Asthma in Ireland

Asthma is a very common condition seen in primary care in Ireland. Indeed, the following headline dated 11 November 2013 appeared on the Asthma Society of Ireland website “Ireland is Top in Europe for High Asthma Rates.” Also in 2013, the European Respiratory Society noted that Ireland has a comparatively high adult mortality rate for asthma, and is at the top of the European table after Serbia, Albania, Azerbaijan, Uzbekistan and Kyrgyzstan. The situation is equally worrying for childhood asthma, with Ireland listed in the countries with the most cases of childhood wheezing and asthma.

High rates of uncontrolled asthma:

According to a presentation given to the Joint Oireachtas Committee on Health and Children by the Asthma Society of Ireland on 7 February 2013:

• 60% of asthma sufferers (in Ireland) do not have their asthma under control.
• 62 people died from asthma in 2011. Tragically, a large number of these deaths were preventable because asthma is a controllable disease with the right treatment and management.

The 60% cited in the first point above, is based on the HARP (Helping Asthma in Real Patients) study which found that across a number of participating GP surgeries, up to 60% of patients failed to meet international criteria for asthma control.

Also, again according to the Asthma Society of Ireland, recent research has found that “more than half of Irish people with asthma are awakened at night by asthma symptoms, and nearly three-quarters of sufferers experience some limitation in their normal activities due to asthma. Worryingly, almost eight in 10 children with asthma did not have their illness under control”.

Other information about the effectiveness of asthma care and control in Ireland which has been stated on the Asthma Society of Ireland website is as follows:

• Ireland has the fourth largest prevalence of asthma in the world.
• Almost 1 in 10 of the Irish population has asthma.
• 18.9% of 13 to 15 year olds in Ireland have asthma.
• More than one person a week in Ireland dies from asthma
• There are about 20,000 asthma related hospital Accident & Emergency Department attendances annually in Ireland for asthma.
• For the many Irish people with low incomes, the high costs of medicines and GP visits can prove a barrier to effective asthma care and management.
• Some asthma patients are rationing their medicines, particularly the preventative inhalers, or even foregoing them entirely due to their prohibitive expense.
• Almost 8 in 10 children with asthma do not have their illness under control.

Asthma care, control and management guidelines:

Informed self-management and adherence to prescribed treatment play a key role in the control of severe asthma. Patients and doctors/nurses need to work in partnership to achieve optimal asthma care and control. Guidelines for asthma care vary somewhat from country to country. However, most asthma care guidelines highlight effective control of asthma as the most important goal, as a way to ensure that the asthma patient is able to lead a normal and physically active life.

Essentially, this means the objectives for the patient are: (a) to be completely free of any symptoms e.g. cough, wheeze, breathlessness, (b) to attend work or school regularly and to participate fully in all activities, including sport, (c) to have restful sleep, free from night-time cough and/or wheeze, (d) to minimise the number of asthma attacks, and (e) to avoid hospital admissions.

Medication is the mainstay of asthma care. However, internationally there is growing interest in non-pharmacological ways of controlling asthma, and in particular, the Buteyko Breathing Technique (BBT).

Improving asthma care and control with the Buteyko breathing technique

According to Bruton and Thomas (2011), many patients have concerns about taking regular medication, particularly inhaled corticosteroids, for their asthma care. In an article published in ‘Nursing Practice’, Hambleton (2013), a respiratory nurse specialist, notes that integrating the Buteyko technique into asthma care can promote patient autonomy and reduce the need for drugs.

She states:

“Buteyko breathing technique (BBT) can be used to improve asthma control and is included in the BTS (British Thoracic Society) guidelines. It hands back control to the patient and can reduce the amount of drugs they are required to take.”

“Initially only one consultant sent me referrals for BBT. However, as I began to demonstrate the benefits for patients and successful use of the technique, other consultants have now engaged with the service.”

In an article published in ‘Practice Nursing’, Godfrey (2010) notes that the Buteyko breathing technique is being increasingly used in the UK’s National Health Service in asthma care. She also notes that research has demonstrated the Buteyko technique to be a safe technique that it is suitable for asthma care in the majority of the population, including children (from age 4).

If you would like to read one of my recent articles on use of the Buteyko method for asthma, you may do so via the links below. For the first article which appeared in ‘Nursing in General Practice’, click here and see pages 14 to 16.

For the second article which appeared in ‘Irish Pharmacist’, click here and see pages 24 to 25.

You may find details of other articles (on the Buteyko Method and other subjects) written by me in the ‘My publications’ page of this website. click here

Global Initiative for Asthma (GINA) assigns clinical evidence rating of ‘A’ to Buteyko

The Global Initiative for Asthma (GINA) was launched in 1993 in collaboration with the National Heart, Lung, and Blood Institute (USA), the National Institutes of Health (USA), and the World Health Organization. GINA’s strategies for asthma care are shaped by committees made up of leading asthma experts from around the world. One of GINA’s key objectives is to improve the management of asthma.

In May 2014, GINA published a report titled ‘Global Strategy for Asthma Management and Prevention 2014 (Revision)’. On page 40 of this report, GINA assigned Breathing Techniques (including Buteyko) an evidence level rating of ‘A’. For evidence level ‘A’, the sources of evidence must be: (a) randomised controlled trials (RCTs) and meta-analyses, and (b) a rich body of data.

GINA defines evidence level ‘A’ as:

“Evidence is from end-points of well designed RCTs or meta-analyses that provide a consistent form of findings in the population for which the recommendation is made. Category ‘A’ requires substantial numbers of studies involving substantial numbers of participants.”

In the online appendix (page 38) of the aforementioned report, it states:

“Several studies of breathing and/or relaxation techniques for asthma and/or dysfunctional breathing, including the Buteyko Method and the Papworth Method, have shown improvements in symptoms, SABA use, quality of life and/or psychological measures, but not in physiological outcomes.”

“Breathing techniques may thus provide a useful supplement to conventional asthma management strategies, including in anxious patients or those habitually over-using rescue medication.”

Also, in the revised (2014) GINA ‘Pocket Guide for Asthma Management and Prevention: A Pocket Guide for Physicians and Nurses’, it states the following on page 19:

“In addition to medications, other therapies may be considered where relevant, to assist in symptom control and risk reduction.”

Note: For information on asthma and its link to anxiety click here.

One of the examples given of other therapies “with consistent high quality evidence” was Breathing Techniques which according to the pocket guide “may be a useful supplement to medications.”

You may access the above documents by clicking on the following links: the GINA report (Revised 2014), the appendix (Revised 2014), and the Pocket Guide (Revised 2014).

Buteyko Breathing Clinics (Dublin and County Wicklow)