Mrs. Campbell: Everyone in the House probably knows someone who is badly affected by asthma. Yet in 1950 fewer than one in 50 of the world population had asthma, and before the 1960s, asthma was not regarded as a fatal illness. However, there has been a massive increase since then. The National Asthma Campaign estimates that about 5 million people in the United Kingdom currently receive treatment for asthma, and 8 million people have been diagnosed as having asthma at some point in their lives.
Over the past quarter of a century, the number of first or new asthma cases has increased considerably. Compared with 25 years ago, the incidence of asthma is three to four times higher in adults and six times higher in children, and it is particularly problematic in the UK. The international study of asthma and allergies in childhood found that the highest number of children reporting asthma symptoms were in the UK, Australia, New Zealand and the Republic of Ireland. Asthma has also become more serious: in the UK, about 1,500 deaths a year have asthma registered as the cause.
This epidemic imposes a huge cost on the national health service, employers and individuals. The estimated annual cost to our health care system of treating asthma is more than £850 million a year, and those costs account for just one third of the total cost to society. There is also an enormous cost to employers, with more than 18 million working days lost to asthma each year.
I am pleased to see that The Independent on Sunday is running a campaign to get us to take the disease more seriously and to spend more money on research. I applaud the paper's sentiments and fully support its campaign to reduce traffic and other forms of pollution. However, I shall argue that pollution is a trigger, not a primary cause of asthma. Increasing levels of pollution and ozone affect existing asthmatics but do not create new ones. The medical community still does not know what fundamentally causes the disease.
It is time we admitted that the current treatments appear to be making us worse, not better, and I want to take a look at the possible causes and treatment of asthma. I shall describe the work done by a Russian doctor, Konstantin Buteyko, in the 1960s; it attempted to explain why people get asthma, and offered a management regime for the disease.
Dr. Buteyko's methods were practised widely in Russia in the 1980s, and that may still be the case. They spread to Australia when an Australian doctor suffered an asthma attack while visiting Russia. He was admitted to hospital and was taught the Buteyko method for controlling his
Buteyko blames hyperventilation for a number of civilisation-induced diseases. We all hyperventilate at times of stress. Indeed, the "fight or flight" response to stress is well documented. It was useful in building energy reserves when stress was likely to be caused by a wild animal or physical attack by an enemy. However, continuous over-breathing is certainly damaging and can cause disease. The importance of correct breathing is acknowledged by the National Asthma Campaign's website, which states:
It is not only emotional stress that causes hyperventilation; anyone who is sensitive to environmental factors such as pollution, tobacco smoke, pollenswhich are especially noticeable at this time of yeardog and cat hair or house mites, will experience them as stress and can start to hyperventilate as a result. Certain foods also act as a trigger for asthma, notably chocolate, red wine, cheese and even strawberriesin fact, most of the things that I like best.
Other stress factors are illness, such as chest infections, or exercise. They are all experienced as stress and cause us to breathe too quickly. The effect of that hyperventilation is to increase the amount of oxygen but also to deplete the amount of carbon dioxide, which falls below the level needed for our bodies to function efficiently.
If carbon dioxide is too low, death will ensue, so when the level falls below a certain limit, the body takes retaliatory action. The smooth muscle surrounding the airways goes into involuntary spasm and tightens, thus preventing people from breathing out and losing more carbon dioxide. At the same time, the airway inner linings become swollen or inflamed and excessive amounts of mucus are produced. That is what many of us who are asthmatics experience as an asthma attack.
Usually we try to compensate by breathing more, even though that compounds the problem. An asthmatic may also resort to using reliever medication, which can be a life saverbut it works by relaxing the muscles around the airways, allowing the asthmatic to hyperventilate even more and making the problem worse. Buteyko concluded that asthma is actually a defence mechanism, to guard against the fatal loss of carbon dioxide by over-breathing.
Patients who need reliever medication frequently are usually prescribed steroid preventer medication, which helps to reduce the swelling of the inner airway tube. That works well, but unfortunately, it also depresses the immune system, thus making the patient more vulnerable to coughs, colds and chest infections.
