Asthma deaths are rising in Ireland, and hospitalisations due to the condition remain well above the European Union (EU) average, despite “game-changing” advances in respiratory healthcare.
The benefits of new thinking on management of the condition are yet to be maximised among the estimated 450,000 people who live here with asthma. It is a chronic lung condition in which the airways become inflamed in reaction to various triggers. This affects people’s ability to breathe – and can be fatal for a very small minority.
The provisional figure of 94 deaths last year, says the chief executive of the Asthma Society of Ireland, Eilís Ní Chaithnía, is significantly up from 82 in 2022, which in turn was up from the 60-plus recorded in previous years.
“For the vast majority, it’s very mild, and easily controlled with just periodically using an inhaler,” says Prof Richard Costello, a professor in respiratory medicine at the Royal College of Surgeons in Ireland (RCSI) and respiratory consultant at Beaumont Hospital in Dublin. But the type of inhaler, along with when and how it is used, is key to keeping it under control.
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“One rethinking aspect of asthma is that we are definitively, absolutely, getting rid of the people using their blue inhaler as their treatment,” he says. Instead of this blue, or reliever-only inhaler, they should be using an inhaler that has a preventer mixed in with it, a combination treatment.
“The second kind of rethinking is that we’re really keen to get people properly diagnosed,” says Prof Costello who will be speaking at a public RCSI event on “Rethinking Asthma – what works, what’s new and why it matters”.
He was a driving force behind the development of the Inca (INhaler Compliance Assessment) device. This is a stethoscope-like gadget that attaches to an asthma sufferer’s inhaler. It can detect if the inhaler is being used correctly to deliver the corticosteroid medicines into their airways and if the breathing is improved as a result.
Prof Costello’s idea for the device, which he developed with engineer Prof Richard Reilly from Trinity College Dublin, were two observations from his clinical work. “The first is it’s not easy to diagnose asthma because it comes and goes right through the year, depending on the season, depending on viruses and pollution and pollen. So if you just schedule a random test in a hospital, you may miss the diagnosis. The second was that we know that quite a lot of people don’t use their inhaler correctly. It’s quite cumbersome to use.”
Data gathered by the device between appointments gives doctors a much clearer picture of what is going on for about one in 10 people with asthma who cannot control their symptoms. Perhaps “you see them in January and you see them again in March and they were fine in March, but they were terrible in February. They might struggle to explain just exactly what was going on.”
With this diary of monitored lung function and inhaler use, doctor and patient can sit down together for a forensic look into their condition. The information helps distinguish between those who have “severe asthma”, defined as asthma that doesn’t get better with conventional inhaler treatments, and those who could recover through more effective use of inhalers. It might even show, he says, that somebody’s lung function was fine at a time they felt very ill and had thought it due to asthma. Maybe they should then be investigated for a heart issue instead.
[ ‘I don’t think asthma is taken as seriously as it should be’Opens in new window ]
An international study, led by RCSI University of Medicine and Health Sciences and funded by the Health Research Board, then looked at potential healthcare cost savings. The results, published in the Lancet Respiratory journal in 2023, showed that using this digital assessment in the management of uncontrolled asthma saved €3,000, on average, per patient.
As it takes a medical device company with the necessary expertise to develop a product for the market, says Prof Costello, their Inca prototype is now “retired”. Established companies adopted the idea and produced similar devices.
He has now created an RCSI spin-out company, Phyxiom, which is an AI platform that analyses the data recorded on these devices and feeds the results to doctors. He draws the comparison of a patient having a blood test at the GP. There is then a whole lab process before the doctor opens up their computer to read the results.
Phyxiom, which was opened earlier this year, is like a diagnostic lab for digital data. It is already being used in almost every respiratory centre in Ireland, he says, and they will start pilot schemes in the UK in November.
On improving diagnosis, “the HSE have done a superb job,” he says – acknowledging that is a phrase not often seen in the media in relation to health service management – in putting diagnostic hubs together under Sláintecare, that work alongside primary care. “It should not be acceptable to go to a GP and for the GP to say, you have asthma and here’s a treatment and I’ll see you the next time I see you.”
There’s a very clear, new set of ways of diagnosing asthma, he says – “and in fact, a simple blood test will accurately diagnose it in about 50 per cent of people”.
The fundamental changes in asthma management in the last 10 years are all geared to breaking the inhalers-antibiotics-inhalers-steroids cycle that people can get into, he says. Once asthma is confirmed as the root cause of a patient’s health issues, is it fixable with effective use of the right inhaler or is biologic therapy needed? The HSE is funding these expensive, new biologics (ie drugs produced from living cells rather than chemicals) for severe asthma, he says, but on the basis that the clinicians do “due diligence” in deciding which patients really need them.
The MyHealth RCSI’s “Rethinking Asthma” event takes place on Tuesday, October 21st, at 6pm. Free booking at rcsi.com/myhealth. A recording of the event will be available as a YouTube video and podcast. The next discussion in the MyHealth RCSI series, supported by Presidio, will be on Movement for Healthy Brains and will go live as a YouTube video and podcast on December 2nd.
While Prof Costello treats the worst cases of uncontrolled asthma, a fellow speaker at the MyHealth seminar, nurse Joanne Walsh, sees people who are generally not significantly unwell with the condition. She works at Mercer Medical centre, a GP practice in Dublin, which is part of the RCSI where she is doing a PhD in asthma education.
People are still catching up, she says, with the shift in guidelines, such as the move away from traditional inhalers. She believes there is a huge over-reliance on the reliever inhaler, Ventolin. “It’s gotten many people out of difficult situations and eased their asthma symptoms, so they trust it.”
But now asthma experts are trying to build patients’ confidence in the new way of thinking. “Like using one, combination inhaler, as they did with Ventolin, for quick relief of symptoms but also taking that same inhaler daily, which we know from the research will give adults with asthma the best, long-term results.”
The reality for people with asthma is stark: deaths are rising in Ireland
— Prof Marcus Butler
However, “what just gets to me”, she says, is that some adults with asthma “normalise living an abnormal life”.
They are resigned, for instance to not being able run around with their children – but it does not have to be like that. “If it’s well managed and we teach them the skills to go manage it themselves and work with them, they can live a completely normal life, as in minus the symptoms.”
The management of asthma is very collaborative, “but at the same time, it’s a lot on the patient day-to-day at home by themselves.” It’s not just a matter of popping a pill.
People might think the summer, with high pollen counts, is peak time for asthma but winter brings other problems. There are many viruses around; smoke from stoves and fireplaces can be a trigger and many people do not realise that cold air is an allergen too.
When it gets really frosty, cold air, which is not humidified, hits the back of the throat and causes wheeziness, she says. If asthma sufferers want to go out for a walk in the evening, they just need to pull a scarf up over their nose so it humidifies the air going in. Extreme emotions, such as stress, is also a year-round trigger.
Medication is tailored to the individual, but most people will respond to the inhaled corticosteroids, she says, which is why it is becoming the cornerstone treatment for asthma. But these MART (maintenance and reliever therapy) combination inhalers, up to €80 a month, are more expensive. The Irish Asthma Society is disappointed that Budget 2026 failed to address the affordability of this “gold standard” medication. It had conducted a survey in which 24 per cent of patients said that they had gone without their asthma medication in the previous three months, due to financial constraints.
“The reality for people with asthma is stark: deaths are rising in Ireland, hospitalisations remain well above the EU average, and too many families struggle to afford essential medication,” says the society’s medical director, Prof Marcus Butler. Making MART inhalers free, he says “would lift the financial burden on already stretched household budgets, reduce hospital admissions and save lives”.
