Take a deep breath

Are steroids the only option for chronic asthma sufferers? Catherine Nixey reports on the alternatives

Last month it was announced that Britain has the highest asthma rates in the world among 13- and 14-year-olds. In Scotland, nearly 40 per cent of them have the condition. The media, Greek chorus-like, lamented the evils of modern diet, pollution and parenting, and the nation tore its hair.

But if Britain excels in producing asthmatics, it also excels in helping them. "GPs in the UK are very, very good at treating asthma," says Professor Peter Barnes, a member of the scientific committee for the Global Initiative for Asthma (Gina), who published the research. "Modern treatments can control it extremely effectively."

Nevertheless, not everyone feels happy with daily doses of medication for themselves or their children, especially if that medication is steroid-based (steroids are taken by some asthmatics as a preventative), and many people are keen to supplement their normal medicine with complementary therapies. One such therapy is Lyprinol. In a recent study conducted at the University of St Petersburg, Lyprinol was found to decrease the number of inflammatory cells in asthmatic airways, and hence to lessen sufferers' reliance on their conventional treatments.

"In the best cases, people have reported benefits in two to three days. But usually it takes a couple of weeks," says Damian Bond, the managing director of DB5 Healthcare, who distribute Lyprinol in the UK.

Jenny Barrett started taking Lyprinol after she read about it in a magazine. "I've had asthma since I was about 14. Not badly, but every evening I would feel wheezy. It was like an allergic reaction. My skin would go blotchy and my chest felt as if it was itchy on the inside." She did have a preventative brown inhaler, but never remembered to take it. "So I used to wake in the night a lot, short of breath, and it was then that I'd have to take my blue one. I used to use it every evening. But since taking Lyprinol, I've hardly used it at all."

Lyprinol is made from an extract of green-lipped mussels and is taken by, among others, Paula Radcliffe, the marathon runner. The mussel contains an inhibitor of an enzyme involved in the mechanism of an asthma attack. Professor Barnes was involved in the trials: "Lyprinol slightly reduces the symptoms of asthma, but it's not nearly as effective as inhaled steroids. We don't consider that it would be a substitute for [them]. But it may help to improve the patient's control [of the condition] on top of inhaled steroids, or it may mean that people don't have to use such a high dose."

Other sufferers say they find allergen avoidance helpful. House dust mites are a common trigger for asthma and they thrive in warm, damp, ill-ventilated environments. The modern house, with its double-glazed windows, numerous bathrooms and wall-to-wall carpets, provides these in abundance. Last year, a development of specially designed "low-allergen" houses went on sale in Perth. These houses were built with smooth floor coverings, such as linoleum, instead of carpets, and lime plaster instead of moisture-retaining wallpaper. They also had a new type of roof insulation laid in that drew air into the building but filtered out moisture. Case studies on people who moved into the houses have been extremely positive. One resident said that their home had given them "a new lease of life".

Professor Barnes is unmoved. "There are always case studies about people who find a particular thing wonderful. But there is very little scientific evidence that allergen avoidance helps. It is extremely difficult to avoid exposure to allergens completely, particularly the house dust mite. You can try various manoeuvres such as removing carpets, but you can't wholly avoid them. It only requires a very low level of exposure to cause an attack."

Professor Martyn Partridge, the chief medical advisor to the National Asthma Campaign, is also doubtful about alternative treatments. "I do very much respect the observations of sufferers, especially somebody like Paula Radcliffe. And people are very keen to find ways of treating their asthma that do not involve drugs. But most of these things have not been subjected to proper trials."

As well as not being proven, such treatments are also not cheap: 30 capsules of Lyprinol cost £12.95. Plus, alternative asthma therapies can occasionally be downright dangerous: royal jelly has been implicated in the deaths of some asthmatics.

There are lifestyle changes, however, that can be genuinely beneficial. Firstly, avoid things that you are allergic to. If you are animal-allergic, "get rid of the family cat," says Professor Barnes. And if you are allergic to pollen, avoid walking in fields when the pollen count is high (from May to July).

There is also some evidence that diet can have an influence on asthma. Research carried out by the Italian Agency for Public Health found that eating fruit and vegetables seemed to protect against shortness of breath and wheezing, while the consumption of bread, butter and margarine seemed to exacerbate it.

Asthma rates have risen sixfold among young people in the last 20 years. Theories for what is responsible abound, but none has yet been proven. "All we know is that it's related to the Western lifestyle - but which component of the Western lifestyle is not completely clear," says Professor Barnes. "The most popular theory is that it's due to too much cleanliness."

This is the "hygiene hypothesis". In our pristine modern lives, we wash at least once a day, cook our food thoroughly, take antibiotics and tend to keep our toilet and our toilette water distinct. As a result, we lead relatively sterile lives. But our immune systems evolved to detect and destroy a daily barrage of bacteria, viruses and other nasties, sowhen there is the slightest stimulus, such as a house dust mite or a pollen grain, the immune system goes into overdrive. But these stimuli by and large aren't actually harmful, so in trying to attack them, the body only succeeds in attacking itself, resulting in asthma, allergies and so on.

This theory was prompted by scientists noticing that children who grew up on farms, or in a household with a cat, or with older siblings (all of which are excellent sources of infection) seemed much less likely to develop asthma. Plus, asthma rates are much lower in developing countries, where standards of hygiene are also lower.

However, many of the things that make an individual less likely to develop asthma in the first place - such as increased exposure to cats - can make the condition worse in those who have already developed the disease. So what is the best thing for an asthma sufferer to do? Take their drugs, and learn how to take them effectively. "There are numerous excellent studies showing that if you teach patients how to manage their medication themselves you can dramatically reduce suffering from asthma," says Professor Partridge.

In "self-management", a patient is given personalised instructions that advise them how to increase their therapy if they wake at night with asthma, when to supplement their usual therapy with steroid tablets, and when to seek medical advice. It is an extremely successful approach: patients who manage their condition in this way can expect a 20 per cent reduction in disturbance of sleep, a 20 per cent reduction in emergency department attendance and a 40 per cent reduction in hospitalisation.

"The evidence is overwhelming that if you give that sort of plan you can expect massive benefits," says Professor Partridge. "And yet, despite the fact that we've been saying that for 14 years, only three per cent of people in the UK report having been given personal asthma campaigns."

So, however good we might already be at treating asthma in the UK, it seems there is still a long way to go.