In recent months, there's been increasing awareness that asthma may be more than one disease and the leading medical journal The Lancet has even called for the term to be dropped. There's increasing evidence that the causes, too, are varied. Dr Peter Dingle puts together some of the pieces of the asthma puzzle.

Asthma is one of the most common respiratory diseases. In Australia, New Zealand, the UK, US, Canada, many European countries, and now in many Asian countries, asthma is on the increase and has reached proportions of one in four children and one in 10 adults.

The asthma rates in these countries have doubled in the last two decades and fortunately they, at last, seem to be levelling off. But as other countries become Westernised, the rates are quickly catching up to our levels. Asthma is a potentially life threatening and debilitating respiratory disease. Not only do asthmatics have to face potentially fatal attacks, but they may also have to deal with headaches, depression, mood swings, hyperactivity, learning difficulties, chronic fatigue and allergy related afflictions such as allergic rhinitis and eczema.

It's unlikely that the genetics of the population has had an influence in such a short period of time, but it is likely that a degree of genetic susceptibility is being triggered by a combination of modern factors, perhaps the epigenetics factor I wrote about a few months ago. The rise of modern, Western society has brought with it many changes. Many of these appear innocent when considered in isolation, but when contemplated in combination, they present a formidable threat to our health and the health of our children.

The most probable cause of asthma and many other modern child health problems is a combination of Diet, Environment, Attitude and Lifestyle (DEAL) factors. To wait for definitive scientific proof that may never come, is to put a growing number of kids at severe risk. Asthma is not just an inconvenience, it kills.

The "Westernised" diet seems to be a contributing factor. Because asthma involves an immune response to various trigger substances, decreases in the average weekly consumption of fresh fruit, green and mixed vegetables and an increase in the amount of processed foods have all been linked with increasing asthma rates. And nowhere is this more evident than in Asian countries where the diet is rapidly becoming Westernised. The "new" diet provides fewer antioxidants, fewer minerals such as magnesium, selenium and zinc, and fewer vitamins, including Vitamins A, B, C and E - all of which are considered to be necessary co-factors in the immune function. The modern diet is also very low in methyl donors such as folate and vitamin B6 which may be having an impact on how the genes for asthma are expressed.

A number of studies have shown decreased levels of minerals such as selenium and zinc in subgroups of asthma sufferers. There is also evidence that people with reduced intake of fresh fruit and vegetables have lower ventilatory functions (they take in less air with each breath) and other studies which link diets low in fruit and vegetables with increased rates of asthma, and more severe symptoms. There's growing evidence of the benefits of vitamin, mineral and antioxidant supplements on the severity of asthmatic symptoms. For example, the essential fatty acids (EFAs), particularly an increase in Omega 3 oils, have been shown to reduce the incidence of asthma in children in some studies. In the old days, parents used to feed their kids cod liver oil and kids would eat home grown vegetables and free range eggs, all of which are a source of EFAs.

A number of studies have also shown a relationship between asthma and the mother's eating habits. Children born to women who supplement with Omega 3 oils are less likely to develop asthma. Some studies have also found reduced symptoms and rates of asthma in children who were breast-fed for longer as infants. The precise reason for this is unknown, but is probably due to the protective effect of breast milk and the detrimental effect of cows' milk. Apart from other essential nutrients in human milk, it's a rich source of EFAs, choline and important immune factors. And there is growing evidence mounting over the use of cows' milk and increasing allergies and food intolerances.

Some of the food colourings and other food additives that our kids consume in relatively large quantities are also linked with asthma attacks. Ones that are particularly relevant include the colours 102, 110, 127, the sulphur preservatives (220- 230, sulphur dioxide, sodium sulphite and bisulphite potassium bisulphite and sodium and potassium metabisulphite) and MSG (621). Investigations throughout the world confirm a link between asthma and a person's sensitisation to indoor allergens, such as dust mites, pet fur and feathers, insects and mould. Nevertheless, these allergens have probably always been present in houses although the quantities of allergens and degree of exposure may have increased in many homes.

