In this edition: House Dust Mites Air Pollution and Asthma Prime Real Estate for People with Asthma Conquering Asthma Together – A history of asthma research in Australia House Dust Mites House dust mites are one of the major triggers of asthma, but also one of the most difficult to remove! Sarah Tutt, Asthma Information Line Coordinator, gives us the dirt on dustmites. What are house dust mites? House dust mites are tiny creatures that thrive in warm, humid climates – which is why coastal Australia is a perfect location for them! They feed off human skin scales and are therefore mostly found indoors inside bedding, soft furnishings, carpets and clothing. Dust mites are considered to be the most common allergen trigger for asthma in Australia. In actual fact, it isn’t the creature itself we are allergic to, but actually the proteins contained in their droppings. Research indicates that the more exposure someone has to house dust mites, the more likely it is that they will develop an allergy to them. How to avoid dust mite allergens One of the main things a person with asthma needs to find out is what sets off (‘triggers’) their asthma or makes their asthma worse. Recognising and avoiding these triggers is what we call allergen avoidance, and forms part of what we consider to be good asthma management. By reducing exposure to allergens, sensitised individuals can experience a reduction in symptoms and some people may also be able to reduce their medication usage. There are a number of suggested house dust mite avoidance measures that may be beneficial in alleviating asthma symptoms. The Asthma Foundation of NSW strongly recommends that people with asthma have a proven diagnosis of house dust mite allergen before undertaking dust mite minimisation strategies that can be costly. In other words, if you do not definitely know that dust mites trigger your asthma any of the following measures may be ineffective and a poor use of money. You can find out what your triggers are by visiting your doctor or a respiratory specialist and ordering an allergy test such as a skin prick test or blood (RAST) test which will detect antibodies to specific allergens. The following house dust mite avoidance measures aim to kill house dust mites, remove their allergens and destroy the places where they may live and breed. Whilst they are useful measures for some people, there is conflicting research as to how beneficial they can be for all people with house dust mite allergy. There is sufficient evidence to suggest that sprays, domestic humidifiers and air cleaning devices are not necessarily effective in controlling house dust mite levels. The following measures may be effective, but remember to clarify your triggers with your doctor before pursuing the following activities: 1. Covering mattress, pillow and doona with house dust mite resistant covers. 2. Washing bed linen regularly (at least weekly) in hot water (at or above 55 degrees celsius) 3. If washing in cold water, using a commercial product containing essential oils (eg. tea tree, eucalyptus oil) 4. Removing sheepskin and woollen underlays from beds 5. Removing soft toys and cushions from beds (washing soft toys using the methods in point 2 and 3 may be effective; freezing soft toys overnight will kill mites but will not remove allergen) 6. Damp dusting weekly 7. Vacuuming carpets weekly using a HEPA filter vacuum cleaner. Allow 20 minutes for the dust to settle 8. Where possible removing carpets and replacing with hard floors 9. Keeping your house dry and well ventilated; reduce humidity if possible 10. Replacing curtains with easy to clean blinds. For more information about dust mites and allergen avoidance suggestions for house and garden, please contact our Asthma Information Line on 1800 645 130. REFERENCES: “Asthma and Allergy, A Guide for Health Professionals”, Australian Government Department of Health and Ageing, 2004 “Asthma and Allergy, What You Should Know”, Australian Government Department of Health and Ageing 2005 “Asthma and Infant Bedding, A Guide for Health Professionals”, Australian Government Department of Health and Ageing, 2005 “Know Your Asthma”, Christine Jenkins, Vital Books, Silverwater 2005 Air Pollution and Asthma The fact that air pollution affects people with asthma has been known for two decades. But how important is the issue of air quality when and where it counts? Air pollution is identified as a trigger for asthma and can be found in most of our living environments, both outdoors and indoors. Outdoor air pollution can be either man-made (motor vehicle emissions, tobacco smoke, wood heaters) or natural (pollens, bacteria, fungi). It can also include sulphur dioxide and nitrogen oxide which emit from burning coal or oil. These outdoor pollutants can filter into our houses through natural air flow and ventilation systems and become indoor air pollutants. Indoor pollutants also include tobacco smoke, nitrogen dioxide which comes from unflued gas heaters, and formaldehyde gas which comes from things like glues, paints, markers and dyes. Although it does not cause asthma, when air pollution is high it can increase the severity of symptoms, trigger asthma attacks, and generally make an individual’s day to day experience of asthma worse. Sydney’s Smog In Sydney, air pollution is made up primarily of smog, which constitutes a combination of ozone and nitrogen oxide produced by the burning of coal and gas and car exhausts. In 2005 the Auditor General announced that Sydney would only meet two of its six air quality targets in 2008 because people were so reliant on using their cars and were not using available public transport. The new Cross City tunnel was supposed to deliver a health dividend by cutting traffic emissions, but its high tolls and the narrowed lanes for non-tunnel traffic has produced CBD gridlock and condensed the pollutants. At the same time, the only monitoring station for air pollution in the CBD has been removed. Despite Australia having one of the highest rates of asthma in the world, having asthma identified as a National Health Priority, and the continuing rise in prevalence of the condition, it seems there is little concern on the part of the government about the affects of smog on air pollution and the impact this then has on those with respiratory conditions. The