Asthma Care in Ireland: A Move Towards Integrated Community-based Care
Asthma is one of the most common chronic respiratory diseases in Ireland, with approximately 1 in 10 people affected by this condition. Globally, asthma impacts millions of people, making it a leading cause of morbidity and healthcare utilisation worldwide. Managing asthma effectively requires a comprehensive, multi-faceted approach that engages not only healthcare providers but also patients, their families, and the wider community. In Ireland, asthma management has evolved significantly in recent years, with community-based care playing a pivotal role in improving health outcomes for individuals with asthma.
The Global Initiative for Asthma (GINA) provides guidelines that emphasise the importance of self-management education for asthma patients. According to GINA, asthma patients need comprehensive education on inhaler use, medication adherence, symptom monitoring, and the development of asthma action plans. Effective asthma management relies on empowering patients to make informed decisions about their care, including when to use medications and how to recognise when their asthma is under control or worsening.
Sláintecare is a national reform program aimed at improving healthcare access and equity in Ireland. It focuses on providing care closer to home and ensuring that healthcare services are more accessible to all citizens, particularly those in rural or underserved areas. Under this reform, new Regional Health Areas (RHA) have been established to offer more equitable access to healthcare services across the country. Within these RHAs, Community Healthcare Networks (CHN) have been developed. (Sláintecare – the Strategy for Improving Ireland’s Healthcare System – About the HSE, n.d.).
A key component of Sláintecare is the Integrated Care Programme for the Prevention and Management of Chronic Disease (ICPCD). This initiative aims to improve the care and management of patients living with chronic conditions, including asthma. Other chronic conditions included in the programme are COPD, diabetes and cardiovascular disease. The ICPCD model focuses on integrating healthcare services across primary, secondary and community care, providing a patient-centred and co-ordinated approach. The model prioritises prevention, early detection, and self-management, enabling patients to receive appropriate care closer to home, reducing hospital admissions, and improving overall health outcomes. For asthma patients, this involves utilizing local services for ongoing monitoring, education, and preventative care, which greatly reduces the need for more intensive, hospital-based interventions. (Federmanet al., 2019).
One of the cornerstones of the ICPCD is the End to End Model of Care (MOC) for adults with asthma. This model of care focuses on providing comprehensive asthma management through integrated community solutions. The MOC spans a wide range of services, from primary prevention to more specialised care. The goal is to ensure that asthma patients receive continuous, appropriate care at the most suitable level, preventing unnecessary hospitalisations and improving long-term disease control. The MOC encourages patient empowerment, ensuring that individuals with asthma are involved in decision-making processes regarding their health and treatment. This model encourages patients to manage their condition independently whenever possible, reducing the need for specialist interventions and fostering greater control over their own health.
The MOC for asthma care in Ireland follows a pyramid structure, with the bulk of asthma management occurring at lower levels of care in the community setting. At Level 0, the majority of asthma patients live well with their condition and require minimal intervention. These patients are typically able to manage their symptoms with the support of general practitioners (GPs) and community healthcare services. Level 1 care involves management by GPs, who play a vital role in monitoring asthma symptoms, adjusting medications, and providing ongoing support. At Level 2, patients may be seen in Community Specialist Ambulatory Hubs, where they can access more specialised care and diagnostic services without the need to visit a hospital. Level 3 care involves acute speciality ambulatory services, where patients who require more intensive care are treated, and Level 4 care is reserved for patients who need speciality hospital care.(Model of Care – HSE.Ie, n.d.).