We have made our buildings more airtight through changes in design, weatherproofing and the use of air conditioning. This traps allergens and chemicals inside buildings, whereas in older homes there is greater airflow. The constant temperature and humidity also produce ideal conditions for dust mite and fungal growth. These conditions are further exacerbated by the fact that many people keep all their doors and window closed and that we spend 90 per cent of our time indoors.

A number of studies have found a strong relationship between house dampness, fungal growth and respiratory illness. This is not only from obvious dampness such as condensation on windowpanes, but also the amount of time spent in the shower and bath. Mould and mould spores are a major problem for asthmatics. Mould can usually be controlled by increasing the ventilation in bathrooms and other wet areas. Fibre cleaning is very effective in controlling mould and doesn't involve the use of toxic chemicals.

Allergen avoidance, particularly for mould, dust mite allergens and pollen, has been shown to reduce both the onset of asthma and asthmatic symptoms. This avoidance appears to be especially important during the first 12 months of life, when the immune system is maturing. Some research also suggests avoiding substances that may cause reactions, even though not related to immune function . This includes some biologically active chemicals and some medications such as aspirin, sulphur dioxide, metabisulphate, coal tar dyes and flavour enhancers, such as MSG.

By contrast, while many pets produce problematic allergens, there's increasing evidence to show that having a pet may offer some protective effect. In fact, living on a farm and close to animals generally confers some protection against asthma.

Probably of greater importance is that we have dramatically increased our use of synthetic chemicals which, at higher doses, are linked with asthma and respiratory disease. More and more studies are showing this link with even lower levels of exposure to chemicals, such as those found in new or renovated homes.

Cleaning chemicals, spray cans, deodorants and perfumes are all increasingly being linked with contributing to the cause of asthma and potential asthma attacks. The evidence is also mounting that these chemicals may be influencing our genetic expression through epigenetics.

The overuse of these chemicals may also be contributing to what is called the "hygiene hypothesis" which is that we are not being exposed to enough micro organisms and therefore not stimulating the immune system at the right stages of growth. Unflued gas heaters (the ones that don't have a flue or chimney) and other appliances are linked with increased respiratory illness. Many countries and some states in Australia have banned these appliances. There are now dozens of studies showing associated health problems. There is little doubt about the effect of direct smoking and passive smoking on asthma and a litany of other diseases. While more and more people go outside to smoke, there are others who still expose their children to this cocktail of very toxic substances. Many of the thousands of chemicals found in tobacco smoke are toxic. Even worse, parents who smoke are showing their kids through their actions that smoking is okay. If you smoke you are teaching your kids to do the same, despite what you might say to them.

As the old adage says, "Actions speak louder than words". Attitude is important because not only is it likely to reduce the risk of illnesses, but it also determines what an individual will do to prevent or reduce illness. Attitude is closely linked with education, the willingness to learn more and the desire to look after yourself. This does not mean ignoring the medical system. In fact, it's the complete opposite. It means working with your doctor and asking lots of questions.

Remember asthma can be a life threatening illness, so you need to understand it and take it seriously. Our lifestyle has changed enormously over the last four decades. The structure of the family unit and how families interact, our level of physical activity and our dependence upon the car, television and computers have brought different pressures and demands. Many of these factors have negative impacts on our health and our ability to deal with asthma. Physical activity, breath control and stress management are essential for an asthmatic's development of a healthy lifestyle. I have seen many instances where implementation of these has not only improved how a person deals with asthma, but also reduced the severity and frequency of symptoms. For a small number of asthmatics, strenuous physical activity can initiate an asthma attack. Be active, but also understand your limits. Unfortunately, despite the growing scientific evidence, the medical paradigm tends to prevail in our society that we can't do anything about asthma because we don't have the definitive proof yet of the causes. Science, on the other hand, shows a different perspective, that there are probably many contributing factors that need to be addressed and all can help just a little.

Apart from this also being a common sense approach, it also helps with many other health issues not just asthma. So isn't it worth trying?

more online articles available

or pick up this month's copy of
NOVA Magazine
<< FREEDOM >>