Dr. Basil Elnazir:

All I can do as a clinical person is write a letter saying this definitely impacts negatively on the welfare of the child and it will lead to exacerbation of asthma attacks, hospital admissions, time off school, time off work for the parents and so on. As the Deputy said, the local authority staff will look at it and the parents will come back and say nothing happened after the letter I wrote and ask me to write another letter. This happens every day in clinical practice.

One in ten adults and one in five children in Ireland suffer from asthma. This is a difficult area for us as a doctoral practice in paediatric medicine because many other conditions in the first five years of life can confuse the diagnosis of asthma. Many viral infections can result in symptoms similar to asthma and, on many occasions, we treat them with asthma medication and that leads to people using the common phrase, "He had asthma but he has outgrown it". While the incidence among children is one in every five, there is a grey area. If I were to base it on clinical practice, it would be probably one in seven or one in eight and this becomes one in ten later in life.

Professor Crown asked about the guidelines. The society has developed an e-learning programme in collaboration with the Irish College of General Practitioners, ICGP, and while the uptake is not great, we try to make sure we are standardising the care of asthma in Ireland but we need to do more work to makes sure this filters all the way down and that primary, secondary and tertiary care is standardised according to the guidelines.

Deputy Doherty asked an important question about inequality or inequity in treatment. The medicine, Xolair, is like a key in a lock. If the key fits in the lock in the cell, it excites a reaction and releases many substances that can cause asthma symptoms - difficulties in breathing, wheezing and shortness of breath. This medicine targets the key and, therefore, it stops the key going into the lock. It is not suitable for every asthma sufferer but it is definitely suitable for what we call severe allergic asthmatics and, in Ireland, according to figures we have, 450 people qualify for the use of the medicine. It takes the form of an injection under the skin, which must be taken every two to three weeks. There has been significant improvement, according to a study performed by Professors Lane and Costello, which highlighted a significant reduction in exacerbation and improvement in quality of life. We do not know why there is an inequality but the medicine is not covered by any of the schemes or high tech programmes. One of our colleagues treating adults in Cork has 40 eligible patients who cannot secure funding to start treatment.

Asthma is a simple condition, if managed properly. One of the parents who tragically lost her daughter wrote "I wouldn't have thought that my Tricia would die of an asthma attack in a million years. I am paying a very high price for something I didn't know. I am living without Tricia and that is just a nightmare". Education, therefore, is key among all sectors of society but particularly among the patients themselves. That brings us to the national asthma programme. We urge that this be expedited because this will bring everything back to the level of the patient and primary care. There must be education with a properly resourced programme with asthma nurses. It has been shown time and time again that the role of nurses in the management of asthma, particularly in paediatrics, is huge.