Last month it was announced that Britain has the highest
asthma rates in the world among 13- and 14-year-olds. In
Scotland, nearly 40 per cent of them have the condition. The
media, Greek chorus-like, lamented the evils of modern diet,
pollution and parenting, and the nation tore its hair.
But if Britain excels in producing asthmatics, it also
excels in helping them. "GPs in the UK are very, very good
at treating asthma," says Professor Peter Barnes, a member
of the scientific committee for the Global Initiative for
Asthma (Gina), who published the research. "Modern
treatments can control it extremely effectively."
Nevertheless, not everyone feels happy with daily doses
of medication for themselves or their children, especially
if that medication is steroid- based (steroids are taken by
some asthmatics as a preventative), and many people are keen
to supplement their normal medicine with complementary
therapies. One such therapy is Lyprinol. In a recent study
conducted at the University of St Petersburg, Lyprinol was
found to decrease the number of inflammatory cells in
asthmatic airways, and hence to lessen sufferers' reliance
on their conventional treatments.
"In the best cases, people have reported benefits in two
to three days. But usually it takes a couple of weeks," says
Damian Bond, the managing director of DB5 Healthcare, who
distribute Lyprinol in the UK.
Jenny Barrett started taking Lyprinol after she read
about it in a magazine. "I've had asthma since I was about
14. Not badly, but every evening I would feel wheezy. It was
like an allergic reaction. My skin would go blotchy and my
chest felt as if it was itchy on the inside." She did have a
preventative brown inhaler, but never remembered to take it.
"So I used to wake in the night a lot, short of breath, and
it was then that I'd have to take my blue one. I used to use
it every evening. But since taking Lyprinol, I've hardly
used it at all."
Lyprinol is made from an extract of green-lipped
mussels and is taken by, among others, Paula Radcliffe, the
marathon runner. The mussel
contains an inhibitor of an enzyme involved in the mechanism of
an asthma attack. Professor Barnes was involved in the trials:
"Lyprinol slightly reduces the symptoms of asthma, but it's
not nearly as effective as inhaled steroids. We don't consider
that it would be a substitute for [them]. But it may help to improve
the patient's control [of the condition] on top of inhaled
steroids, or it may mean that people don't have to use such
a high dose."
Other sufferers say they find allergen avoidance helpful.
House dust mites are a common trigger for asthma and they
thrive in warm, damp, ill- ventilated environments. The
modern house, with its double- glazed windows, numerous
bathrooms and wall-to-wall carpets, provides these in
abundance. Last year, a development of specially designed
"low-allergen" houses went on sale in Perth. These houses
were built with smooth floor coverings, such as linoleum,
instead of carpets, and lime plaster instead of moisture-
retaining wallpaper. They also had a new type of roof
insulation laid in that drew air into the building but
filtered out moisture. Case studies on people who moved into
the houses have been extremely positive. One resident said
that their home had given them "a new lease of life".
Professor Barnes is unmoved. "There are always case
studies about people who find a particular thing wonderful.
But there is very little scientific evidence that allergen
avoidance helps. It is extremely difficult to avoid exposure
to allergens completely, particularly the house dust mite.
You can try various manoeuvres such as removing carpets, but
you can't wholly avoid them. It only requires a very low
level of exposure to cause an attack."
Professor Martyn Partridge, the chief medical advisor to
the National Asthma Campaign, is also doubtful about
alternative treatments. "I do very much respect the
observations of sufferers, especially somebody like Paula
Radcliffe. And people are very keen to find ways of treating
their asthma that do not involve drugs. But most of these
things have not been subjected to proper trials."
As well as not being proven, such treatments are also not
cheap: 30 capsules of Lyprinol cost pounds 12.95. Plus,
alternative asthma therapies can occasionally be downright
dangerous: royal jelly has been implicated in the deaths of
some asthmatics.
There are lifestyle changes, however, that can be
genuinely beneficial. Firstly, avoid things that you are
allergic to. If you are animal-allergic, "get rid of the
family cat," says Professor Barnes. And if you are allergic
to pollen, avoid walking in fields when the pollen count is
high (from May to July).
There is also some evidence that diet can have an
influence on asthma. Research carried out by the Italian
Agency for Public Health found that eating fruit and
vegetables seemed to protect against shortness of breath and
wheezing, while the consumption of bread, butter and
margarine seemed to exacerbate it.
Asthma rates have risen sixfold among young people in the
last 20 years. Theories for what is responsible abound, but
none has yet been proven. "All we know is that it's related
to the Western lifestyle - but which component of the
Western lifestyle is not completely clear," says Professor
Barnes. "The most popular theory is that it's due to too
much cleanliness."
This is the "hygiene hypothesis". In our pristine modern
lives, we wash at least once a day, cook our food
thoroughly, take antibiotics and tend to keep our toilet and
our toilette water distinct. As a result, we lead relatively
sterile lives. But our immune systems evolved to detect and
destroy a daily barrage of bacteria, viruses and other
nasties, so when there is the slightest stimulus, such as a
house dust mite or a pollen grain, the immune system goes
into overdrive. But these stimuli by and large aren't
actually harmful, so in trying to attack them, the body only
succeeds in attacking itself, resulting in asthma, allergies
and so on.
This theory was prompted by scientists noticing that
children who grew up on farms, or in a household with a cat,
or with older siblings (all of which are excellent sources
of infection) seemed much less likely to develop asthma.
Plus, asthma rates are much lower in developing countries,
where standards of hygiene are also lower.
However, many of the things that make an individual less
likely to develop asthma in the first place - such as
increased exposure to cats - can make the condition worse in
those who have already developed the disease. So what is the
best thing for an asthma sufferer to do? Take their drugs,
and learn how to take them effectively. "There are numerous
excellent studies showing that if you teach patients how to
manage their medication themselves you can dramatically
reduce suffering from asthma," says Professor Partridge.
In "self-management", a patient is given personalised
instructions that advise them how to increase their therapy
if they wake at night with asthma, when to supplement their
usual therapy with steroid tablets, and when to seek medical
advice. It is an extremely successful approach: patients who
manage their condition in this way can expect a 20 per cent
reduction in disturbance of sleep, a 20 per cent reduction
in emergency department attendance and a 40 per cent
reduction in hospitalisation.
"The evidence is overwhelming that if you give that sort
of plan you can expect massive benefits," says Professor
Partridge. "And yet, despite the fact that we've been saying
that for 14 years, only three per cent of people in the UK
report having been given personal asthma campaigns."
So, however good we might already be at treating asthma
in the UK, it seems there is still a long way to go.