My name is Irantzu Muerza and I have difficult-to-control severe asthma. I am President of the Association of Support for People Affected by Asthma in the Basque Country (ASMABI) and National Asthma Coordinator of the Spanish Federation of Allergy and Respiratory Disease Patients' Associations (FENAER).

I was diagnosed with severe asthma in 2018, although I have been underdiagnosed for approximately 20 years, which is why my disease has become so serious. The coughing and shortness of breath make it hard for me to get a good rest. Sometimes, this means that I can hardly get out of bed in the morning. It also gives me very strong and debilitating migraines.

Asthma impacts every aspect of my day. The first thing I do when I get up is take my medication. I use my nebulisers and the inhalers prescribed by my specialist. All of this while dealing with the multiple side-effects they produce (anxiety, irritability, osteoporosis, cataracts, presbyopia, loss of teeth, mycosis in the mouth, tremors and tachycardia, among others). I then take all the measurements needed to monitor my asthma, including oxygen saturation, peak flow measurement, blood pressure and heart rate. These are all vital because at any time I could have an asthma attack that could cost me my life.

Even showering, which most people find pleasant or relaxing, is a challenge for me. I cannot shower alone and must nebulise beforehand to avoid having an asthma attack. I use cold water, because steam would trigger my asthma, and I would need 15 minutes to recover from the exertion. One of the things I miss the most is a peaceful night's sleep. I usually wake up every half hour with a cough, migraine, apnoea, dyspnoea or headaches. I have to sit up, wait to stabilise, use my rescue medication if I need it and try to sleep again for the next half hour.

This all has a big impact on my mental health, something not often considered for people living with a serious and chronic illness. Every day I do some yoga, meditation or mindfulness to help alleviate my anxiety and depression.

Every day before I leave the house, I have to check the pollen and pollution levels in my area to see if it is safe for me to go outside. Then, if I am able to, I exercise, either walking or cycling. I always wear a mask and try to be as alert as possible to the triggers of an asthma attack. In my case, these are almost innumerable: perfumes, dust, mites, air fresheners, cars, air pollution, pollen, humidity, sudden changes in temperature, air conditioners or hot air, animal epithelium, fumes and chemical smells. Of course, I always carry my rescue inhalers; I may forget my mobile phone at home but never my inhaler.

I have adapted my house with air purifiers, and I try to ventilate the house for 5 minutes in the morning and 5 minutes in the evening, but sometimes even this is not possible because there may be too many triggers in the outdoor air. When I am in the city, there are more pollutants than in my second home in the mountains. So, when the city environment becomes unbearable and my asthma starts to get worse, I escape to my other house for a few days to get some clean air and stabilise my asthma so that I don't end up in hospital.

On average, I am admitted to hospital every 2 months and every month I visit the emergency department at least once, either for breathlessness or shortness of breath, or because my asthma is getting worse due to the quality of the air I breathe in the street.

Last year, I had two attacks so severe that I had to be induced into a coma for intubation, as my lungs were not able to function. I was on the verge of death. This is what I mean when I say that living with severe asthma is to live in fear of dying every day. At the same time, I have learnt to live and enjoy every day as much as I can and to adapt my life to my asthma.

However, it is clear from the list of my asthma triggers that the climate has a major impact on my asthma. I currently live in a city in the north of Spain, which usually does not experience extreme temperatures, but these last few years have seen record breaking heat and drought due to climate change. My asthma means that I have to avoid all weather extremes, but here I am limited as I cannot use air conditioners. So, I have to make do with fans and air purifiers, and occasionally douse myself with cold water to cool down. By contrast, when it is cold, I have to cover up with a mask and scarves, so that the air that enters my body is warm and does not cause any issues.

Climate change means that the seasons are no longer distinguishable. In the spring it starts to get unusually hot and dry which then lasts into the summer and sometimes until mid-autumn. This has a serious effect on my asthma, as breathing and physical activity are much harder in the heat. Climate change is also lengthening the pollination periods. Before, it was limited to 3 months but this year there has been 6 months of high pollen levels.

The droughts that we have been suffering in recent years, and which are getting worse and worse, are a handicap for me. The lack of rain does not allow the environment to be cleaned of the pollutants and atmospheric agents that are in the air I breathe. The only remedy I have is to stay at home and only go out if it is necessary for me. At home I can control the quality of the air I breathe, but in the street it is impossible for me to do this.

Unfortunately, it seems that we are only going to suffer more and more extreme weather phenomena in the future. It will be difficult for any part of the planet to be saved from the catastrophe that I believe is looming. This will lead to more hospital admissions for those of us with severe asthma, even increasing mortality. In addition, there will be more and more respiratory patients, so the mortality rate from asthma will be severely increased.

The general population is not yet fully aware of this, especially if they do not have conditions like mine that will be adversely affected. Masks and other protections will become perpetual for the entire population. Those of us who suffer from respiratory diseases will have to limit ourselves to not leaving the house or moving somewhere where the climate is more regular, if there is any such area left, which I doubt very much. Action must be taken now to improve environmental factors that affect the quality of life of asthma patients like me. This would reduce both the number and severity of hospital admissions and deaths due to asthma every year.