This year the Asthma Society of Ireland is celebrating 50 years in operation – what does that mean for the support and representation of people with asthma in Ireland? The Society’s Mary McDonald, Patient Services Manager, and Eilis Ni Chaitnia, Interim CEO, explains.
The organisation came into formal existence in 1973 when a group was formed to help raise public and political awareness of asthma and offered a support service to people affected by this chronic condition. A medical committee of experts was established to address the patient information gap and create the first Asthma Society leaflets.
What does the Society do?
The mission of the Society is to stop preventable asthma deaths and the vision is that everyone with asthma lives a full life, symptom free. In the past 50 years the Society has responded to the needs of people with asthma by providing the following services:
Adviceline
In 1982, the Asthma Adviceline was set up and, today, continues to provide education and self-management support. In 2022, the respiratory nurse specialists on the Adviceline conducted almost 4,000 consults.
In 2016, 30% of callers were recorded as taking medications for COPD. Through a collaboration with the HSE, COPD Support Ireland and the Asthma Society provided agreed packages of care for COPD to be delivered by a qualified respiratory nurse and physiotherapist.
WhatsApp Nurse messaging service
In 2019, the WhatsApp Nurse Messaging Service was developed. This innovative digital health patient education and self-management service allows users to send a query via WhatsApp, which will be answered by a dedicated respiratory nurse specialist. The service disseminates education videos and graphic resources that can be saved directly onto the user’s phone to boost daily self-management. In 2022 support was provided to over 700 users.
Webinars
A series of webinars are held throughout the year to further educate people with asthma and their carers including healthcare professionals. Webinars on seasonal topics involve different respiratory experts, nurse panellists and patient and teacher representatives.
Advocacy and research
Advocacy and research are an integral part of our work. Priorities include:
The cost of asthma
The Asthma Society of Ireland is a strong advocate for the need to reduce healthcare and treatment costs for people with asthma.
Equitable access to medication
Biologic medications are used for some people with severe asthma symptoms. The Society is working to ensure that those who would benefit can receive this treatment.
Clean air
We have been advocating for improved air quality measure in Ireland since the 1990s, most recently for the Solid Fuel Regulations, introduced by the Minister for the Environment in October 2022 Pollution from traffic, fuel and industry can worsen air quality and have detrimental health impacts.
TobaccoThe Asthma Society of Ireland has a long history of advocating against smoking and tobacco including e-cigarettes. We are members of Alliance 21 and work towards a tobacco-free Ireland.
Short Acting Beta Agonist (SABA) overuse
Human Market Research Ireland and the Society partnered with AstraZeneca to analyse individual patient data to determine the annual rate of SABA usage since initiation of treatment over a five-year period in Ireland. SABA overuse (three or more canisters used in a year) is associated with an increased risk of exacerbations and hospital admission, and the use of 12 or more canisters in a year is associated with increased risk of asthma-related death.
It was found that SABA overuse is prevalent across all age groups. However, as patients get older the rate of SABA overuse increases and hence morbidity also increases. The highest increase in SABAs overuse occurs between years 1 and 2. We conducted an award-winning digital campaign educating asthma patients on the different physiological aspects of asthma and the fact that SABAs only treat bronchospasm. We also highlighted the important message that the use of more than three SABAs per year indicates a need for a treatment review.
Oral Corticosteroid (OCS) use
The Society also commissioned HMR to conduct research on the use of OCS between 2018 and 2020. Findings showed that, of an estimated 380,000 people with asthma in Ireland, almost 27% filled a prescription for OCS from a retail pharmacy in 2020, with 82,500 patients collecting up to two OCS prescriptions over a 12-month period1. Moreover, 18% are using the medication three or more times per year, potentially leaving them at significant risk of immediate side effects, as well as cumulative long term health risks associated with OCS use.
Despite the overall drop in OCS usage in 2020, there has been an alarming increase in OCS use among a small but vulnerable group of people (4,212) where numbers have increased between 2019 and 2020 by a staggering 26%. These are patients who have collected OCS prescriptions three months or more in a row and are being prescribed consistent dosages over those months. Independent of dose, prolonged use of steroid tablets has proven to be problematic for severe asthma patients – experts claimed that they “could not find a well-founded threshold for side-effects of OCS or a dosing window for a ‘safe’ long-term use”2. There is a need for education on the safe prescription of OCS.
Conclusion
The Asthma Society’s services are designed to meet patient need, regardless of what level of care they require, responding in a timely, appropriate manner to offer support, guidance and referral to GPs.
1Research conducted by HMR November 2018 to October 2020 on behalf of the Asthma Society of Ireland, supported by AstraZeneca
2Volmer T, Effenberger T, Trautner C et al, Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature.