Gasping for breath: Are exhaust fumes suffocating our children? Geoffrey Lean investigates the causes of the asthma epidemic
Sunday 10 October 1993
'She was at the very limit of life,' says her mother, Valerie. 'Her face was blue, her lips were purple, and her chest was hollow - and she was really scared. How could I explain to her what was going on?'
A bright, red-headed child, Lydia had been struck, without warning, by asthma. She survived, but over the past five months she has twice more had to be rushed into hospital. Her parents now dread the slightest cold, fearing that next time their daughter might lose her fight for breath.
Lydia's father happens to be my wife's cousin, but there is nothing out of the ordinary in that. Almost everyone has a victim of the asthma epidemic in their family. One out of every seven children in Britain now suffers from the disease. It puts 100,000 people in hospital every year. It is the greatest single cause of hospital admissions after heart disease and strokes, and now kills more than 2,000 people, old and young, a year.
It is the only treatable, chronic disease to be advancing, apparently unstoppably, in Western countries, in defiance of an impressive armoury of drugs and treatments. The number of young children admitted to hospital in Britain with asthma has increased 13- fold since 1960.
Valerie Wolfe realised what was happening to her daughter because her brother had been asthmatic as a child. But she says: 'In those days - and that was only 16 years ago - he was a rarity. Now, whenever I mention our experience, there is someone who has a similar story.'
The causes of this escalating epidemic - which particularly targets children and has hit almost every family in the land - have attracted surprisingly little scientific inquiry and even less political concern. Senior government scientists admit that research has been neglected, and asthma received scant attention in last year's White Paper on health.
Last week was Asthma Week, but you could be forgiven for not noticing. The National Asthma Campaign and the British Lung Foundation duly sent out leaflets to a largely indifferent media. The political response was limited to the belated formation of the first all-party parliamentary group on asthma. So far it contains few MPs, although its chairman, the Conservative Sir Peter Emery, announced (with a slight air of discovery): 'It is amazing how many people today suffer in some way or another from asthma, and this is as true in the House of Commons as anywhere else.'
Yet this issue is likely to prove a political time-bomb. Tick by tick, evidence is accumulating from little-noticed scientific studies all over the world that one of the main factors behind the epidemic is the growth in the use of private cars. This month, 4,000 of the world's top chest physicians, meeting in Florence, reached a broad consensus that air pollution from car exhausts at least exacerbates asthma.
Nothing, as yet, is proven. But if, as seems probable, the evidence coalesces into certainty, people in developed countries will be faced with a poignant choice - between their convenience and their children's health.
ASTHMA is a modern disease. Records at the Westminster Hospital show that it admitted its first asthmatic child in 1910, and that the disease was rare until after the First World War. But then it began its rapid rise.
It is also a disease of civilisation - or, rather, of what passes for it in an increasingly Westernised world. Asthma is 10 times as common, for example, in Australia as in China. It seems to occur more frequently in the developed parts of Israel than in the poor areas, to be rare in rural Africa, but to increase as Africans migrate to cities.
So scientists are looking for causes hidden in more affluent lifestyles. It is not easy, because asthma is a complex disease. For a start, it often runs in families, so there seems to be a genetic component predisposing people to developing it. Nevertheless, many people with no family history of asthma still get it. People with asthma also have more sensitive airways, and scientists believe that these remain inflamed even when the victim feels well. What originally causes the inflammation remains a mystery, but it seems that attacks are triggered when something irritates them, releasing a cascade of chemicals which brings on the crisis. The airways constrict and the attack is under way.
It starts with wheezing, breathlessness and tightness in the chest. Breathing gets harder and harder in a severe attack - and in a very bad one the amount of oxygen in the blood drops alarmingly, and the face and lips turn blue. Sometimes, and more and more often, the victim suffocates.
