LIFE wasn’t much fun for Max Dunne when he was a toddler. The youngster endured regular hospital visits and couldn’t run around, engage in horse-play with his pals, or play outdoors on summer evenings — the damp night air brought on coughing fits.
Since the age of two, Max was in and out of hospital as staff tried to ameliorate his regular fits of wheezing and coughing with nebulisers and steroids.
Too young to undergo a lung function test which would confirm the presence of the condition, asthma, he was not yet three when he was prescribed an inhaler and put on a waiting list to see a respiratory consultant.
“Diagnosing pre-school children is a bit more challenging than diagnosing older children, teenagers or adults,” explains Dr Basil Elnazir, Consultant Respiratory Paediatrician at the Adelaide and Meath National Children’s Hospital in Tallaght, and chairperson of the Asthma Society's Medical Advisory Group.
This is partly because there are some conditions which mimic the symptoms of asthma, and partly because there’s no test to diagnose asthma in pre-school children.
“We go with the cluster of symptoms which parents report and these may point us to make a diagnosis of asthma. These symptoms would include a cough or wheeze, eczema and allergies such as food allergies.
“There would be a cough or wheeze every time a child exercised, or it would be night-time coughing, or some children would cough or wheeze when playing or laughing.In this context it’s crucial that the parents of a young child with suspected asthma be familiar with the child’s symptoms,” says Dr Elnazir. And, he says, a smartphone can be a big help.
“With younger children, we rely on having the history, as there may only be very subtle signs when you are examining a child.”
Parents need to be able to give a doctor a detailed profile of their children’s symptoms, he explains. “We cannot do a lung function test on smaller children because it’s too difficult to get a small child to do it properly. It can be helpful to the health care professional if parents take a video- shot of their child coughing. You can do it with your smartphone!”
In older children, the history is also important, he says, but the test is a huge support: “With any child over the age of five we can do a lung function test and that helps with the diagnosis in conjunction with the history.”
Asthma is nothing new to the Dunne family — Max’s mum Orla had it until she was 13, and his big brother Josh suffered from the condition until he was seven. All the same, there were still some things to learn — as they discovered when they brought Max to a special clinic run by the Asthma Society.
In 2010, while Max, then three, was waiting to see the consultant, his grandmother heard about a special Asthma Society Open Day in Ballymun.
Max was brought to one of the Asthma Clinics held as part of the Open Day. The visit was an eye-opener for Orla, who made a number of changes to Max’s inhaler use, lifestyle and living conditions as a result of what the nurse had to say: “The nurse listened to Max’s breathing and went through his history with us.
“She asked a lot of questions,” recalls Orla, who says the nurse recommended that Max’s swimming lessons be stopped because she believed the chlorine in the pool was possibly exacerbating his suspected asthma.
Within a few weeks of the Asthma Clinic session, the correct use of the inhaler was making a significant difference to Max’s life: “His breathing was under control and now that we were using the inhalers properly, the difference was incredible.
“The nurse also advised us to take the carpet out of his bedroom and to remove all teddies and books as they hold a large quantity of dust which affects asthma sufferers. We did this and it was of huge benefit to his night-time routine.”
The clinic was very well organised, she recalls: “The nurse took time with us — there was no rush. We spent about half an hour with her, and we got a lot of information about asthma and useful contact numbers for the Asthma Society.