Approximately 9,000 people (12 per cent) living in Bermuda have asthma.

It is the number one reason children take medication whilst at school, and the number one reason they miss school. It’s also the leading reason adults miss days from work.

Respiratory disease is repeatedly one of the top causes of admission to King Edward VII Memorial Hospital. People suffering from asthma were the most frequent visitors to the Emergency Department and Urgent Care Centre last year.

Chronic Obstructive Pulmonary Disease is strongly associated with smoking, factory work and mining. It is a smaller problem in Bermuda than elsewhere, as these factors are less common. Approximately one in seven adults (14 per cent) of people in Bermuda are smokers, according to the STEPS survey 2014.

In 2012 we started to collect COPD inpatient and outpatient statistics at KEMH. I am finding it is underreported and underdiagnosed — as it is around the world — but even after taking this into account we still have a lower percentage of people with COPD in comparison to most other countries.

Why are action plans important?

Education is very important for patients, carers and family members. Asthma and COPD affect the dynamics of a family as a whole, however the greater the education of the family, the more they can help and offer support. It is important that education strategies are also geared to enable patients to self-manage. In the past year alone, there were 1,888 asthma visits to the Emergency Department yet only a small percentage of these patients have come to get asthma education.

Every asthma visit to the Emergency Department and Urgent Care Centre is a failure of treatment. Healthcare professionals can empower their clients and help give them the tools they need to control their asthma by providing their patients with an asthma action plan!

American, British, Australian, Canadian and Global Initiative for Asthma guidelines suggest that all clients are offered self-management education, including a written, individualised asthma action plan.

The National Review of Asthma Deaths in May 2014 by the Royal College of Physicians in England showed that of the 195 asthma deaths from February 2012 until January 2013, less than a quarter (23 per cent), of those had ever been given an asthma action plan.

As a certified asthma/COPD educator I set up the Asthma Centre in KEMH in April 2000. The goal was to create a centre that works to improve the lives of people in Bermuda living with long-term lung conditions.

Today this education continues as part of Bermuda Hospitals Board’s Diabetes Respiratory Endocrine and Metabolism Centre. Located at Fairview Court on the grounds of the Mid-Atlantic Wellness Institute, I provide clients one-on-one asthma and COPD education. The service is covered by insurance. I work in close partnership with the Government Health Department, the Ministry of Education’s school asthma nurse and Bermuda’s asthma charity Open Airways.

Everybody who has asthma should have an action plan from their doctor. The physician gives advice specific to the patient providing the patient with a written agreement that helps them stay in control of their asthma. It includes specific daily asthma medications and what to do when the asthma gets worse, or if they have asthma attack.

An action plan can help reduce the number of visits to the Emergency Department and the doctor’s office, which in turn can improve quality of life and reduce the number of days that people have off work and school due to asthma. An action plan should be updated yearly by your doctor or asthma nurse for most adults, and more frequently if more severe.

Contact asthma.centre@bhb.bm or 239-1652 for more information or an appointment.

• Debbie Barboza is an asthma educator with Bermuda Hospitals Board