How many people die from asthma?

               Currently 1,500 people still die from asthma each
               year, over a third of which are people under the age
               of 65. Many of these deaths might have been
               prevented with adequate routine and emergency care.

               How does asthma effect people's daily life?

               Available care and treatment are not relieving
               symptoms for many people with asthma. This has an
               impact on their quality of life by limiting everyday
               activities like talking normally without becoming
               breathless, walking upstairs, playing sport or sleeping.
               There are, however, some people with asthma -
               perhaps up to half a million - for whom symptoms
               cannot adequately be controlled, even with the best
               available treatments and prevention measures. 

               Where are people with asthma treated?

               Most treatment of asthma is organised by local GP
               practices, but many people do not receive adequate
               information or advice when asthma is first diagnosed.
               Very few people with asthma have a written
               self-management plan explaining when to take
               medication (6%) or what to do if asthma worsens
               (3%).

               How many hospital admissions are due to
               asthma? 

               There are nearly 74,000 emergency hospital
               admissions for asthma each year - approximately
               40,000 adult admissions and 30,000 childhood
               admissions.

               Does asthma effect all people in the same way? 

               Visits to the GP due to asthma are particularly high
               among people from disadvantaged social groups and
               certain ethnic and minority groups. Deaths due to
               asthma among men are highest within lower
               socio-economic groups. 

               How much does asthma cost the health service?

               Treatment for asthma costs the NHS an estimated
               £850 million a year, but that is only a proportion of
               the total. Health costs per case of asthma increase
               according to how severe the person's asthma is and
               how many attacks they have. A significant proportion
               of costs are incurred when hospitalisation and hospital
               treatment occurs. A half of all annual healthcare costs
               for asthma may come from the one fifth of people
               with asthma who experience an asthma attack. 

               How does the UK compare internationally? 

               The UK has a particularly high prevalence of wheeze
               and diagnosed asthma. In a survey of 13-14 year olds
               carried out in 56 counties worldwide, the UK had the
               fifth highest prevalence rate for asthma. Only one in
               twenty people with asthma in the UK and six other
               European countries met all the Global Initiative for
               Asthma standards for asthma control.

               What impact does asthma have locally? 

               The impact of asthma is felt throughout the UK and
               within every community. An average primary care
               organisation dealing with 330,000 people can expect
               to be treating 45,000 people for asthma, with 439
               emergency hospital admissions emergency and eight
               deaths due to asthma each year.

               Notes: 

               You can download the full version of the Asthma Audit
               2001 here. (160K .pdf). Download Asthma Audit 2001

               (This document is in Adobe Acrobat (PDF) format.
               Acrobat Reader is a free application which enables
               people to view and print documents. If you do not
               have the Reader installed already, it can be
               downloaded now from the site below):

http://www.agius.com/hew/resource/asthma.htm
Although there are genetic factors which predispose to the development of asthma, exposure to
certain environmental factors may contribute significantly to the risk of developing the disease.
Once somebody has asthma, exposure to some kinds of environmental factors often increases the
likelihood of suffering from attacks. Thus some people find that in the grass pollen season their
asthma gets worse:
1. Has the frequency of asthma increased with time?

A range of research has shown that over the last few decades there has been an increase in the
prevalence of asthma. Many of the studies have investigated children in various parts of the
developed world. Within each locality, the better studies, have tended to use the same
questionnaire applied to children sampled in the same way but after a time interval. There is
evidence that changes in medical practice and in awareness of the disease by doctors, patients and
the general public alike has been responsible for an increase in hospital admission rates from
asthma, and probably also in the recognition of the disease and its symptoms. However the
consensus of opinion is that changes in medical practice or perception do not account for all the
apparent increase in prevalence of asthma - i.e. some of the increase is "real" although perhaps not
as great as some of the crude data might initially suggest.

2. Can inhaled pollutants cause asthma in people who did not have the
disease and who otherwise would not have developed it?

