Asthma epidemic suddenly recedes
Monday 02 November 1998
After two decades in which the number of adult sufferers has trebled and the number of children affected has risen five-fold, latest figures show a sharp fall in asthma attacks.
Between 1993 (the peak year for asthma) and 1997, the number of patients consulting GPs with acute attacks fell by 25 per cent to the lowest level for 10 years. The trend is clear for all age groups, from the under-fives to the over-65s.
The figures contained in the annual report of the Royal College of General Practitioners' research monitoring unit in Birmingham were collected through weekly returns from 90 practices around the country. The unit is best known for its work monitoring winter outbreaks of 'flu. Its asthma research is less well known.
Despite this, Dr Douglas Fleming, director of the unit which is funded by the Health Department, said a paper he had submitted on the fall in asthma attacks to The Lancet medical journal had been rejected on the grounds that the information was "not new".
The unit monitored attacks of asthma (which fell from over 60 episodes per 100,000 patients at the 1993 peak to under 50 episodes last year), not the number of patients, so its findings should be treated with caution, Dr Fleming said. But he added: "I do believe the total problem of asthma has declined."
Asthma attacks rose in the early 1990s when new devices and drugs were introduced, and had started falling only after 1993. A possible reason was that asthma was following the natural course of diseases. "All diseases have an innate variability. If you go through history there is scarcely an illness that hasn't had periods of rising and falling," said Dr Fleming. "If there were a nice neat germ that caused asthma, you would say it was due to changing virulence, but there isn't."
The causes of asthma and its extraordinary worldwide rise between the 1970s and the early 1990s remain a mystery. Possible causes include lifestyle changes, like central heating and wall-to-wall carpets (which provide the perfect home for house dust mites), maternal smoking, vaccinations and the use of antibiotics.
The National Asthma Campaign said it was unaware of the falling trend. Dr Martyn Partridge, expert adviser to the charity and consultant chest physician at Whipps Cross Hospital, London, said: "The prevalence of the condition is undoubtedly increasing, but we are getting better at treating it, so the suffering is declining."
He said the apparent fall could reflect greater caution among GPs about diagnosing asthma in very young children and greater involvement of nurses in treating it.
Dr Partridge added: "At the National Asthma Campaign we have stuck very strictly to the science. If there is evidence that it is getting better, we would be very interested in seeing that data. But I think there needs to be a little caution in interpreting it."
The NHS Breast Screening programme is on target to save 1,250 lives a year, according to Julietta Patnick, the national co-ordinator of the programme.
Around 1.25 million women were screened last year, and 3,156 cancers smaller than 15mm were detected - an increase of 12 per cent on the previous year. The programme also detected 1,431 cancers which had not spread beyond the breast ducts - an increase of 7 per cent. The screening service, which costs pounds 37m a year in England and Wales, was now doing as well as the Swedish trial it was based on, which had seen mortality cut by 40 per cent. "We are getting the same levels of cancer reduction and we should see a similar reduction in mortality in a few years' time," Ms Patnick said.
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