Last week the Independent on Sunday revealed that Britain suffered the world's worst-ever epidemic of asthma during this summer's heatwave. At least 1,000 people had to go to hospital with acute breathing difficulties. Experts have called on ministers to set up a pollution early warning system for hospitals to prepare them for future epidemics.
The Department of Environment issued a new air pollution alert for yesterday, the third so far this month. Studies show that the pollution - mainly from car exhausts - exacerbates the asthma epidemic which now affects one in every seven British children and kills some 2,000 people across the nation each year, roughly one every four hours.
But the warnings to asthma sufferers are nearly always wrong. Figures collected by the Government's Warren Springs Laboratory - which has just been closed - record the number of times that 'poor' or 'very poor' air quality (the worst two categories) was forecast for coming days in seven regions of England, Scotland, Wales, and Northern Ireland, and what actually happened. The forecasts were made public through a telephone helpline and given to the media to warn people to take precautions.
The figures show that only 54 correct warnings were made; on 339 occasions the forecast got it wrong. On 147 occasions serious pollution occurred without being forecast. The more dangerous the air pollutant, the worse the record. The predictions got ozone pollution right one time in every four, but last year's poor summer meant that the gas (which increases with sunlight) did not cause serious trouble. For sulphur dioxide, the strike rate was one in six. And for nitrogen dioxide - the most damaging of the pollutants in exacerbating asthma - the forecasters got it right less than once in every 10 attempts.
'The Government's record of forecasting poor air quality episodes is embarrassing,' says Tim Brown of the National Society for Clean Air and Environmental Protection. 'If it really expects people to take action to protect their health on the basis of its forecasts, it is going to have to get them right.' He says the predictions are so bad because Britain has too few air pollution monitoring stations - just 74. By contrast there are 200 stations measuring nitrogen dioxide alone in Germany, and 2,000 in Japan.
The Department of Environment says it is studying how to improve the forecasts, and has forged computer links with Germany and the Netherlands to get information on their measurements, but it insists: 'We have the best system in Europe for giving information to the public.'
Meanwhile doctors and scientists are trying to make sense of the unexpected asthma epidemic which followed violent thunderstorms on the evening of Friday, 24 June.
Luke Eustace, aged 11, was one victim of the outbreak. Sitting in the playground at the Ellen Wilkinson primary school, Newham in London, clutching his inhaler, he said last week: 'I've been to hospital, you know. It was the day of the big storm. I felt really sick all day. And then I was sick a lot and had to go to hospital with an asthma attack. They put me on a nebuliser and I had to stay there all night. They would not let me go home again until the next day. It was a little bit scary.'
Ten-year-old Nicholas Martin said: 'I had an attack that day too. I could not breathe and I turned blue. My nan got up and saw me and ran to ring the doctor. My grandad stayed by my bed looking after me while she was downstairs. The doctor had to come round and change my inhaler for one with steroids.'
The schoolfriends are just two statistics in a rapidly growing total. Luke was one of 96 emergencies seen at Newham General Hospital on the night of 24 June and the next morning. It was one of the worst-hit hospitals in the country. Sixty people were taken to Old Church Hospital, Romford, London, and one - an asthmatic who had not experienced any symptoms for years - died. There was another death at the Lister Hospital in Stevenage, Hertfordshire.
Nobody yet knows how many people fell ill - or how many died - in the epidemic. A group of doctors and public health officials is now trying to collect data nationwide. So far it has counted 1,210 acute cases at 39 hospitals, mainly in London and the Home Counties. Staff at Guy's and St Thomas's hospitals called in the national poisons unit because they feared at first that the rush of cases must have been due to an escape of poison gas.
Tania Honan, a registered nurse in the accident and emergency department at Whipps Cross Hospital, north-east London - the first to feel the impact of the epidemic - was on duty the night that the storm broke. 'They just came in one after the other,' she said. 'The doctors were going up and down the line seeing asthmatic after asthmatic. The porters were being sent down throughout the night to fetch oxygen tanks from other parts of the hospital. Most were not regular asthma cases, but people who usually only got hayfever.'
This phenomenon, repeated at other hospitals, is one of the most puzzling features of the epidemic. Dr Martyn Partridge - the chairman of the National Asthma Campaign and one of the investigating team - says that it seems to have hit people who never had asthma before.
Besides trying to assess the size of the outbreak, the group is aiming to find out what substances were in the air that night and what set off individual attacks.
Thunderstorms are known to have sparked off three much smaller outbreaks after dry weather in the Eighties - one in Birmingham and two in Melbourne, Australia. They seem to release highly allergenic pollen and fungal spores. But this cannot be the full explanation, because many storms did not cause epidemics.
