Doctors don't really know why August is the month with the highest number of fatal asthma attacks but apparently it is. Being an asthma sufferer myself it's a relief to know that very few people do, in fact, die of the condition and that most deaths are actually preventable, writes Sheila O'Flanagan.
I have what is called "persistent" asthma but I rarely have the kind of attack that most people think about when, or if, they ever consider asthmatic attacks. I don't go blue in the face and gasp for air although I have, once or twice, needed to visit my doctor to have slightly more radical treatment than the use of the preventative and reliever inhalers that I normally use.
Most of the time I go through the day without even thinking that there's anything wrong with me; mainly because I don't feel that there is - I swim (badly), go to the gym (reluctantly), play badminton (with varying degrees of success) and none of these activities are hindered by feeling that breathlessness is an issue. This is because when doing any of these things I don't normally feel breathless.
So if someone sees me use an inhaler they're usually surprised, yet the number of friends who ask me about asthma inhalers has increased dramatically over the last few years. Astonishingly, it seems that Ireland is currently fourth in the international league tables for asthma prevalence behind the UK, New Zealand and Australia. According to the Asthma Society of Ireland there are currently 274,280 people in Ireland with asthma and internationally it affects one in seven children and one in 20 adults.
There are numerous studies which suggest that asthma and affluence go together and certainly the higher a country's GNP the higher the rates of asthma it has. Given that mine started in the less tigerish 1960s when the living wasn't as easy as it is now and we were actually allowed to play in the dirt without being scrubbed by an anti-bacterial wipe, I can't really accept wealth as the cause. But we have a family history of allergies to various pollens and dust and so I guess I'm a historically poor rather than rich asthmatic.
However, I can afford my monthly supply of inhalers without which my condition would be much more serious. In fact the basic minimum cost of both preventative and reliever inhalers is below the social welfare monthly threshold. But for families on marginal incomes this can be a problem, though one which they shouldn't have to face. Preventative treatment for asthma is spectacularly effective. Taken regularly it will see a person with asthma lead an active life with little or no problems. As it takes a while for the effect to build up, and because preventative inhalers work by relieving the inflammation of the airways, they need to be taken daily to remain effective. Preventative inhalers are twice as expensive as relievers. Therefore, marginal-income families are likely to stop taking preventative inhalers once the symptoms have disappeared. Unfortunately this means that sooner or later the person concerned will begin to wheeze again and will become progressively worse. This will necessitate another visit to the GP, another prescription for inhalers and still more preventable expense.
It makes sense to stop attacks in the first place and to spend healthcare money on education and prevention rather than dealing with wheezing, breathless and sometimes panicky patients at a busy doctor's surgery. In 1998, an audit of 290 asthmatic schoolchildren in the south-east of Ireland was conducted by the Asthma Society to determine how well their asthma was controlled in comparison to international guidelines. Regretfully, despite the advances in the treatment of asthma, Ireland is bottom of the international league table of developed countries for asthma control. One of the main reasons is under-use of this preventative treatment and a lack of understanding regarding how to get the most benefit from both preventative and reliever inhalers. Although for many people it's a question of cost, for others it's a question of denial. I met a woman recently whose child had been diagnosed with asthma but who felt that using a preventative inhaler made him reliant on a drug.
She believed that her son would (as many children do) "grow out of it", but by using a preventative inhaler now she might impair his ability to heal himself. And she was concerned about the fact that these inhalers contain steroids (though in extremely low doses). Medical reports, however, tell us that if the inflammation of the airways caused by asthma is left untreated, ensuing damage will occur which cannot be repaired. So a child could be left with permanently damaged airways.
That's not to say that he or she can't then live a perfectly normal life by using prescribed inhalers, but why allow damage to occur when it can so easily be prevented? For a time I "grew out" of my asthma, having no wheezing and sneezing for a number of years. Then it came back. I struggled along for a while but was feeling increasingly wretched. I tried alternative remedies but with limited success as they didn't relieve the breathless feeling enough for me to feel comfortable. In the end I thought that a decent night's sleep was more important than living without drugs. Asthma is a condition over which patients have an enormous degree of control. In my case it means not walking through a meadow full of cowslips. Not using aerosol sprays in a confined space. Using my preventative inhaler every morning and every night. And limiting the amount of time I spend in smoky environments.
I find it mildly ironic that being in a place where people are damaging their lungs with their drug of choice I have to reach for my prescribed medicine to counteract it. Given the amount of tax currently raised on cigarettes, it would seem fitting that some of this money could be diverted towards assisting with the cost of preventative inhalers where necessary; thus reducing the number of hospital admissions due to asthma attacks and ultimately saving money. And, hopefully, stopping absolutely preventable deaths no matter what the month.
www.asthmasociety.ie low-call 24 hour information hotline: 1850-445464