The pyramid approach ensures that most asthma patients are managed in community settings, with specialist interventions provided only when necessary. This structure emphasises the need for community-based care, which can prevent exacerbations and ensure that patients receive timely, appropriate care that is closer to home. It also highlights the importance of multi-disciplinary teams (MDTs), which involve a range of healthcare professionals working together to provide comprehensive care. These teams may include GP’s, respiratory physiologists, respiratory specialists, physiotherapists, and nurses, who collaborate to deliver personalised asthma management plans, including self-management strategies and action plans. Specialist Integrated Care Hubs have been developed within the CHN’s, which offer a range of services for chronic disease management. In terms of asthma, diagnostic spirometry & FeNO testing is carried out. Consultations with asthma specialists, including the respiratory consultant and specialist respiratory nursing staff are available. After confirming the diagnosis, patients can receive educational support on their asthma self-management, including the use of peak flow meters, inhaler techniques, and the development of a personalised asthma action plan. The integrated care hubs aim to provide a “one-stop-shop” for patients with asthma, where they can access both specialist care and education in a convenient, community-based setting. By bringing respiratory care out of hospital settings and into local communities, these hubs improve access to care and reduce the need for hospital visits. (Respiratory – HSE.Ie, n.d.) The importance of community-based care in managing asthma cannot be overstated. Most asthma patients in Ireland receive their care within community settings, making it essential to ensure that these services are robust, accessible, and effectively integrated into the healthcare system. Asthma management involves ongoing monitoring, education, and personalised care, all of which can be effectively addressed within a community-based framework. By offering regular check-ups, educational resources, and support systems, community care can significantly reduce emergency interventions and hospitalisations while improving patients’ quality of life.
A key component of community-based asthma management is the GP Chronic Disease Management Programme. For adult patients with asthma who have a medical card or GP visit card, they can attend their GP practice to obtain a structured review of their asthma with the GP or practice nurse. The chronic disease management programme allows patients to avail of a personalised care plan, and a review of existing care plans and inhalers. If a referral to a specialist is required, the integrated care hubs are there in the community, close to where the patient lives, to provide this specialist service.
Globally, the importance of community healthcare workers in asthma management has been widely recognised. The Global Strategy for Asthma Management and Prevention underscores the role of community healthcare workers in providing education and support to asthma patients. Asthma self-management education, delivered by trained community health workers, has been shown to improve patient outcomes and reduce healthcare utilization. In many cases, community healthcare workers can deliver educational programs, monitor symptoms, and help patients develop asthma action plans, ensuring that individuals with asthma receive the support they need to manage their condition effectively. (2024 GINA Main Report – Global Initiative for Asthma – GINA, n.d.). The success of these community-driven initiatives demonstrates the critical role of local healthcare workers in ensuring asthma patients receive the education, tools, and support necessary for managing their condition independently. This approach can reduce reliance on acute healthcare services, such as emergency department visits or hospitalisations, by promoting proactive care and self-management. By teaching patients how to recognise early warning signs of asthma exacerbations, adjust their medications, and manage their symptoms effectively, community healthcare workers play a crucial role in improving asthma control.
One of the key aspects of asthma self-management is the ability to monitor asthma symptoms and peak expiratory flow (PEF). PEF monitoring allows patients to track their lung function and recognise early signs of asthma exacerbations. This empowers individuals to seek timely medical attention and adjust their medications, helping to prevent more severe asthma episodes and reducing the need for hospital interventions. Moreover, asthma self-management education helps patients understand the importance of medication adherence, the correct use of inhalers, and avoiding triggers that can worsen asthma symptoms. Through education and ongoing support, patients can feel more confident in managing their condition independently, which leads to better asthma control and better patient wellbeing.
In both Ireland and internationally, the integration of asthma management into community care systems has been shown to improve outcomes and reduce healthcare costs. Community care not only improves access to care but also empowers patients, reduces hospitalisations, and enhances the overall quality of life for individuals with asthma. In Ireland, initiatives such as the End to End Model of Care and Specialist Integrated Care Hubs reflect the global recognition of the importance of community-based asthma care. These initiatives align with global strategies, such as those proposed by GINA, that emphasise the role of education, self-management, and community-based healthcare workers in improving asthma control.
In conclusion, a community-focused approach is central to the effective management of asthma, both in Ireland and internationally. As asthma rates continue to rise worldwide, fostering community-based solutions will be critical to ensuring that individuals with asthma receive the support they need to manage their condition effectively. Community care is essential not only in reducing the burden on hospital systems but also in providing timely, personalised care that meets the unique needs of each patient. As the burden of asthma continues to grow, fostering community-based solutions will be essential in improving asthma care, enhancing patient outcomes, and creating a more sustainable healthcare system.
Written by Dr Deirdre McDermott, Respiratory Registrar, Galway University Hospital and Dr Sinead Walsh, Consultant Respiratory Physician, Galway University Hospital & Galway City Integrated Care Hub
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