Pollution levels were relatively low on the night of the outbreak, but several leading scientists believe that poor air quality and high pollen counts in preceding weeks could have sensitised the victims' lungs and made them more likely to get attacks. Certainly many of Britain's three million asthmatics have felt sick during this sunny, polluted summer. In Derby, Julia Scaife, 37, has been forced to remain indoors with a fan blowing, the windows closed and the curtains drawn. She said last week: 'I have only been outside twice since the heatwave started, and I have had an attack both times. It is unbearable.'
In Bishopton, Renfrewshire, Fiona Garrett said that her seven-year-old daughter had to go to hospital last month: 'Jennifer had a bad attack in June and was really really ill. I had to take her into casualty and she was put on steroids for five days. Usually when she has a bad attack she recovers fairly quickly, but this summer it hasn't really happened that way.'
Sarah Owen, 25, a trainee teacher in Egham, Surrey, said: 'At the moment at night I'm taking more asthma drugs to help me breathe more easily. The air seems to be worse in the early evening - perhaps it builds up during the day - and I take more drugs before going to sleep to get me through the night. I've been having anxiety dreams about not being able to breathe, being suffocated, so maybe I'm having problems breathing while I'm asleep.'
Asthma is the only treatable, chronic disease to be advancing in Western countries, despite improving medical care. It is now the greatest single cause of hospital admissions after heart disease and strokes.
The number of young children taken to hospital with the disease has increased 13-fold since 1960 and it is now responsible for a quarter of the school days lost through illness nationwide. It costs the country at least pounds 750m a year in lost production, treatment costs and social security payments. And yet much about it remains a mystery. It is officially described as an 'atopy', medical jargon for 'unclassifiable disease'.
Though known for centuries, its rapid increase is a modern phenomenon. It was rare before the First World War (the Westminster Hospital admitted its first asthmatic child in 1910) and appears to be a disease of relative affluence. It is 10 times as common in Australia, for example, as in China and is rare in rural Africa, increasing as people move to the cities.
Some people are genetically predisposed to asthma. Scientists at Oxford University have recently identified a gene, passed from mother to child, which seems to make people vulnerable: they believe there may be four or five similar genes yet to be discovered.
But this cannot explain the escalating epidemic. Human beings cannot have altered their genetic make-up fast enough to account for it, and many people without any family history of the disease still get asthma. Other factors must be at work.
Every time we breathe, small particles are carried into our lungs with the air, irritating surface cells. Normally our bodies' defences cope with them, but in asthmatics they go into overdrive, producing a cascade of chemicals which bring on a crisis. The airways constrict, causing wheezing, breathlessness and tightness in the chest. In a bad attack, breathing gets harder and harder, and in a very bad one oxygen levels fall dramatically and the face and lips turn blue. Sometimes the victim dies of suffocation.
Many things may trigger the attack. Smoke and smoking is one of the most obvious causes: the children of women who smoke in pregnancy are 30 per cent more likely to develop asthma by their teens. Fur from pet animals, pollen, breathing in cold air, can precipitate attacks, while an epidemic in Barcelona was caused by dust from soya beans being unloaded in the docks.
But much of the present attention is being focused on comfort and cars. Soft furnishings and wall-to-wall carpets, combined with central heating, encourage dust mites. A bed may contain two million of them: each square inch of carpet may harbour 100,000.
Air pollution, particularly from ozone and nitrogen dioxide, is increasingly implicated - and many studies from Europe and North America indicate that it is at least exacerbating the epidemic. Research work has shown that air pollution damages the lungs, helping to bring on the chemical cascade that triggers attacks. Emissions of nitrogen dioxide from car exhausts have increased by 73 per cent in Britain since 1981, and official figures show that 19 million Britons are regularly exposed to pollution that exceeds European Union guidelines. In many cases a variety of factors are probably at work - genetic predisposition, pollution, and allergens such as dust mites and pollen.
Children are particularly vulnerable because they breathe in more air relative to their body weight than adults, exercise more, and have narrower airways. Many children grow out of the disease - but as their lungs are still maturing, pollution can affect them permanently, leaving to a lifetime of breathing difficulties.
No cure has yet been found - so treatment concentrates on preventing attacks and alleviating those that occur. Preventative drugs aim to stop the body over-reacting to asthma triggers, alleviating ones are designed to relax the muscles surrounding the airways to combat restriction. Both are often administered by inhaler.
But nobody yet knows how to stop the rapidly increasing epidemic. Luke Eustace and Nicholas Martin are resigned to a long, hot, wheezy summer. 'Asthma is annoying,' says Nicholas. 'You have to take it easy when it's really hot.'
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