Thursday 7 May 2015

Max can breathe easy thanks to chance visit

A chance visit to an Asthma Society open day clinic literally proved to be a breath of fresh air for young Max Dunne. Ahead of World Asthma Day, his family share their story with Áilín Quinlan.

Áilín Quinlan

Published 06/05/2014 | 02:30

Max Dunne and mum Orla
Max Dunne and mum Orla
Max Dunne

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.

The asthma nurse also demonstrated the correct use of Max’s aero-chamber: “The aero-chamber is a kind of plastic cylinder — the inhaler goes at one end and the child puts his mouth at the other end and inhales. It turned out Max was not doing this properly.

“The nurse showed us exactly what to do to ensure Max was using the inhaler properly. He had a preventative inhaler twice a day and the blue or Ventolin inhaler in case of attack.”

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.

“If it was not for that clinic, we’d have been using the inhaler incorrectly for another six months before we got to see the consultant, so that session at the Asthma Clinic was fantastic.”

The family also received a number of follow-up calls from the Asthma Society to see how Max was doing, says Orla: “I was very impressed by that — I think people should really use this facility, especially if you’re awaiting a diagnosis.

“It’s great to go and speak to them and it was particularly important to hear that the swimming lessons were not of benefit to him. “Some, asthma sufferers, like Max, are negatively affected by the chlorine, but not all. We didn’t know this at all because chlorine did not affect Josh when he had asthma.”

Now aged six, Max is attending Tallaght hospital’s respiratory clinic on a regular basis, and his condition is well-managed.

Says Orla: “His asthma is under control now. He’s seen regularly by the staff at the respiratory clinic in the hospital.

“He can run and play and is out playing all the time, and is using his inhalers.”

He still comes in early in the evenings as the damp night air still affects him, and he’s not back at his swimming lessons yet, Orla continues.

“We’ve decided to wait ‘til he’s seven so his lungs should be stronger by then,” Orla explains.

Parents need support — and, through its advice lines and special clinics, the asthma society ensures support is available, says the organisation’s Chief Executive, Sharon Cosgrove, who emphasises that, as part of the arrangements surrounding World Asthma Day tomorrow, May 6, the Asthma Society of Ireland will hold clinics in shopping centres in Dublin from May 6 - 9 (see panel below).

Asthma sufferers are encouraged to visit the clinics to get practical advice on inhaler techniques and medication, devising an asthma management plan and general information on how to better control the condition.

There will also be specialist advice available to empower parents of children with asthma.

“One of the common problems that we see is inhaler technique. People have difficulty using their inhalers, so sitting down with a nurse in a clinic where she shows you how to use it is very important.

“The clinics give very practical and hands-on advice, provided on a one-to-one basis.”

Another common problem is the lack of an asthma management plan, she says. “This is a basic tool for understanding your child’s asthma and the triggers behind it.

“The asthma plan will help you to understand your symptoms and what to do about them,” she says, adding that the plan can be drawn up in conjunction with your GP or with the asthma nurse at the asthma clinic or in hospital. The society also has asthma guidelines for schools on its website, www.asthma.ie, and sends its nurses into schools to give talks about the condition. Dr Elnazir is looking forward to the roll-out of the National Asthma programme, which, he says, “will be like a kind of ‘Asthma NCT’.”

The programme will feature scheduled annual visits to the GP to monitor people with asthma, during which their asthma control is assessed and the GP ensures that each patient has an up to date asthma management plan.

“The programme is in its final phases and is expected to be rolled out in the next year,” he explains.

WORLD ASTHMA DAY, MAY 6

THERE’S a lot happening to mark World Asthma Day, May 6:

(1) The Asthma Society of Ireland and Boots Ireland will join forces to help parents and children ‘breathe easy’, with asthma management clinics to be held throughout May.

World Asthma Day is a global initiative to raise awareness of the respiratory condition and increase education of the most effective ways to control and treat it. To mark the global awareness day, Boots Ireland will be providing provide free ‘Let’s Breathe Easy’ asthma consultations and support packs in Boots its pharmacies nationwide throughout the May and The Asthma Society of Ireland will hold clinics in shopping centres throughout across Dublin from 6th – 9th May 6-9.

For advice or support on asthma, or for further information about the asthma management clinics to be held nationwide, visit www.asthma.ie or www.boots.ie.

(2) World Asthma Day Straw Test: Members of the public are invited to take the ‘straw test' on World Asthma Day, May 6, between 12.30-2pm at Boots pharmacy, St. Stephens Green Shopping Centre. People taking the Straw Test are asked to exercise on the spot for five minutes,before breathing then breathe through a straw whilst pinching their nose; this gives some idea of the challenges of having breathing difficulties, such as in the onset of an asthma attack.

*Asthma Society of Ireland Clinics:

6th May 6, 11am-4pm, Blanchardstown Shopping Centre, Dublin 15

May 7, 11am-4pm, LiffeyValley Shopping Centre, Clondalkin, Dublin 22

May 8, 11am-4pm, The Square, Towncentre, Tallaght, Dublin 24

May 9, 11am-4pm, Northside Shopping Centre, Coolock, Dublin 17

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