In this interview, Sarah O’Connor, CEO of the Asthma Society of Ireland charts today’s key challenges around asthma in Ireland and beyond
Asthma is everywhere in Ireland. They have the fourth highest prevalence of asthma globally and it stands out as the most common chronic condition in the country. As we begin this interview with the CEO of the Asthma Society of Ireland, Sarah O’Connor, she reveals that more than one person each week loses their life to asthma in Ireland and of these deaths, 90% are considered to be preventable. These figures highlight the impact of a disease which many dismiss as a simple childhood condition or ‘nothing to worry about’.
This interview covers a number of important areas around asthma, including those who do not have their condition under control, the importance of ensuring that everyone with the condition lives a full and symptom-free life, the research priorities and the policy priorities in the field.
What are your thoughts on those who do not have their condition under control?
In Ireland, it is estimated that up to 60% of people with asthma don’t have their condition under control. For many people, this is due to the high cost of the essential controller medication which forms the core of asthma management. Controller inhalers can cost up to €70 each per month and asthma, despite being a lifelong condition, is not included in the long-term illness scheme in Ireland. As a result, these people are at risk of an asthma attack. Many people are completely unaware of how well they would feel if their condition was properly managed.
What challenges do people face in managing their asthma today?
Asthma, like many chronic conditions, is a complex disease. The diagnosis process can be quite confusing for many people and it challenges people to fully get to grips with the condition and how to manage it. Ongoing education is crucial in supporting people with asthma throughout the journey and we are actively working to expand the resources online and in person available to people during this “just diagnosed” stage.
Asthma management is an ongoing challenge which involves taking control of environmental factors and making lifestyle changes, as well as taking medication as prescribed. Identifying the factors which kick-off asthma symptoms (known as asthma ‘triggers’) are a huge part of maintaining asthma control. This can often seem overwhelming, especially for those who have just been diagnosed. People are trying to learn about and manage their homes, the weather, smoking, exercise, and air pollution. Many people are unaware that there are even ‘triggers’ to consider, they think asthma attacks and other symptoms are a normal, routine and expected part of the condition.
Asthma is a condition that can affect people at any stage in life, but it is disproportionately prevalent in children. This can bring separate and distinct challenges, as adults sometimes dismiss asthma and do not see its importance and children can struggle to express the serious impact it has upon them and can find it hard to communicate when they are feeling very unwell.
What needs to be done to ensure that everyone with asthma lives a full and symptom-free life?
In order to ensure that everyone with asthma can live a full, active life free from asthma symptoms, better and equal access to medication is desperately needed. We cannot accept a situation where people with asthma are living with the risk of an asthma attack because of the cost of preventative medication or GP visits.
On a broader spectrum, a better public understanding of asthma is required to battle the misconception that asthma is a harmless or ‘easy’ disease. People with asthma need to understand that asthma is a condition that results in one death a week in Ireland and they need to change their behaviour about how to manage the condition. Asthma attacks are a clear indication that a person’s asthma is not under control and we want people to see their GP if they have an asthma attack.
It is crucial that people with asthma take their condition seriously and avail of all the helpful self-management tools which are available to them. Exercise can really help people with asthma to stay fit and well, but it does require many people with asthma to manage their condition so that they can exercise safely. We need to help people with asthma on that journey so that they get the most out of their lives.
What do you think are the research priorities for the field?
Internationally, most drug-related research focuses on new and innovative ways to reduce the symptoms of people with severe asthma. These are people who remain symptomatic and experience serious asthma escalations even at high doses of traditional medication – including asthma attacks and repeated hospital admissions.
Other new research generally relates to directly influencing the immune system. Immunotherapy is a key area of interest in asthma as it relates to controlling the symptoms of allergic rhinitis and asthma symptoms. Sub-lingual immunotherapy (SLIT) is one method which is being extensively researched in Ireland and is showing success for some patients.
On a more domestic scale, a significant research gap exists in Ireland. Studies are needed to ascertain the true number of people living with asthma in Ireland in recent years, as well as those most at risk of asthma-related death. We are seeking funding for these vital research projects so that we can better answer the big questions about people for asthma and improve their lives as a result.
Without this research, it is impossible to determine the needs of the asthma population or even ascertain the true impact of any existing or forthcoming asthma-related initiatives. We need better information to get this challenging area of health policy right.
What are the policy priorities in terms of pushing forward asthma at that level?
It is crucial that the needs of people with asthma are supported by policy decisions. The most pressing of which is government action to substantially reduce the cost of asthma medication and the provision of a free annual asthma GP review, as promised when the National Clinical Programme for Asthma was created. Together, these initiatives would significantly reduce the economic and emotional burden of asthma and certainly save many lives.
There is a severe lack of dedicated paediatric asthma services, particularly given that asthma affects 20% of children in Ireland. The level of current paediatric services completely inadequate given the prevalence of the disease. Ireland currently has the lowest number of respiratory consultants in Europe, after Macedonia, at 1.3 per 100,000 people.
It is essential that the treatment of severe asthma and access to new drugs be made consistent across the country. At the moment, the provision of these lifesaving medications is dependent on the budget of individual hospitals and the drug is completely unavailable in certain areas – this makes it essentially a post-code lottery. This is an unacceptable and extremely dangerous situation for the people living with severe asthma in Ireland.
A full breakdown of the key issues we believe should be addressed by the Oireachtas is available in our pre-budget submission 2019, available on www.asthma.ie .
Sarah O’Connor
CEO
Asthma Society of Ireland
Tel: +353 (0)1 554 9201
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