Memorandum by Asthma UK (WP 95)
Asthma UK is the charity dedicated to improving
the health and well-being of the 5.2 million people in the UK
who have asthma. To achieve this we work with people with asthma,
healthcare professionals and researchers to develop and share
expertise to help people to increase their understanding and reduce
the effect of asthma on their lives. Our work includes the funding
of demonstration projects, research programmes, fellowships and
professorships and the provision of services including a nurse
specialist Adviceline and our PEAK holidays for children with
asthma.
Will the proposals enable the Government to achieve
its Public Health goals?
1. Asthma UK welcome the public health White
Paper, in particular, we are pleased that the Government published
a document that is wide ranging. The action outlined to protect
against obesity is also a welcome development for asthma—obesity
and poor asthma control reinforce each other. The poorer a child's
control of their asthma the poorer their access to exercise. The
less they exercise the harder it becomes to achieve good asthma
control—there are 1.1 million children with asthma in the
UK. The Government states in the White Paper that halting the
growth in childhood obesity is their prime objective and have
rightly identified the need for children to exercise regularly
and have set a target of 75% of children spending at least two
hours every week on sports and exercise either inside or outside
the curriculum.
2. In order for the Government to be able
to meet its targets on public health we strongly believe that
it should consider the impact that asthma has on the ability of
our children to be physically active. Asthma is the most common
long-term condition in children, with approximately one child
in 10 currently being treated for doctor-diagnosed asthma. Consequently,
the impact asthma has in schools forms a large part of our work
and we have produced our own "schools asthma pack" that
gives information for schools, on how to best deal with asthma
issues in schools, including physical exercise.
3. The strengthening of school nursing services
is also welcome—it would make sense to strengthen the role
of the school nurse beyond the proposals for diet and sexual health
proposed to encompass training in the management of long-term
conditions in schools. Although asthma is by some way the most
common of these conditions, research we conducted on behalf of
the Department of Health in 2003 leads us to believe such work
would be welcomed by the parents of children with a wide range
of long-term conditions.
4. There is some evidence that smoking prevalence
among people with asthma may be higher than among the population
and that is the subject of great concern. Our own data, as yet
unpublished, identifies a significant link between smoking and
poor asthma outcomes. The British Guideline on the Management
of Asthma[178]
observes that "no studies were identified that directly related
to the question of whether smoking affects asthma severity"
yet goes on to recommend "Smoking cessation should be encouraged
as it is good for general health and may decrease asthma severity".
Research funded by Asthma UK and carried out by Glasgow University[179]
found that smoking interacts with corticosteroids (one of the
most effective anti-inflammatory therapies for chronic asthma)
to undermine the effectiveness of the drug.
5. Smoking does not only worsen the symptoms
of asthma and undermine the effectiveness of asthma medication;
there is growing evidence that smoking is a primary cause of asthma
in adults[180]
and young people.[181]
Additionally, of course, there is strong evidence that exposure
to second-hand smoke at work and at home also causes asthma.[182]
Consequently we welcome the proposal for more health promotion
work to reduce the prevalence of smoking and the proposal for
more work with the voluntary sector.
6. Asthma UK is concerned that the White
Paper was unable to give more attention to the impact of outdoor
air pollution on the public health. This is an issue of special
concern to people with asthma and their families. As we said in
our initial consultation response, air pollution and specifically
traffic pollution is a concern for people with asthma and that
is why it is a concern for Asthma UK. A National Asthma Panel
survey found that almost half of people with asthma strongly agree
that traffic fumes make their asthma worse.
7. Many report that pollution aggravates
their isolation, restricts their access to exercise and even makes
them more likely to travel by car. 42% report that traffic fumes
stop them walking or shopping in congested areas occasionally,
sometimes or often, one in four say fumes discourage them from
cycling and 39% are discouraged from exercise. There is also a
strong sense among people with asthma that the Government has
been too slow to act.
Are the proposals appropriate, will they be effective
and do they represent value for money?
Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
8. Our greatest area of concern refers to
the provisions for protecting people from second-hand smoke at
work and in public places. Occupational Asthma is the most common
occupational respiratory disease in the UK[183]
and occupational exposure to second-hand smoke has been demonstrated
to double the risk of the onset of asthma. In terms of health
and safety at work the rationale to protect bar staff only where
food is served seems unfair—the SCOTH report states that
"some groups, for example bar staff, are heavily exposed
at their place of work". We don't agree that working in a
pub that does not sell food should exclude staff from the protection
against second-hand smoke. We note that the proposals will prohibit
smoking in the "bar area" but this cannot provide adequate
protection for employees or members of the public. Smoke cannot
be confined to one area of a pub and ventilation systems are expensive
and ineffective. The impact of this must surely be to aggravate
inequalities in health by giving most protection in venues attracting
higher socio-economic groups and least in those venues that are
most common in area of greater social deprivation.
9. We are pleased to see in the White Paper,
the Government acknowledge that asthma attacks are linked to inhalation
of second-hand smoke. Often, it really is the case that a small
amount of second-hand smoke can trigger an instant attack that
could prove fatal. For the 3.5 million adults with asthma in England
the Government's proposals are potentially, a major concern. Our
research suggests that 40% already find that they are discouraged
from accessing smoky pubs and restaurants and, while the proposals
mark a very great step forward in this regard, they leave open
the question of an action under the Disability Discrimination
Act (DDA). Such an action would apply only pub by pub and so would
add to the confusion among publicans and their customers while
affording protection only to those who are able to seek redress
under the law. The proposed exemptions will add an unnecessary
burden on business and local enforcement bodies—comprehensive
protection would be fairer, simpler, and more effective.
10. The assertion since the publication
of the White Paper that comprehensive action on smoke-free public
places might result in a displacement of smoking from public places
to the home is contrary to the available evidence. The consistent
evidence on smoke-free workplaces shows the reverse; people whose
workplace goes smoke-free are in fact more likely to quit or to
smoke less at home. Exposure to second-hand smoke at work doubles
the chance of an adult developing asthma.
RECOMMENDATIONS
In order for the Government to be able to meet
its targets on public health we strongly believe that it should
consider the impact that asthma has on the ability of our children
to be physically active.
We urge the Government to reconsider its plans
on smoke-free public places and to follow the example set by Ireland,
Scotland and other countries in Europe.
The Government should make a commitment to introduce
legislation to prohibit smoking in all places of work in England
in the next Queen's Speech.
January 2005
178 British guideline on the management of asthma,
Thorax 2003;58; Supp 1. Back
179
Influence of cigarette smoking on inhaled corticosteroid treatment
in mild asthma, S A Little, L J Thomson, C P McSharry, N C
Thomson Thorax 2002;57:226-230. Back
180
Smoking and asthma in adults. Piipari R, Jaakkola JJ, Jaakkola
N, Jaakkola MS. Eur Respir J. 2004 Nov;24(5):734-9. Back
181
Impact of airway liability, atopy and tobacco smoking on the
development of asthma-like symptoms in asymptomatic teenagers
Rasmussen F, Siersted Happy Computers, Lamberechsten J, et al
Chest 2000; 117:1330-5. Back
182
Environmental tobacco smoke and adult-onset asthma: a population-based
incident case-control study. Jaakkola M S, Piipari R, Jaakkola
N, Jaakkola J J Am J Public Health. 2003 Dec;93(12):2055-60. Back
183
The Health & Safety Executive estimate between 3,000 and
5,000 new cases of Occupational Asthma per year. Back
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