The clear answer to this question from occupational epidemiology, i.e. systematic studies of
symptoms and/or lung function tests in large numbers of workers, is yes. Several such
epidemiologic studies show an increased risk of asthma as a direct consequence of occupational
exposure to various substances. For these and other substances there is also very clear clinical
evidence that they can cause occupational asthma. Some, such as di-isocyanates (used for example
in twin-pack spray painting) can cause asthma symptoms in sensitised individuals at concentrations
even as low as a few parts per billion, and have even been responsible for a few fatalities,
Epidemiological studies of workers exposed to hexachloroplatinates (intermediates in the refining of
platinum) suggest that if workers are exposed to high enough concentrations for long enough, they
might all develop asthma. Incidentally, occupational epidemiology data clearly show that, for some
of the workplace exposures, tobacco smokers are at a higher risk of developing asthma, earlier on,
than non-smokers.

However, although occupational exposure is responsible for a few thousand new cases of asthma
in Britain alone every year, it clearly does not explain the apparent increase in asthma prevalence,
especially in children.

3. In parallel with the changes in asthma prevalence, have there been any
changes in airborne pollutant concentrations?

Yes, there have been changes in air quality, but in different ways and in different directions!
Pollution from the burning of coal, which resulted in emissions of sulphur dioxide and particulate
matter has decreased considerably over the last few decades. However, overall average
concentrations of pollution from motor vehicles, notably oxides of nitrogen, particulate matter from
diesel internal combustion engines, and some other compounds has surprisingly not tended to
increase, as one might have expected, in parallel with the increase in numbers of motor vehicles.
However, the frequency of peaks of traffic related pollution and the geographical extent of it have
probably increased. Episodes of pollution from secondary pollutants, notably ozone, produced by
photochemical oxidation, have also increased. Moreover, we must not forget that in tandem, there
have also been changes in people's diet, lifestyle, and in homes and other indoor environments. For
example, homes have tended to become warmer and, in this and other ways, much more appealing
to cohabitation by dust mites.

4. Can current levels of outdoor air pollution aggravate asthma
symptoms/precipitate attacks in people already suffering from the disease?
1. Has the frequency of asthma increased with time?

A range of research has shown that over the last few decades there has been an increase in the
prevalence of asthma. Many of the studies have investigated children in various parts of the
developed world. Within each locality, the better studies, have tended to use the same
questionnaire applied to children sampled in the same way but after a time interval. There is
evidence that changes in medical practice and in awareness of the disease by doctors, patients and
the general public alike has been responsible for an increase in hospital admission rates from
asthma, and probably also in the recognition of the disease and its symptoms. However the
consensus of opinion is that changes in medical practice or perception do not account for all the
apparent increase in prevalence of asthma - i.e. some of the increase is "real" although perhaps not
as great as some of the crude data might initially suggest.

2. Can inhaled pollutants cause asthma in people who did not have the
disease and who otherwise would not have developed it?

The clear answer to this question from occupational epidemiology, i.e. systematic studies of
symptoms and/or lung function tests in large numbers of workers, is yes. Several such
epidemiologic studies show an increased risk of asthma as a direct consequence of occupational
exposure to various substances. For these and other substances there is also very clear clinical
evidence that they can cause occupational asthma. Some, such as di-isocyanates (used for example
in twin-pack spray painting) can cause asthma symptoms in sensitised individuals at concentrations
even as low as a few parts per billion, and have even been responsible for a few fatalities,
Epidemiological studies of workers exposed to hexachloroplatinates (intermediates in the refining of
platinum) suggest that if workers are exposed to high enough concentrations for long enough, they
might all develop asthma. Incidentally, occupational epidemiology data clearly show that, for some
of the workplace exposures, tobacco smokers are at a higher risk of developing asthma, earlier on,
than non-smokers.

However, although occupational exposure is responsible for a few thousand new cases of asthma
in Britain alone every year, it clearly does not explain the apparent increase in asthma prevalence,
especially in children.

