Ann McMurray

Project: Parent and patient perspectives of fatal and near fatal asthma, a qualitative study

According to the National Review of Asthma Deaths (NRAD) report a substantial proportion of asthma deaths are neither identifiable by clinical algorithms nor by patient understanding of personal risk: 58% of patients who die from asthma were classed as mild/moderate asthma and 43% had not had primary care contact for review of asthma in the previous year. Severe asthma exacerbations are difficult for patients to gauge as they are typically a continuum of symptoms experienced at other times – even very severe symptoms get better with time, especially in children. Although there have been a number of reports into asthma deaths and near fatal asthma events, they are all from a medical perspective. There are no studies that have looked to use the experience of those who have had near fatal attacks to identify key factors (social, behavioural and symptoms) that could inform patients with asthma of a critical opportunity to seek help.

Aims/ objectives

1. To provide a consensus definition of near fatal asthma.

2. To identify key time-critical experiences of those who suffer near fatal asthma (or their parents) that may provide a window of opportunity to seek help.

3. To elucidate family circumstances and behaviours that may place children and young people at greater risk of asthma death/near fatal asthma and enable these behaviours to inform education, primary care severe asthma registries and emergency service responses.

Study design

1. Literature review

2. An e-Delphi survey of clinicians. Key clinicians will be identified (approx. 100) who have experience of caring for children and young adults following near fatal asthma and develop a Delphi Network.

3. Achieving the first aim of her PhD study, Ann was able to gain consensus on a definition for Near Fatal Asthma (see Publications below). This definition was used as inclusion criteria for qualitative study of children, young people and parents affected by near fatal asthma attacks.

About me

Ann began her nursing career in Belfast where she completed her adult training, later moving to Edinburgh to complete her Sick Children’s training at the Royal Hospital for Sick Children. Ann completed her first degree in Child Health Nursing at Edinburgh Napier University in 2010 and has worked as an Asthma Nurse Specialist since 2002 developing a keen interest in research over the years. Ann had a 3-year secondment from the hospital to complete her research. Ann is the current chair of the National Paediatric Respiratory and Allergy Nurses Group.  She is actively involved in teaching, locally and nationally.

Since completing her PhD, Ann has been working on another fatal asthma study in the Centre (see below).  She has also recently been invited to become part of the CARE-UK study team.

Near Fatal Asthma in Children and Adolescents

Publications

• The availability and use of oxygen saturation monitoring in primary care in order to assess asthma severity. Cunningham S, McMurray A. Primary Care Respiratory Journal. 2006 Apr;15(2):98-101.
• Cluster randomized controlled trial of the effect of introduction of an acute wheeze/asthma integrated care pathway on patient outcome. [Abstract] Logan C; McMurray A; Dunn M; Richardson N; Lockerbie L; Prescott R; Cunningham S, European Respiratory Journal, 2006, 28, (Suppl 50): 481s [P2779]
• Integrated care pathways significantly reduce drug dosing and administration errors in patients with acute asthma. [Abstract] McMurray A, Logan C, Dunn MJ, Richardson N, Lockerbie L, Prescott RJ, Cunningham S. European Respiratory Journal 2006, 28 (suppl 50) :481s [P2777].
• Strategies to screen for adrenal suppression in children with asthma should take account of compliance with inhaled corticosteroids. Brodie M, McMurray A, Crofton PM, Bath L, Cunningham S. European Journal of Pediatrics. 2007 May;166(5):493-4.
• Effect of an integrated care pathway on acute asthma/wheeze in children attending hospital: cluster randomized trial. Cunningham S, Logan C, Lockerbie L, Dunn MJ, McMurray A, Prescott RJ. Journal of Paediatrics 2008 Mar;152 (3):315-20.
• Observational study of two oxygen saturation targets for discharge in bronchiolitis. Cunningham S, McMurray A. Archives of Disease in Childhood. 2012 Apr;97(4):361-3.
• Attentional bias to respiratory- and anxiety-related threat in children with asthma. Lowther, H; Newman, E; Sharp, K; McMurray, A. Cognition & Emotion, May, 2015.
• Asthma in children. Daines L, McMurray A InnovAiT 2016 10 (1) 5-14
• A Young child with a history of wheeze. Paton J, Bindels P, McMurray A, Biggins J, Nantanda R, Stubbe Østergaard M Primary Care Respiratory Medicine 2017 http://rdcu.be/p8Qm

• McMurray A, Cunningham S, Fleming L. Defining Near Fatal asthma – an international eDelphi study. European Respiratory Journal Sep 2019, 54 (suppl 63) PA949; doi: 10.1183/13993003.congress-2019.PA949

British Journal of School Nursing

McMurray A

Asthma in schools: a Scottish Perspective (2008)

Asthma part 1: signs, symptoms and diagnosis (2010)

Asthma part 2: managing treatment in schools (2011)

Asthma 3: common misperceptions and stigma (2011)

Supporting children and young people with asthma (2014)

Managing asthma attacks in the school environment (2016)

Smart Asthma – what connected devices can mean for care (2017)

McMurray A Wark S. Responding to the needs of adolescents with asthma (2014)

McMurray A Westwood J. Teaching children good inhaler technique (2016)

Independent Nurse

McMurray A. Treating Asthma in Children: the stepwise approach (2012) 

Oxford Handbook of Clinical Skills for Children’s and Young People’s Nursing

Dawson P Cook L Holliday LJ Reddy H, 2012 Chapter 12 Respiratory System

Published sections:

• History taking and assessment
• Oxygen saturation monitoring
• Recording Peak Flow
• Recording Spirometry