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10.30 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I congratulate my hon. Friend the Member for Cambridge (Mrs. Campbell) on securing a debate on such an important subject, and for managing to bring with her my hon. Friends the Members for Norwich, North (Dr. Gibson), for Eccles (Ian Stewart), for Ipswich (Mr. Mole) and for Hayes and Harlington (John McDonnell). That, I think, conveys the seriousness and importance of the topic.
I must declare an interest. I am a hay fever sufferer, and as a child I suffered from eczema as well. I know that my hon. Friend recognises that the two complaints are related. The subject is dear to her heart, but it is also dear to mine, and I am pleased to have an opportunity to state the Government's policy clearly.
I know how distressing and debilitating this condition can be for people, their carers and their families. There is currently no cure for asthma, and the cause is not fully understood. Treatment is based on relieving the symptoms, and while that remains the case sufferers are bound to experience some frustration.
Asthma is the commonest chronic disease in the United Kingdom. It affects about 3.4 million people, and it affects all age groups. It causes breathing difficulties because of inflammation and swelling in the airways, which can be reversed spontaneously or by treatment.
People may become asthmatic at any time. There are two major types of asthma. There is the allergic version, caused by a bad reaction to allergens such as pollen or dust. It often results in wheezing, and makes life particularly difficult for sufferers at this time of year, especially young people. And there is the non-allergic form, which usually affects people in their 20s and 30s and older people.
We would welcome a drug-free treatment that was found to improve asthma symptoms as effectively as existing medicines. I think, however, that it would be helpful if I outlined the drug regimes currently used to relieve symptoms before turning to the drug-free methods described by my hon. Friend.
There are two kinds of asthma medicines, relievers and preventers, which work in very different ways. Relievers help to relieve asthma symptoms when they happen; preventers help to control swelling and inflammation in the airways, and reduce the chance of asthma symptoms. Relievers are safe and effective medicines that patients can take immediately to relieve their symptoms. They quickly relax the muscles surrounding the narrowed airways and allow the airways to open wider, making breathing easier. However, they do not reduce inflammation and swelling in the airways. Preventers control the inflammation and swelling, and stop the airways from being so sensitive. They need to be used daily, and it may be up to two weeks before they are fully effective.
Although asthma has become more common in recent years, as my hon. Friend the Member for Cambridge suggested, treatments have improved. It is important to stress that the number of deaths from this very debilitating disease, which can be fatal for many people, has fallen. Since 1988, in England and Wales, the number of asthma deaths has fallen by about 25 per cent., and in 2000, the latest year for which figures are available, 1,272 died from the condition. In 2000, there were 14 deaths in young people aged 19 and under.
The management of asthma mainly takes place in the primary care arena. The chronic disease management programme, introduced in July 1993, provides arrangements for health promotion under the GP contract. Participating GPs—around 93 per cent. of the total—receive a fixed annual payment for running organised programmes of care for patients with the complaint.
My hon. Friend the Member for Cambridge spoke about the Buteyko method, which is claimed to be the most effective drug-free approach to the management of asthma and other breathing-related health problems. I commend my hon. Friend on the way in which she illustrated the effects of the approach, and of her personal account of how she has benefited over the past year or so.
The Buteyko method teaches people under stress to control their symptoms through calm, controlled breathing. My hon. Friend will be pleased to know that I spent much of this evening reading through the relevant website, and that I have the pages with me. I may well take up some of the practices to help my hay fever, as the website suggests that they may be of assistance.
If the Buteyko method proved to be as effective as is claimed, it would indeed be a breakthrough in the treatment of asthma. I should like to see robust scientific evidence to support the proposition that treatments such as the Buteyko method are effective in the treatment of asthma and provide long-term benefits for patients. I would expect that any such treatment would have to be as effective as existing drug therapies.
I know that a pilot study, involving a small number of children, was completed by the university of Aberdeen last year. My hon. Friend mentioned the work in Glasgow, and it is interesting that much of the work on this matter is going on north of the border. I hope that we can make links.
