Supporting asthma patients during the pandemic

In late February 2020, the Asthma Society of Ireland’s team realised that an outbreak of Covid-19 was a very likely event in Ireland and we began to plan accordingly. We used initial Community Foundation funding to buy laptops to move our operations online, we adapted the working of our asthma adviceline so that all telephone calls could be managed remotely and we assessed which programmes would need to be paused in the event of the pandemic outbreak. On one hand, this makes us sound prescient and forward-thinking, but on the other hand, we had no idea what we were about to face.

Our Covid-19 response team – advocacy and awareness response

We established a Covid-19 response team, comprising of our Advocacy and Research Manager, Advocacy Officer, CEO, Communications team, and our Medical Advisory board, and our staff triaging and managing calls, who all worked tirelessly to ensure we had accurate information, advice and recommendations in relation to asthma and Covid-19 on our website and social media. In the initial weeks from March until July 2020, we created updates of our Covid-19 FAQ, getting input and approval from our clinical advisors and the HSE National Respiratory Clinical Programme.

When the scale of the challenge became clear, we realised we couldn’t afford to rely on our one-to-one services and we focused on how to scale up our patient supports to help us in answering the incredible volume of queries and very real anxieties from patients and their carers. Where visits to our website had stood at over 410,000 in 2019, we had in excess of that figure visiting www.asthma.ie in the six weeks from the initial pandemic outbreak alone.

With each iterative wave of concern from patients, we proactively responded with medical guidance, advice and support through our own channels, digital media and traditional media. With each of these waves, we listened to patients and advocated to the Minister for Health, Department of Health, HSE, and Respiratory Clinical Programme for what patients needed.

Asthma adviceline

Our flagship patient support service, our asthma adviceline service (1800 44 54 64), truly came into its own during the pandemic. It is hard to convey the scale of the challenge here. Twenty years in existence, our specialist respiratory nursing team delivering this service have built up extraordinary expertise in supporting and educating patients over the telephone. In order to maximise the impact of the nurse appointment, our team operated a triage system for months, ensuring that the patients most in need of advice, support, and guidance had access to the nurse.

All other patients were supported by members of our patient services team, providing advice approved by the National Clinical Programme signposting to HSE materials and supports, and offering guidance and reassurance as required.
Ordinarily, the Asthma Society has one full-time receptionist taking adviceline calls; this increased from March until June 2020 to five full-time staff triaging and managing calls and scheduling nurse appointments. In 2020, the triage team managed 6,816 incoming/outgoing support calls to the adviceline. We provided 4,416 nurse appointments across the asthma and COPD adviceline, a 148 per cent increase from 2019.

Despite a focus on Covid-19 related queries, asthma action plans were discussed in 88 per cent of adviceline nurse appointments – helping patients to understand the need for improved asthma control and providing a key intervention recognised internationally to prevent asthma deaths.

New service – WhatsApp nurse support

In May 2020, in conjunction with an Asthma Awareness Week theme focused on supporting asthma patients through the pandemic, we launched a new Sláintecare-funded service – a nurse WhatsApp support messaging service. Staffed by a respiratory specialist nurse team, it offered support, guidance and advice for patients. With 610 users from May to December 2020, the service involved 5,064 patient chats with the nurse. Some were quick queries and others long, extended conversations about asthma management.

Despite a focus on Covid-19 related queries, asthma action plans were discussed in 88 per cent of adviceline nurse appointments

Healthcare professionals can refer patients to this service and using it could not be simpler – patients send a message on WhatsApp to 086 059 0132 with their question, or concern and the nurse responds to support them with advice, best practice asthma management, videos or links – depending on what they need.

While the Asthma Society was reactive in the initial weeks after the pandemic outbreak, by May 2020 we were in listening mode and our 2,400 respondent strong survey helped us to listen to patients and give them the supports they needed. We created a whole host of specially designed Covid-19 supports tailored to their needs:

• An Asthma Self-Management masterclass,
• Covid-19 asthma and COPD management leaflets,
• A Protecting the Cocooners pack, webpage and video guidance programme,
• A Back to School/Back to Normal awareness programme to support children returning to school or people returning to work,
• A series of respiratory supports including wellness, patient education webinars, and awareness building (in conjunction with other respiratory charities, with the support of Bank of Ireland),
• A Winter Wellness campaign,
• Videos and leaflets to support patient sub-groups particularly impacted by Covid-19 outbreaks – like members of the Traveller community and the Roma community,
• Asthma and Covid-19 patient packs, through Careplus pharmacies.

The Covid-19 legacy

Over 16 months in, we are left trying to understand the collective trauma of the pandemic – for all of us in Ireland. For those of us in the Asthma Society, that trauma is very real. Our fundraising has been seriously impacted and we have not been able to retain our full team as a result. There has been no improvement into 2021 and we are challenged with continuing our work. The Society cannot continue to provide its services without a substantial upturn in funding and fundraising – we may have to lose services in advocacy, awareness, research, and patient supports.

This is a very serious realisation for us and for our patients – and all while our latest research launched during Asthma Awareness Week 2021, which shows that one-in-four patients avoided an emergency department visit when they needed it for fear of contracting Covid-19. We have never been more needed and we have never been less able to continue to meet the needs of patients.

By 2030, we want to end asthma deaths in Ireland, but we need our work and services to survive to accomplish that goal. We need your help to do that – as healthcare professionals who can create meaningful asthma interventions with patients, boosting their asthma management skills, but also as Asthma Society donors. Please go to www.asthma.ie to become a healthcare professional member of the Society and to donate on a monthly basis.