Asthma is an incurable chronic disease that is now growing at alarming rates in industrialised countries. Relatively unpolluted and green-issue aware New Zealand is a world leader in asthma cases, but it shares that dubious status with the UK, Australia, Ireland, the US and Canada. By contrast, Indonesia, Greece, China, Taiwan, India and Ethiopia are relatively asthma-free. One theory suggests that in developed countries we have become too clean for our own good. High hygiene standards and the overuse of antibiotics mean that the immune systems in the young never get to mature. Children in the developing world, however, are repeatedly infected by bacteria and parasites and their immune systems are less likely to respond to minor irritants such as dust as if they were life-threatening bacteria.

Rural Life Beneficial

One advantage of farm life is that it protects against asthma attacks. Children raised on a farm are frequently exposed to parasites and microbes associated with farm animals. In the US, a study of the Hutterite¹ sect showed that, although they are genetically prone to asthma - 15 percent have it - they do not have the traumatic attacks that plague most asthma sufferers. Researchers believe that the Hutterites' rural lifestyle has given them protection.

The latest theory is that junk food can increase the likelihood of children becoming asthmatic. A study of children in Saudi Arabia found that children whose diets were low in vegetables and vitamin E were two to three times more likely to develop asthmatic symptoms than other children. There is also speculation that the low level of activity of Western children is contributing to the rise in asthma. Studies have shown that lungs are inclined to get twitchy if people go for more than half an hour without taking deep breaths.

Many Triggers

Between 60 and 80 percent of people with asthma are sensitive to the faecal material of the house dust mite. And, as any vacuum cleaner salesman will confirm, there's a lot of it about. Every square metre of mattress, for example, has 24 dust mites and each dust mite produces seven faecal particles a day. In every ounce of mattress dust there are a quarter of a million faecal particles.

After dust mites, pets are the most common asthma trigger. Pet allergens spread throughout the house and even the most stringent cleaning can't remove them. Strong emotions, stress, exercise, food, preservatives, cold air, aspirin, cigarette smoke, diesel fumes, perfume, pollen, newsprint, nail polish - the list of asthma triggers can test the sympathy of family and friends. Marcel Proust² famously spent most of his life in a cork-lined room in an attempt to avoid asthma triggers. When he was too breathless to speak, he would write notes to his servant Celeste. One such reads.

I've just coughed more than three thousand times, my back and stomach are done for, everything. It's madness. I need very hot sheets and woollen pullovers. Remember all your sheets have a smell that starts my useless coughing. I hope you'll take strict account of my order, otherwise I shall be more than angry.

Can Be Controlled

These days there are drugs that can effectively control asthma attacks. Amazingly, though, it has been estimated that up to 50 percent of asthma sufferers do not take their medication as instructed by their doctor. And as many as 60 percent of people with asthma fail to recognise worsening symptoms; those with severe asthma are often the least likely to realise how badly their airways have become obstructed. The only way to accurately gauge your condition is by regular self-monitoring with a peak flow meter.

One reason people neglect to take their asthma drugs is that the cure can seem worse than the disease. Steroids may have saved the lives of thousands of people with asthma, but they have a bad name, since steroids, both inhaled and taken orally, can have side-effects. Inhalers can cause oral flush, inflammation of the tongue, hoarseness and thin skin. They may slightly impair growth in children. Oral steroids can have more serious side-effects such as glaucoma, osteoporosis and psychological changes such as depression. Many of the side-effects are reversible when the treatment stops. Doctors say that with proper medical management about 80 percent of asthma deaths could be prevented.

Asthma Lore

Proust's doctor prescribed caffeine, beer, champagne or brandy, claiming that the alcoholic 'euphoria' would cause the asthma symptoms to subside. A recent study showed that alcohol, especially wines, can actually trigger asthma attacks. But Proust's doctor may have been right about the caffeine. Asthma lore has it that several cups of strong coffee can head off mild asthma attacks if medication is not available.

At the Asthma Information Center on the Internet there is a gallery of art works inspired by asthma. Painted by people with asthma, they have titles such as Head with knotted neck, Girl squeezed between two rocks and Chained lungs. They portray the horror of suffocation, the desperate gasping for breath that makes asthma one of the most traumatic conditions that humans suffer, all the more so since an asthma attack can happen at any time.