~ The End of Asthma? Medical Notes

Evening Standard - London, 08-17-06

The announcement that British scientists have identified a deficiency in the lining of the lungs of people with asthma that renders them particularly susceptible to coughs and colds could prove a turning point in the ongoing battle against a disease which now affects more than five million people in the UK. It's a major breakthrough that is likely to result in the first real new treatments for 30 years, and possibly, one day, even a vaccine.

Inflammation of the delicate lining of the lungs following exposure to inhaled allergens, pollutants and viruses is the primary cause of asthma, with the resulting congestion and narrowing of the airways causing the cardinal symptoms of cough, wheeze and shortness of breath.

Up until now, treatment, for all but the mildest cases, has centred on the use of anti-inflammatory " preventers" such as steroid inhalers, but we have reached the end of the line in terms of their development. While today's anti-inflammatories are significant advances on their forbears developed in the Sixties and Seventies, they are not that much more effective, and around half of all people's asthma in the UK today remains poorly controlled.

One-in-six experiences a severe attack (one that leaves them so breathless they struggle to speak) at least once a week and around 1,400 people die from the condition every year - 40 of whom are children.

The reason this new discovery is so exciting is that it could explain why people with asthma develop the inflammation in the first place. The team of researchers, led by Professor Sebastian Johnson of London's Imperial College, have discovered that people with asthma are deficient in a protein that protects the lining of their lungs from day-today threats - in this case a family of viruses responsible for the common cold.

Put simply, while most of us shrug off such infections, the weakened local defences in the lungs of someone with asthma allow the virus to trigger inflammation and asthma attacks - an all too familiar scenario to any parent taking little Johnny to their GP because "the cold has gone to his chest".

And it is not just viruses that are implicated. Weakened frontline defences could explain the lung's abnormal reaction to a range of possible triggers - from the infamous house dust mite and traffic fumes, to indoor "pollutants" such as bleaches, air fresheners and cooking in our modern hermetically-sealed homes.

The next step is to deliver the missing protein into the lungs to see if that helps, something that could theoretically be done by a new breed of inhaler. And beyond that it may even be possible to develop treatments that switch on production of the missing protein, normalising the lining of the lungs and "curing" asthma. The latter could be offered to young children and form the basis of the elusive asthma vaccine.

All of this is at least five to 10 years away - isn't it, always? - but we shouldn't let that detract from the significance of the Imperial College team's discovery. At the very worst it's likely to revolutionise our understanding of the root causes of asthma, and at best it could transform the outlook for the one in 12 adults and one in 10 children who currently depend on some form of existing asthma medication.

For more information on all aspects of asthma visit www.asthma.org.uk

Biggest Risks Are Both Legal

THE latest YouGov poll into attitudes to drugs has caught my eye, not least because most of the 3,000 people interviewed said they thought alcohol and tobacco posed more of hazard to the nation's health than illegal drugs. When I voiced a similar opinion in an article in the mid-Nineties I was hauled over the coals for "being soft on drugs". How times change.

As a father of two teenage girls, I have mulled over the debate repeatedly.

While I would be mortified if either of them dabbled in drugs, 20 years in medicine (including many nights working in AE) have taught me that the biggest dangers they face - both in the short and long term - are almost certainly completely legal.

Drink Boosts Cancer Threat

THERE is an old adage about breast cancer that younger women worry too much, while older women don't worry enough.

Eight out of 10 of the 42,000 women diagnosed with breast cancer every year in the UK may be over 50, but the sad death of golfer Darren Clarke's wife, Heather, is a poignant reminder that younger women get it, too. She had two young children and was just 39.

There has been a nigh-on 50 per cent increase in breast cancer rates since the early 1980s and younger women have not been immune - around 1,400 women in their twenties and thirties will develop the condition this year.

Experts I have spoken to cite a number of factors for the increase, such as rising obesity levels and the trend for leaving it later and later before starting a family, but it's the link with today's drinking habits that intrigues me. Not least because, given everything written about breast cancer, it doesn't seem to get that much publicity.

When compared to teetotallers, Cancer Research UK predicts there will be three extra cases of breast cancer for every 200 women who drink just two glasses of wine a day. A significant risk that increases by a further seven per cent for every extra glass.

Or to put it another way, drinking more than the equivalent of the recommended daily maximum of two to three very small (125 ml) glasses of wine increases a woman's risk of breast cancer as much as taking hormone replacement therapy (HRT).

For more information visit www.cancerresearchuk.org

Vitamins Might Help After All

With the notable exception of folic acid, I have never believed that pregnant women should take vitamin supplements unless under the direction of their GP or midwife. It is a stance backed by the belief that there is precious little evidence that they do any good, and in the case of vitamin A, at least some that they could be harmful. But I may now have to eat humble pie.

New research from the US has found that women who took multivitamins while trying for a baby were less likely to develop pre-eclampsia - a complication of pregnancy associated with high blood pressure, fluid retention and poor foetal growth that affects as many as one in 10 pregnant women.

The reason for the apparent protection remains unclear, but it would seem fair to conclude that taking a multivitamin supplement designed for pregnancy (and containing no vitamin A) while trying for a baby is unlikely to do any harm, and may be beneficial. Just make sure it contains the right dose of folic acid (ask your pharmacist).
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