Friday, August 24, 2012

One asthma death too many

Tisha Smith 1993 - 2008
One person dies every week in Ireland from asthma. It's a shocking statistic and despite improvements over the years in asthma management and patient awareness, this tragic statistic remains unchanged.

There is no loss more devastating than the death of a child, a painful reality that Waterford couple, Geraldine and Martin Smith, and their family are struggling to live with every day.
Their 14-year-old daughter, Trisha, died en route to hospital in 2008 from an asthma attack. Trisha's brother and sister, Stephen and Claire are heartbroken by the loss of the sister they loved so much.
"Our Trisha was the most beautiful girl. She was very academic, was well liked at school by students and teachers, and she was my treasure and strength, particularly after her brother Martin died in a drowning accident, 12 years ago now," Geraldine recalls.
"My husband is asthmatic and Martin was asthmatic. Trisha was diagnosed with asthma as a child. She was allergic to the pups we had - that's how it started.
"Her asthma was quite mild, but she still carried her inhaler around with her. It never stopped her being active and having fun, in fact she had walked a marathon for a cancer charity only three weeks before she died.
I'm her mother and I would never have thought that asthma would rob my baby of her life," says Geraldine, her voice brittle with a sorrow that is never far from the surface.
"It was only when Trisha turned 14 in December 2007 that her asthma started acting up. She had an attack in January and I brought her to the hospital and once she got the nebuliser she was grand. Then in June, she had a cough for a couple of weeks so I brought her to the GP. I didn't know that the coughing was asthma-related.
"I thought it was an infection. I was so worried about her. The GP listened to her chest, gave her antibiotics, and advised me not to be so anxious. I know I was an overprotective mother, but I was all too aware of how fragile life is - I had already lost a child. I wrapped Trisha up in cotton wool and I still lost her. She used to say to me ‘mammy, why do you love me so much?' I told her every day of her life that I loved her, because of Martin.
"I wouldn't have associated death with asthma but look what I lost. Trisha was my strength when Martin died. She was a beautiful child, a beautiful child to rear and everything. It's not real what we're going through as a family. I do blame myself, I didn't take asthma seriously enough."
Geraldine struggles deeply with the knowledge that she was not at home when Trisha died. Each year on the anniversary of her son Martin's death, she and her husband went away together as a means of coping with their pain. That weekend, Trisha was staying nearby with family friends.
"She and her friends were in the house chatting and laughing, doing the ordinary things that teenagers do. Trisha got a fit of laughing and she couldn't catch her breath and she panicked," Geraldine recalls.
"Her friends called a taxi to bring her to the hospital, and she got the attack in the taxi. The taxi driver being very well meaning, put her in the recovery position, which you're not supposed to do with people with asthma, they're supposed to sit up but few people would know that. He was doing his best to help.
"I wrapped Trisha up in cotton wool and I still lost her"
"They called the Gardai and the Garda on duty performed CPR but I'd say at that stage Trisha was dead. She was 14 and a half," says Geraldine."I wouldn't have thought that my Trisha would die of an asthma attack in a million years. I'm paying a very high price for something I didn't know. I'm living without Trisha and that's just a nightmare. You have to believe that they're in a better place. But I hurt a lot."
Over the past decade, Ireland along with many other western countries has seen a significant increase in the prevalence of  asthma. More than 470,000 Irish people suffer from this increasingly common and often debilitating condition and prevalence in Ireland is now the fourth highest in the world.
While death from asthma remains an uncommon event, reducing these preventable fatalities and improving the quality of life for asthma patients is the driving force behind the work of the Asthma Society.
"Asthma deaths in this day and age are unacceptable. The vast majority are preventable, but without the correct information, treatment and support these tragic deaths will continue and more families will be left devastated by the loss of a loved one," says Dr Jean Holohan, CEO of the Asthma Society. 
Asthma mortality figures in Ireland have remained static over the past five years, in the range of 55 to 60 deaths per year.
When this number dropped dramatically to 34 deaths in 2010 - a 40% decrease on the previous year and the lowest recorded figure to date - the Asthma Society was cautiously optimistic that perhaps this tragic trend was reversing.
"Unfortunately, we have just received mortality figures for the first half of 2011 and they are already back up to 38 deaths. We have no idea why the number was so low in 2010, but what is clear is that we are not having an impact on the number of asthma deaths in this country and this has to change. That is why we have decided to make asthma deaths the focus of World Asthma Day this year," Jean explains.