State’s Cigarettes Tobacco smoke is another form of air pollution and is the worst indoor air pollutant, especially around young children. The issue of air pollution from cigarette smoke has been exemplified in the government’s recent discussions about smoking in pubs and clubs. Ex-Premier Bob Carr pledged to make all pubs and clubs smoke free by 2007, but the compromised “75/25” legislation, passed in February 2006, reneged on Carr’s original promise. According to the new “75/25” legislation, pubs and clubs only need to have one quarter of a room open for them to be classed as “outdoors.” Such classification ignores research that demonstrates that harmful smoke is still trapped in furnishings, carpets and curtains. Two days after the NSW decision, the UK joined New Zealand, Ireland, Tasmainia and Queensland in the “smoke free” club, making all pubs and clubs smoke free zones. The Asthma Foundation of NSW, along with the Cancer Council and the Heart Foundation, is committed to the Go Smoke Free campaign, which intends to keep pressure on the government to uphold its health priorities and its promise to make all pubs and clubs smoke free. In the meantime, people with asthma should try to find a pub which has a genuine outdoor area and make sure they always carry reliever medication with them. Air Pollution and Your Asthma The Department of Environment and Conservation issues air pollution reports for Sydney, Illawarra and the Lower Hunter twice daily, although changes in monitoring CBD air pollution means there is less information available for city dwellers. The reports are in the form of the Regional Pollutant Index (RPI) and rate air pollution as low (0-24), medium (25-49), high (50+) or hazardous (200+). The RPI is usually considered hazardous for health when pollutant levels are very high, such as during severe bushfires. People’s asthma is most likely to be affected when the RPI is high or hazardous. If you know air pollutants trigger your asthma, when the RPI is in the high range watch your symptoms closely and make sure you always carry your reliever medication. If you have asthma, you might consider the following measures during days that are classified high or hazardous: • Stay indoors when at the office • Consider working from home • Avoid doing sport or exercise where there are heavy traffic fumes • Wear a mask when outside • Always carry your reliever medication. • If symptoms persist, see your doctor Good asthma management always involves knowing your triggers and taking action to minimise your exposure to those factors. See your GP and get an Asthma Action Plan, which will help you to identify those triggers and keep your asthma in check. Prime Real Estate for People With Asthma. It is well known that different environmental factors can trigger a person’s asthma, so it is therefore no surprise that some people with asthma search for the perfect place to live. onAir explores the prevalence of asthma across Australia, the difficulty in predicting how a new environment will affect your asthma and ways to improve your asthma at your current address. The reason for prevalence of asthma in a specific location is not clearly understood but is thought to be made up of a combination of factors including internal environments, diet and genetic background. Some people think that the prevalence of asthma is lower in the country where there is less pollution, or up north where the weather is warmer. The Australian Centre for Asthma Monitoring (ACAM) recently published a report titled Asthma in Australia which compared asthma in different areas across the country. The report showed that the prevalence of asthma did not vary significantly across the nation, with approximately 1 in 7 children and 1 in 9 adults in all areas having asthma. We know therefore the prevalence of asthma remains constant from state to state, between city and rural areas and even across socioeconomic groups. However, even though the prevalence is the same across the nation, this does not mean that your asthma will necessarily behave the same when you are in different parts of the country. The difficulty lies in predicting which environmental conditions will suit you best and whether or not other factors, such as high pollens that trigger your asthma, are present in that new location. The same is the case on an international scale, with the 1998 ISAAC study of asthma and allergies in childhood showing that certain areas in China with high levels of pollution had relatively low levels of asthma, compared to certain regions of New Zealand with low rates of pollution had high rates of asthma. We do not have enough evidence at this stage to make recommendations about where the best place is for someone with asthma to live. But we do have plenty of information about how to improve your asthma management at your current address. The first step is to discover what triggers your asthma so you can then work on trying to avoid those triggers. Common asthma triggers include allergens such as dust mites and pollens and moulds, irritants such as paints and cleaning agents, physical factors such as exercise or changes in temperature as well as upper respiratory tract infections. In certain instances a move to a new location may improve a person’s asthma. However, such a move to a new location should not be taken lightly and you should be well informed about your asthma, its triggers and best management, before making a decision. For more information on the best way to avoid your triggers, contact the Asthma Foundation on 1800 645 130. References: 1. ACAM (Australian Centre for Asthma Monitoring) Asthma in Australia 2005. 