There are several suspect triggers in the modern lifestyle. Passive smoking is perhaps the best established. Mothers who smoke are much more likely to have asthmatic children. But Dr Martyn Partridge, chief medical adviser to the National Asthma Campaign, says: 'If you stopped all smoking, this would have a relatively small effect on the disease.' Something - or some things - even bigger is to blame.
Fur from pet animals and pollen may trigger attacks, but the prime suspects are now comfort and cars. Comfort comes into it because it suits house dust mites, which can also provoke asthma: fitted carpets and soft furnishings provide homes for mites, and central heating and double glazing supply a congenial atmosphere.
Increasingly, however, research is implicating two pollutants from car exhausts: ozone and nitrogen dioxide. Ozone, a blue-tinged form of oxygen, may be a life-saver up in the stratosphere where it forms the layer that screens out the harmful ultra-violet rays of the sun. But it is a dangerous pollutant nearer ground level; tiny concentrations of it crack stretched rubber and, not surprisingly, harm delicate human tissue. Nitrogen dioxide has a similar effect; a government report suggested earlier this year that it caused the 'greatest concern' of any air pollutant.
The two combine to cover much of the country with damaging levels of pollution. Nitrogen dioxide levels build up in towns because of the traffic. Emissions from car exhausts have increased by 73 per cent since 1981, and last year a government study reported that 19 million Britons were exposed to pollution that exceeded EC guidelines. Ozone, which is also increasing, takes longer to form and drifts on the winds out to the countryside in the process: Britain's highest levels are often recorded at East Sussex's idyllic Lullington Heath.
Studies in the United States have linked ozone with lung damage and asthma, while research in Canada, Switzerland and Sweden has implicated nitrogen dioxide. Recent work at the East Birmingham Hospital has shown that when levels of either pollutant rise, more people have to be admitted with asthma attacks. The study shows that 'acute respiratory admissions' increase at pollution levels 'well within the current EC daily, monthly or annual guidelines' adding that 'significant' numbers of people have become sick 'at these presumed safe levels'.
This month, Professor Robert Davies of St Bartholomew's Hospital has published new research which shows that both ozone and nitrogen dioxide damage the lining of the respiratory system (allowing triggering substances to penetrate), impair the cilia (the tiny hairs that clear infection from cells) and help the chemical cascade that brings on asthma attacks.
He says that evidence has built up so strongly over the past few months that 'there is now no doubt that air pollution exacerbates asthma'.
Dr Malcolm Green, chairman of the British Lung Foundation, said yesterday that 4,000 top chest specialists meeting this month reached a 'consensus' that air pollution made asthmatics worse. It is not yet agreed that pollution can cause asthma in people who have not already had the disease but, says Dr Green, this is 'almost a matter of semantics'.
He explains: 'If pollution is making people with bad asthma worse, and makes those with a little suffer more attacks, it is quite likely that those on the threshold of asthma may be tripped over it.'
The pollution hits children hardest because they are much more vulnerable. Children under three breathe in twice as much air as adults for each pound of their body weight. Kids exercise more, and so take in more air - and more pollution. Their airways are narrower, and so more vulnerable to constriction. And, as their lungs are sill maturing, pollution can affect them permanently, leading to a lifetime of breathing difficulties.
At St Catherine's School in Bletchingley, Surrey, a quarter of the children have asthma. Most parents blame the nearby M25 motorway and say the situation has got dramatically worse in the past five years.
NINETEEN years ago, the Medical Research Council's Air Pollution Unit reported: 'There is by now much evidence of an association between the general prevalence of respiratory illnesses in children and the amounts of pollution in the areas where they live.' In nearly two decades, you might have expected them to have cracked it long before now.
Well, you might. But Mrs Thatcher's first government axed the unit, and killed off the Clean Air Council for good measure. The ostensible reason was that Britain had solved its air pollution problems, once the Clean Air Acts had eliminated the old London smogs. The old pollution has indeed largely gone, but the growth of ozone and nitrogen dioxide, experts say, is now causing as much respiratory disease as the smogs of the 1950s.
