Asthma Fatigue: We Can Do Better

There are no signs that the asthma epidemic in children is abating in this country. It has been established in four successive phases of the questionnaire-based International Study of Asthma and Associated Allergic Conditions (ISAAC) study in Ireland (from 1995-2007) that the prevalence of asthma, those who responded yes to the question ‘ have you had asthma ever? ‘ has increased from 16.3% to 21.6% , an interval increase of 33%. If one examines those responded yes to ‘having wheezed in the past 12 months ‘ the prevalence rose over the same period from 29.5% to 38.9%, an interval increase of 32% (1,2).

This is in contrast to many high prevalence developed countries where rates of asthma are stabilizing or even falling. With increased awareness of the condition among the general public and clinicians and the availability evidence based treatment guidelines like GINA, SiGN/ BTS or PractALL it is easy for us to get complacent and one would anticipate improved outcomes for children with asthma. Death from childhood asthma remains a n uncommon event and undoubtedly there has been a significant fall in the rates of hospitalization for asthma particularly in pre-school children ( ). However these are crude outcome measures.

In 2005 we published results from the Asthma Insights and Reality in Ireland (AIRI study) which randomly ascertained a population of 400 individuals with current asthma (150 were children) to survey to determine their healthcare utilisation, symptom severity, activity limitations and level of asthma control. Over the previous year, 27% had either an emergency visit to the hospital or their general practitioner (GP) and 7% were hospitalised for asthma. In terms of asthma control, 19% experienced sleep disturbance at least once a week, 29% missed work or school and 37% of respondents experienced symptoms during physical activity over the previous 4-week period. Based on these findings, it was concluded that the level of asthma control and asthma management in Ireland falls well below of recommended national and international asthma guidelines.

Six years later there appears to be no significant improvement. In a survey of 271 randomly ascertained children with asthma, it was found that although 92% of parents were satisfied or very satisfied with their child’s asthma control, 35% used their rescue inhaler either daily or weekly. Furthermore, 59% experienced night-time awakenings, 25% had exercise limited days and 26% missed school on either daily or weekly basis. Poor asthma control affects sleep, school performance, sporting activity and self esteem. The apparent contradiction between parental perception of asthma symptoms and actual control using conventional criteria. Parents appear to have a tolerance for symptoms in their offspring and seem unaware of the criteria for good control. Further awareness raising measures directed at the general public , children themselves and schools about asthma and prospects for complete symptom control seem more than justified.

1) Manning PJ, Goodman P, O’Sullivan A et al. Rising prevalence of asthma but declining wheeze in teenagers (1995-2003): ISAAC protocol.

Ir Med J. 2007 Nov-Dec;100(10):614-5.

2) Lai CK, Beasley R, Crane J et al.

Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood.

Thorax. 2009 Jun;64(6):476-83.

3) Manning PJ, Greally P, Shanahan E.

Asthma Insights and Reality in Ireland.

Ir Med J 2005; 98(10):231-4.

4) Rollercoaster.ie Survey on Children’s Asthma

2010, Data on file MSD , Ireland.