Buteyko's conclusion was that rather than giving people more drugs, which usually make the condition worse, it would be better to teach them how to breathe correctly. However, it is important to stress that Buteyko practitioners always instruct people to continue using their medication unless it is reduced under the supervision of a GP.
Asthmatics whose stress response is constantly stimulated by asthma triggers will over-breathe continuously, and in the long term that can be both crippling and life threatening. There is a respiratory centre in the brain that controls our breathing rate, but hidden hyperventilation depletes the body of carbon dioxide and the respiratory centre adjusts to accept those levels as normal.
The respiratory centre has to maintain what it considers the correct levels of carbon dioxide, so it increases the breathing rate whenever the low level is exceeded. Once bad breathing habits have become established, therefore, the respiratory centre's acceptance of low levels of carbon dioxide perpetuates the problem. The good news is that respiratory centres can be retrained to accept higher levels of carbon dioxide. The aim of the Buteyko technique is gradually to reduce the asthmatic's breathing rate to normal, thus increasing the level of carbon dioxide.
The technique is simple and can be taught in periods of one and a half hours once a day over four or five days. Some follow-up work is sometimes needed, but the results can be dramatic. There are specially designed exercises for children and their parents; the technique has as much success in children aged over four as it does in adults.
There are some well documented cases of people who have been helped by the technique. I understand that Jonathan Aitken, when he was Chief Secretary to the Treasury, received treatment from a Buteyko practitioner in London. His asthma was moderately severe, but over a course of consultations and home visits he made a dramatic recovery. A newspaper article quoted him as saying:
What I really regret is that no one told me about the method before. This year I have not suffered from any hay fever, except for a very occasional sneeze, and I wish that someone had told me about the technique some time ago. Alone, I could have saved the national health service hundreds of pounds' worth of medication and myself a lot of needless discomfort. However, the Minister, whom I am happy to welcome to the Front Bench, will be less impressed by anecdote than by medical trials. Unfortunately, there is little evidence to quote so far.
In December 1998 a paper by Bowler, Green and Mitchell was published in Alternative Medicine, in Australia. The paper was called "Buteyko breathing techniques in asthma: a blinded randomised trial." The trial compared the effect of the Buteyko breathing technique with a control group in 39 subjects with asthma. The control group was given instruction in general asthma education, relaxation techniques and abdominal breathing exercises. The experimenters looked at medication use, peak flow and quality of life, among other factors.
After three months, the subjects assigned to the Buteyko group had reduced their reliever medication by 904 micrograms, whereas the control group had a reduction of 57 microgramsa highly significant result at the 0.2 per cent. level of significance. There was also a reduction in inhaled steroid use by the Buteyko subjects, although the sample sizes were too small for that to be statistically significant.
Similarly and more importantly, perhaps from my point of view, there was a trend towards greater improvement in the mean quality of life scores of the Buteyko group. I certainly think that if someone can have uninterrupted sleep, feel better and have more energy, it is worth a great deal to that individual.
I should like to mention Jill McGowan, who was awarded the carer of the year award at the Pride of Britain awards 2002. She knows a lot about asthma because she has the condition herself, and is also a nurse who has worked for many years helping other asthmatics. Like many others who have followed the course, she stopped needing her inhaler within 24 hours.
Jill is also a university lecturer with the skills to look into the theory behind Buteyko. When she decided that the method had merit, she was amazed to find that it was not more widely researched. She applied to universities for grants to allow her to fund a pilot study. When they turned her down, she sold her house and used the £55,000 proceeds to pay for the study herself.
The pilot study has shown excellent resultsa more than 90 per cent. reduction in reliever medication in the first few weeks. Because of those results, a two-year clinical study of 600 asthma sufferers is under way. Jill is also helping to pay for that work by donating three quarters of her salary. That is real dedication. She hopes that the clinical study will prove the benefits of the Buteyko technique, so that one day it can become available to all on the NHS.
I very much hope that as a result of this Adjournment debate, my hon. Friend will ask the chief medical officer to examine the available evidence. In particular, I would ask him to consider the preliminary evidence from the Scottish trial, and to have further trials conducted to ascertain the method's efficacy in the UK.
Let me stress that the technique that I have described does not constitute alternative medicinea term normally used to describe techniques that sometimes succeed, although no one can quite work out why. The Buteyko