Are YOU an asthma sufferer who never uses their inhaler?

Tiernan Green never regarded his asthma as serious. 

If he ever felt tightness of the chest after playing football — something that happened once a week at most — he’d just use the blue ‘reliever’ inhaler and that was it.

He had never had an asthma attack but had been diagnosed after suffering a wheezy chest before he’d even started at school. ‘But it never held him back,’ says his mother Donna. ‘He did PE and played lots of sport.’

As well as his reliever inhaler, Tiernan was prescribed a brown preventer inhaler in his teens.

This contains a small dose of inhaled steroid that’s meant to be taken every day to build up protection against asthma over time, by reducing inflammation in the airways. The idea is that it helps prevent an asthma attack when you come into contact with triggers such as pollen, pollution or dust.

However, like around 40 per cent of asthma patients, Tiernan failed to use his preventer inhaler, thinking that he didn’t need it as his asthma was mild.

‘I remember going into his bedroom and finding that none of the bags of brown inhaler medication were opened,’ says Donna. ‘I didn’t realise the importance of taking it.’

Tiernan was 18 when he had his first asthma attack two-and-a-half years ago.

‘It just came on one afternoon while he was in his bedroom at home,’ says Donna, 43, a housewife from Lurgan, County Armagh, who is married to Stephen, 43, an HGV driver, and has three other children, Stephan, 25, 19-year-old Mise-Eire and Ryan, eight.

‘I could tell he was unwell. His blue inhaler did help a bit, but his breathing was still shallow so I took him to A&E. They rushed him off and he was hooked up to monitors and a nebuliser [a mask over the face to deliver medicines to the lungs].’

So much to give: Tiernan (far left) was 18 when he had his first asthma attack in late 2015

Tiernan ended up spending two days in hospital. ‘The doctors there told him he had to start taking his preventer inhaler,’ recalls Donna. But he never followed this advice — with devastating consequences.

Eighteen months passed without incident, but after a late night out with friends in Belfast, Tiernan, then 20, stumbled into his parents’ bedroom gasping for breath.

‘He was pale, his lips were blue and the veins were standing out on his face,’ says Donna. ‘He was puffing frantically on the blue inhaler but it was having no effect, so I called 999.

‘As he was gasping for breath, Tiernan said: “I’m going to die tonight.” It was the most frightening moment of my life.’

By the time the ambulance arrived ten minutes later, Tiernan had stopped breathing. He was taken to hospital but there was nothing they could do. ‘I can’t believe how quickly asthma took him,’ says Donna. ‘I didn’t realise how serious asthma was and I found out in the most devastating way, when my boy died in my arms.’

Tiernan is one of 1,400 adults and children in the UK who die each year following an asthma attack — a toll that’s risen 17 per cent since 2014. Shockingly, the UK has the worst record in Europe for asthma deaths in children.

And as many as two-thirds of these deaths could be prevented with better care, a Royal College of Physicians review concluded in 2014. Yet new figures published last month by the charity Asthma UK reveal failings in NHS asthma care remain widespread, putting patients at risk. 

Basic asthma care for Britain’s 5.4 million sufferers should include inhaler technique checks to make sure that they are used properly, an annual review with a GP or practice nurse and a written care plan, as set out in separate guidelines from NICE and from the British Thoracic Society and Scottish Intercollegiate Guidelines Network.

Meanwhile, those patients having symptoms or using their reliever inhaler three or more times a week, or using more than one reliever inhaler a month, should have an asthma review sooner as this is a sign that the inflammation in the airways needs better controlling to avoid the risk of a life-threatening asthma attack.

Gone too soon: Tiernan (pictured far right) with loved ones who urge correct usage of inhalers  

Anyone admitted to hospital for an asthma attack should be reviewed by a GP or practice nurse within 48 hours of being discharged, say the guidelines.

But the Asthma UK survey of 7,500 patients revealed that 65 per cent still do not receive the basic care set out in the guidelines. It also found that one in six — around 800,000 people — described their NHS asthma care as poor, and 85 per cent said they felt their asthma was uncontrolled, up from 79 per cent in 2014.

‘We are deeply concerned about this bleak picture of asthma care,’ says Dr Samantha Walker, director of policy and research at Asthma UK. ‘Millions are not getting basic asthma treatment, despite the fact it is proven to save lives.’ So why has there been so little progress?

According to Dr Andy Whittamore, a GP and Asthma UK’s clinical lead, there needs to be better education of doctors, nurses and patients about the importance of keeping asthma under control.

This means making sure patients use their regular preventer inhaler as well as their reliever one, and that they know how to use their inhaler correctly.

If asthma is well-controlled, the blue reliever inhaler should not be needed regularly — patients should have no more than one to two puffs three times a week. After Tiernan’s death last year, Donna discovered he had used his blue reliever inhaler 30 times on the day he died.

Too many: He is one of 1,400 adults and children in the UK who die following an asthma attack, each year

And like many asthma patients, Tiernan didn’t use his preventer inhaler. A study of almost 2,700 people with asthma published in the BMJ Open journal last October revealed nearly 40 per cent of asthma patients never use it.

‘Asthma is a serious condition, and there is a massive problem with patients not taking their preventer inhaler,’ explains Dr Whittamore.

‘Many people get away with just using their blue reliever inhaler, so they think the brown inhaler isn’t necessary.

‘However, in the vast majority of cases, it is essential that people take their preventer inhaler every day, even when they are well, to keep their asthma under control and prevent asthma attacks.

‘We need to get that message across better.’

New NICE guidelines, published last November, recommend that GPs use two tests to confirm a diagnosis — the fractional exhaled nitric oxide (FeNO) test, which involves breathing out into a hand-held machine (if asthma is uncontrolled more nitric oxide is produced) and spirometry, which measures the amount and flow of air that can be inhaled and exhaled.

Using these tests will help reduce the 30 per cent of patients wrongly diagnosed with asthma, says NICE (in some cases, patients may have a wheeze caused by a virus, for instance). Yet the FeNO test is not widely available in most GP practices and many family doctors are not trained to use it.

However, Dr Duncan Keeley of the Primary Care Respiratory Society UK, says their introduction could lead to more problems for patients. ‘It could lead to delays in diagnosis and treatment, and an increase in referrals to specialists at a time when there are unprecedented pressures on the service already,’ he says. ‘It’s just not practical without significant investment, and even then it is unclear whether these tests would provide better results.’

The recommendations could potentially even put asthma patients at risk, he warns, because they conflict with existing guidelines from the British Thoracic Society and Scottish Inter-collegiate Guidelines Network.

These recommend GPs try patients with a high probability of asthma on preventer and reliever inhalers to see if these improve their symptoms, and use the easily available peak-flow test — which measures how fast you can breathe out to see how well your lungs are functioning — to help with diagnosis.

‘We now have substantially conflicting advice on key issues in asthma diagnosis and management,’ Dr Keeley wrote in The BMJ in January. ‘This is causing confusion among health professionals and risking worse outcomes for people with asthma.’

He says the UK needs a single, regularly updated, evidence-based guideline covering both diagnosis and management of asthma.

Since Tiernan’s death in January last year, Donna inevitably worries about her sons Ryan and Stephan, who also have asthma. Theirs is well-controlled, however, and they diligently take both types of inhalers.

‘I urge anyone with asthma to take all the medication they are prescribed by their doctor and to take the condition very seriously,’ she warns.

‘Don’t be fooled into thinking — like Tiernan — that asthma is not a serious condition. I don’t want any other parent to go through what we have been through.’

For more information go to asthma.org.uk/manageyourasthma