A decade of research was lost, the very decade in which the asthma epidemic has developed. Professor Roy Harrison, chairman of the Department of the Environment's Quality of Urban Air Review Group, says: 'We have almost lost all our capacity for research in this field, thanks largely to lack of funds and lack of interest from the Government.'
The Departments of Health and the Environment are finally cranking up research again, but the Government is still cheating on measuring the pollution in the air - and so is grossly underestimating the problem.
As we report on page one, Britain has only seven official monitoring stations measuring nitrogen dioxide pollution, compared to 200 in Germany and 2,000 in Japan. There are 85 times fewer sites per capita in Britain than in Luxembourg, 14 times fewer than in Ireland and Portugal (see chart). As we also show, in a joint investigation with Friends of the Earth, the stations are mainly tucked away from the heaviest traffic, and so record far less pollution than they would if they were sited as EC law dictates.
Britain has also been accused of fiddling the figures on ozone. The Department of the Environment produced a report this summer which painted a reassuring picture, suggesting that EC guidelines were only broken 16 times in 1991 (the last year for which figures were available). But investigation revealed that many of the measuring stations were out of action for much of the time, and that a more important EC ozone guideline had been broken not 16, but 166, times.
CAN cars be made cleaner? From January all new cars will have to be fitted with catalytic converters, honeycombs which fit on car exhausts to trap pollution. Once it was thought that they might solve the problem, but they are both too late and too little.
They are too late because Britain held up agreement on introducing them in the EC for five years. They are too little because, although they reduce pollution massively in ideal laboratory conditions, the real world is much more complicated.
Nearly two-thirds of all pollutants are emitted in the first few minutes of each journey, when the car is started from cold - and the catalysts do not work until after this, when they have been warmed up. They will only be introduced gradually as new cars come on the road, and the effect will soon be overtaken by the increase in traffic. The best that civil servants hope for is a brief breathing space - a cut of perhaps 5 per cent in emissions - before the pollutants rise again, but even this is optimistic. A government report earlier this year concluded that levels of nitrogen dioxide might well not decrease at all in some built-up areas.
Any serious attempt to tackle the pollution will have to be much bolder. It would help if the Government induced manufacturers to market the cars that they have already designed which do twice as many miles to the gallon as the ones they put in the showrooms. Britain might even revive its car industry by such improvements.
But a real solution will have to go further, and consciously turn away from what Mrs Thatcher once lauded as 'the great car economy'. Thirty years ago Professor Colin Buchanan warned that the growth of car ownership threatened 'a national emergency'. Since his warning, the number of cars on Britain's roads has more than doubled, from 8 million to 18 million. Over the next 30 years, ministers predict, it will more than double again.
If they are to get to grips with the asthma epidemic, ministers will have to curb the car and promote public transport, use planning restrictions to curtail out-of-town developments that draw traffic, and start to redesign cities so that people have to travel less to shop, play or work. That would take enough U-turns to grace a learner drivers' convention.
But it is not just a particularly obscurantist group of ministers that will have to rethink their values. The car, as Environment Secretary John Gummer said last week, 'has increasingly destroyed our cities and quality of life, but has also provided a degree of freedom and opportunity to many people who did not have it before'.
Grouse as we may about traffic jams and pollution, we seem quite prepared to put up with them to enjoy the car's convenience. We seem ready to sacrifice our trees, killed by acid rain. We seem ready to destroy our countryside and our cities. We even seem prepared to accept more than 4,000 deaths and nearly 50,000 serious injuries in traffic accidents each year. Will we, if the link with asthma is proved, be prepared also to sacrifice our children's health? Lydia Wolfe, and hundreds of thousands like her, have an interest in our answer.
More information is needed on the issue of children, asthma and cars. The Independent on Sunday' would like to hear of the experiences and views of readers. Please write to Asthma, The Independent on Sunday, 40 City Road, London EC1Y 2DB, or send a fax marked 'Asthma' to 071-956 1469.
(Photograph and graph omitted)
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