3. In parallel with the changes in asthma prevalence, have there been any
changes in airborne pollutant concentrations?

Yes, there have been changes in air quality, but in different ways and in different directions!
Pollution from the burning of coal, which resulted in emissions of sulphur dioxide and particulate
matter has decreased considerably over the last few decades. However, overall average
concentrations of pollution from motor vehicles, notably oxides of nitrogen, particulate matter from

diesel internal combustion engines, and some other compounds has surprisingly not tended to
increase, as one might have expected, in parallel with the increase in numbers of motor vehicles.
However, the frequency of peaks of traffic related pollution and the geographical extent of it have
probably increased. Episodes of pollution from secondary pollutants, notably ozone, produced by
photochemical oxidation, have also increased. Moreover, we must not forget that in tandem, there
have also been changes in people's diet, lifestyle, and in homes and other indoor environments. For
example, homes have tended to become warmer and, in this and other ways, much more appealing
to cohabitation by dust mites.

4. Can current levels of outdoor air pollution aggravate asthma
symptoms/precipitate attacks in people already suffering from the disease?

The epidemiological data suggest that this can happen, although the evidence to date, indicates that
this effect is relatively small, when adjusted for confounding factors, and when compared with
several other factors that contribute to asthma symptoms. It is known from studies in human
volunteers suffering from asthma, that exposure to sulphur dioxide can cause narrowing of the
airways of the lung. However,outdoor concentrations of sulphur dioxide seldom reach levels such
as these and which may be high enough to provoke a worsening in asthma symptoms; but there can
be notable exceptions for example in localities where sulphur dioxide emissions are high and
climatic conditions do not permit rapid dispersal. Peaks of ozone pollution may be associated with
increased frequency of asthma symptoms.

5. Can air pollution generally (i.e. not occupationally) cause asthma in
people who did not have and otherwise would not have developed it?

The available epidemiologic evidence does not, as yet,
support this. However the best types of studies to
investigate this hypothesis are very expensive and difficult
to conduct and would have to be followed up over a long
period of time.

Analysis of routine data on ill-health and on pollution
collected in the current manner, cannot answer this crucial
question. Some studies indicate that exposure to biological
pollutants in the home (such as house dust mite antigen) or
outdoors (such as certain pollen particles or fungal spores)
might be associated with an increased risk of developing
asthma.

hen you have asthma, there are two main things happening in your lungs:
                          constriction, the tightening of the muscles surrounding your airways, and
                          inflammation, the swelling and irritation of your airways. Together, constriction
                          and inflammation cause narrowing of the airways, which results in wheezing,
                          chest tightness, or shortness of breath. If left untreated, there is increasing
                          evidence that asthma can cause long-term loss of lung function.

                          ADVAIR DISKUS is the first and only product available that helps control both
                          inflammation and constricted airway passages at the same time with just one
                          inhalation in the morning and one at night, every day. However, ADVAIR DISKUS
                          does not replace fast-acting inhalers for sudden symptoms.

                                                                                     Click here to see
                                                                                      how ADVAIR
                                                                                     DISKUS treats
                                                                                      the two main
                                                                                     components of
                                                                                        asthma. 

                          Is Your Asthma Under Control? 

                          Have you experienced asthma symptoms (wheezing, shortness of
                          breath) during the day or night?
                                                                                    yes     no 

                           ADVAIR does not replace fast-acting inhalers for sudden symptoms and should not be taken more than twice a day. People
switching from an oral steroid, like prednisone, to ADVAIR, which contains an inhaled steroid, need to be especially careful. While
adjusting to the switch, your body may not be as able to heal after surgery, infection, or serious injury. Tell your healthcare
professional if you have a heart condition or high blood pressure. Some people may experience increased blood pressure, heart rate,
or changes in heart rhythm. See your healthcare professional if your asthma does not improve.

                          ADVAIR™ DISKUS® is the first and only product that effectively treats both the inflammation
                          and the bronchoconstriction of asthma in one easy-to-use1 device. ADVAIR DISKUS does not
                          replace fast-acting inhalers to treat acute symptoms. 

                          Reducing Airway Inflammation and Treating Bronchoconstriction 

                          Optimal therapy for many patients with asthma requires control of both the inflammation and
                          bronchoconstriction components of the disease. Click here to see the effects on inflammation
                          and bronchoconstriction. 

                          Convenience and Ease of Use1 

                          Treatment success for many patients remains a challenge because optimal asthma control often
                          requires more than one controller medication.