The children in Aberdeen were placed in a Buteyko group and a control group, respectively, and the aim of the study was to pilot incorporation of Buteyko breathing technique into conventional asthma nurse training and delivery of care. This would be used to decide whether it was worth doing a randomised controlled trial on a larger scale. I understand that the pilot indicated a number of positive trends, and that the Buteyko group showed a halving of sleep disturbance due to wheezing, as well as a reduction in the average daily dose of inhaled steroids. The university has subsequently made an application for major funding from the Scottish Office to enable it to carry out an additional study.
My hon. Friend the Member for Cambridge mentioned that Australia and New Zealand have support groups for the Buteyko method, and she noted the work of Jill McGowan. I am interested in Dr. Buteyko's methods and I will ask policy officials to find out more about the Glasgow study. I will make available to the chief medical officer a copy of the record of this debate, and I will suggest that he looks further at the matter.
The Government are involved in a broad spectrum of research and development work into the disease. It is important to put that in context. The principal body providing Government funding in this area is, of course, the Medical Research Council. The MRC receives its grant-in-aid from the Department of Trade and Industry and it spent almost £4 million in 1999–2000 on asthma research.
It may be that the Buteyko method is worthy of further research. The MRC always welcomes high quality applications for research, and clinicians with a special interest in Buteyko are able to submit applications for research funding if they wish. I am sure that my hon. Friend is aware, however, that it is a long-standing and important principle of successive Governments that they do not prescribe to the individual research councils the detail of how they should distribute resources between competing priorities. That is something that researchers and research users best decide. The MRC will take all these factors into account when it makes its decision on whether it wishes to fund particular research—alongside some that we know is going on and much that my hon. Friend has talked about—into the Buteyko method.
I should add that a major joint initiative is currently being funded by the Department of Health and the Medical Research Council into air pollution and respiratory disease generally. I listened carefully to what my hon. Friend said about pollution at least adding to the symptoms of the condition. The Department of Health's policy research programme is another source of funding in this area, and it is currently funding three projects investigating the effects of external factors on asthma.
People with chronic illnesses such as asthma have a number of common requirements including needing to deal with acute attacks, making effective use of medicines and treatment, managing pain, fatigue and depression, and having to cope with other people's responses. Both adults and children with asthma will benefit from the emerging expert patients programme that will—via the NHS—provide training in self-management skills for people with long-term chronic conditions. The first pilot phase has recently begun in selected primary care trusts, with activity to take place on a generic and a disease-specific basis.
One of those pilots, in the Medway primary care trust in Kent, is proposing to focus self-management activity on people with asthma. The Medway PCT in Kent has a disproportionately high accident and emergency admission rate for asthma in childhood, and considers that many of those admissions might be avoided by improved self-management. The PCT's proposals will include involvement of a project manager for integrated services, health visitors, midwives and asthma management guidelines derived from those produced by the British Thoracic Society. We hope that expert patients can reduce the severity of symptoms, decrease pain and increase quality of life. I am sure that hon. Members will agree that those are important benefits.
The Department of Health also welcomes the National Institute for Clinical Excellence guidance on inhalers, which it produced earlier this year for children aged between 5 and 15, and in September 2000 for children under the age of 5. We hope that that has relieved the situation for many. We strongly support the guidance that emphasises the importance of ensuring that the device suits the individual needs of the child. I also plan to ask officials to discuss with NICE the feasibility of including the Buteyko method in their technology appraisals programme once we have a little more information about the evidence base.
In conclusion, I am interested in finding out more about the Buteyko method. I will ask policy officials and our research branch to look at the evidence that we currently have about its effectiveness and, once we know a little more, to discuss whether NICE could look at the feasibility of including it in a future technology appraisal programme. My hon. Friend may also want to consider approaching the Medical Research Council for advice about funding further research.
I reassure my hon. Friend that the Government are serious about improving the prevention and treatment of asthma. Our support for research projects and initiatives, such as the national service frameworks and the expert patients programme, and our willingness to look critically at new treatments, such as the Buteyko method, demonstrate that.
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