between attacks Matthew's lungs are clear.

When his asthma begins to bother him, Deirdre brings him to her GP, who prescribes steroids. If these fail to stop the attack, the next step is a trip to casualty. "I know when he's bad and he needs hospital treatment. One time a doctor sent us home at midnight and I knew Matthew was getting worse. We were back in casualty six hours later," she says.

Matthew's worst attack, which occurred late one night last October, resulted in his spending two nights in a high-dependency unit, followed by another two on an observation ward before he was well enough to go home. Deirdre has lost count of the number of times he has been admitted to hospital. She is optimistic, though, that Matthew's asthma will not affect his life unduly. "Asthma is not a life sentence: you can live a normal life with it. And it affects people less as they get older.

"When Matthew is well, I try not to dwell on his asthma too much because I don't want to make him into an invalid. He knows himself when he needs his inhaler: he'll ask me for it. And sometimes all he needs is one puff."

Deirdre looks forward to the day he will be old enough to go on holidays organised by the Asthma Society of Ireland like she did as a child. Matthew will then discover what it is like to be the same as everyone else - because everyone else's bag will also contain an inhaler!