2. Beasley R et al. Worldwide in variation in prevalence of symptoms of asthma, allergen and atopic eczema: ISAAC. Lancet 1998; 351:1225-32 3. National Asthma Campaign; Asthma and Allergy a guide for health professionals. Conquering Asthma Together – A history of asthma research in Australia In popular imagination, the 1960s were the beginning of the modern age. New innovations heralded great social change with such movements as civil rights and women’s liberation. At the same time, the chronic medical condition known as asthma, derived from a Greek word meaning ‘to pant’ or ‘breathe hard’, underwent a similar revolution. Forty years ago treatments were crude and injections of adrenaline and cortisone, which could have damaging long-term effects, were the only known methods of ‘calming’ serious asthma attacks. The understanding and treatment of asthma began to change with the initiatives of two Sydney mothers, Mickie Hardie and Leila Schmidt, both of whom had children with serious asthma and were unable to get satisfactory answers about the condition. The medical profession then knew very little about asthma: they were sceptical about the condition, and were divided into specialties and did not agree amongst themselves. At the time, doctors considered asthma to be either a symptom of over-protective mothering or a product of the imagination, although some did consider asthma was connected to allergies. Supported by others facing similar challenges, Mickie Hardie and Lelia Schmidt established the Asthma Foundation of New South Wales in January 1962. Any reservations the medical profession may have had about the value of such an organisation were dispelled on the first day. As Mickie put it, “We opened our doors and the world rushed in.” In 1962 an estimated 100,000 people in New South Wales with asthma needed help managing their condition. The journey had begun. In the four decades since, the Foundation has gone from strength to strength. Although its methods of raising funds has changed, it has continued to fund a wide range of projects from identifying basic mechanisms of asthma through to research that helps consumers manage their own asthma as well as providing asthma education and training programs. It is estimated that the Asthma Foundation of New South Wales has contributed over $6m into asthma research since its establishment 40 yeas ago. In recent years, contributions have been running at an average of $350,000 per year, making it the second largest supporter of asthma research in Australia after the Federal Government. The short chronology of research achievements that follows bears out the comment from Ros Strong, President of the Asthma foundation of NSW that “each decade since the 1960s has seen thrilling successes and huge progress in the fight to conquer asthma”. 1960s The 1960s began as a decade of ignorance with very little activity in asthma research. Once the Asthma Foundation had put asthma research on their agenda the number of papers describing the disease increased and became the basis for a new body of knowledge. For the first time, the bronchodilator aerosols that could rapidly open the airways during an attack became available for delivery from pressurised canisters. 1970s The 1970s saw great leaps forward in research and in new treatments and medications. Ventolin was introduced, which had fewer side effects and became available both in a pressurised canister and for use with a nebuliser, allowing people to treat their own asthma at home. The first studies in the epidemiology of the disease were carried out in Australia in an attempt to determine the prevalence of the disease and to identify its possible cause. Exercise was recognised as a stimulus for provoking an attack of asthma. The aerosol form of delivering asthma medications now took superiority over the earlier tablet forms of treatment and was identified for both preventing an attack of asthma and for the treatment of an attack. 1980s The 1980s saw more progress in the field of the self-management and education of asthma. A greater understanding of inflammation of the airways was developed and the links between allergies and asthma were established. House dust mite allergy was recognised as being a very important allergen in the home, and non-allergic factors were also recognised as provoking an attack of asthma. New tests involving inhaling aerosols of salt water were introduced to assess asthma severity, which complemented other tests that involved inhaling aerosols of pharmacological agents to identify those people with a propensity for asthma. 1990s The 1990s saw the realisation that asthma was a disease that could affect people differently and that a variety of triggers could induce an attack. Consequently, research exploded in many new areas related to triggers and in the new area of genetics with its role in the development of the condition. 2000s During the first decade of the 21st century we are seeing some of the fruits of four decades of research. Recent Australian Centre for Asthma Monitoring (ACAM) statistics show a halving of the death rate from asthma over the past 15 years and suggest that the prevalence of asthma, which has risen consistently during the past 50 years, may be levelling off. When considering the contribution made by the Asthma Foundation of NSW to asthma research over the past 40 years, it is hard to go past the words of the late Professor John Read: “Financial support for research fellows during their apprenticeship in research is an investment with incalculable long term yield. Long afterwards, when the person's salary is paid by a university institute or hospital, the Foundation is still continuing to reap an investigational dividend in the field of asthma.” The future What of the future? According to the Asthma Foundation of NSW President, Ros Strong, “our vision is a community free of asthma”. Dr Sandra Anderson has likened finding a cure to working on a jigsaw. “From the pieces of the jigsaw we have built so far, we do have a big picture. First we need to focus on strategies that prevent asthma. For those who already have the disease, we need better ways to diagnose the disease earlier, we need to encourage early intervention with treatment. We need to reduce the burden of asthma in the community…” Although no cure or root cause has yet been found for asthma, what has been achieved in four decades is nothing less than a complete turn around for those 2.2 million Australians who have asthma. They now benefit from ongoing research which generates ever-improving medication, better management techniques, education and social programs to help sufferers manage their asthma as well as continued campaigns to make our society more ‘asthma friendly’. *This article is an except from the book Conquering Asthma Together – The Asthma Foundation of NSW’s contribution to understanding asthma which is available from the Asthma Foundation of NSW.
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