Most asthma deaths occur in older patients, many of whom may have other complicating health issues such as a chronic respiratory or heart conditions. However, the Asthma Society was shocked to hear that two Irish children recently suffered fatal asthma attacks.
"These are the first young deaths that we've been aware of in the last couple of years, and it's absolutely heart-breaking," says Jean.
"In previous years we've focused on very positive messages for World Asthma Day - we've been encouraging people to use our information, to use our services to enable them to optimise their own asthma control. But this year we felt that we had to highlight the terrible tragedy of asthma deaths, and that with the correct management, most of these deaths can be avoided."
Most people are surprised to learn that a child is as likely to die from poorly controlled mild to moderate asthma as they are from severe asthma.
While a breakdown of risk factors for paediatric asthma deaths is not available in Ireland, the UK National Review of Asthma Deaths (NRAD) has confirmed that about 50% of deaths occur in children with mild/moderate disease.
The confidential review enquiry also found that of the 20 children who died between 2001-2006, approximately two-thirds did not have a written asthma management plan and only one-in-four had a peak flow measurement recorded. Seven children had spirometry recorded, only one of whom had mild/moderate asthma.
Importantly, almost half of the children who died were poorly compliant with prescribed medication and one-in-three had poorly controlled asthma despite taking their recommended treatment (which was therefore considered to be inadequate). That's according to the first report on asthma deaths in children in the eastern region of the UK, which was published in March this year in the Primary Care Respiratory Journal.
"The key to keeping your asthma under control is to have a written asthma action plan from your doctor or asthma nurse, take your controller medication regularly, every day - even when you're feeling well," advises Jean.
"That's because it works over a period of time to give your airways the protection they need. Keep your controller in a handy place - so that taking it becomes part of your daily routine. It is estimated that 20,000 emergency department attendances per year are as a result of asthma, and many of these could be prevented with simple measures."
Jean reassures people with asthma and parents of children with asthma that their condition can be controlled with appropriate treatment. When controlled, there should be less flare-ups and severe exacerbations should be rare.
"The UK confidential enquiry found that about 50% of children died between June and August, indicating that their flare-ups may have been allergy-aggravated. This suggests that clinicians should really be very thorough about helping people to identify what their asthma triggers are so that they can take extra precautions at those times of the year when they might be vulnerable."
"I think we cannot stress the message enough that people need to be aware of and manage their own asthma, which for most patients is mild to moderate.
"Everybody needs to make sure that they have the best advice, that they are compliant with their medication, and that they are aware of their triggers and take the necessary precautions, even when they're well.
"Don't take risks with your asthma by reducing your controller medication without clear guidance from your GP or respiratory specialist. Get an asthma plan, if you don't have one already, and discuss it with your doctor - it is key to monitoring your condition and being able to identify when you need to seek help, and when you should do so urgently. Never hesitate, and if in doubt seek urgent help."
"It is also vital that the people around you, responsible for you - in schools, in sports clubs - that
they are aware of the simple but very important steps to take in the event of an asthma attack," she suggests.
"Always make sure you have your reliever medication with you - don't leave the house without it; in the school bag, in your handbag, in the sports bag. For younger children it's really important to carry a spacer device. And be aware of the five step rule - it says exactly what people should do, either for yourself or if you're looking after someone.
"Never be afraid of making a fuss, particularly at night. If you or someone else having an attack is not responding, don't worry about upsetting other people. Call for help, and don't take any risks."

The Five Step Rule for Asthma Attacks
1. Take two puffs of reliever inhaler (usually blue) immediately
2. Sit upright and stay calm
3. Take slow steady breaths
4. If there is no improvement take one puff of reliever inhaler
every minute
• You can take up to 10 puffs in 10 minutes
• Children under six years can take up to six puffs in 10
5. Call 999 or 112 if:
• Symptoms do not improve after following steps 1-4 OR you
are worried (If an ambulance does not arrive within 10 minutes repeat Step 4)
During an asthma attack, extra puffs of a reliever are safe!
• Don't put your arm around me or lie me down - this will
restrict my breathing
• Do use a spacer if available
• Do listen to me - I have had attacks before 
From the Asthma Society of Ireland Asthma Attack Card'

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