Fighting children's asthma epidemic

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Fighting children's asthma epidemic

by MICHAEL S. KRAMER AND JUDAH A. DENBURG, Toronto Star

Fighting children's asthma epidemic

As smog hits Toronto, doctors seek your help ...

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May 30, 2006. 01:00 AM

MICHAEL S. KRAMER AND JUDAH A. DENBURG

In the past 30 years, Canada and other Western countries have

witnessed a remarkable and alarming increase in allergies and asthma

(an allergic disease in most instances) among children. This is a

true epidemic.

While World Asthma Day went by on May 2 with little fanfare, we

should note that this disease affects upwards of 15 per cent of

Canadian children. It's a major cause of hospitalization, emergency

department and doctor's office visits, and absences from daycare,

school, and (for the parents) work.

It's also expensive. Using conservative estimates, it costs Canadian

taxpayers more than $2,300 per year to treat an asthmatic child.

One recent study has suggested that uncontrolled asthma cases in

adults and children in Canada generate medical and other costs of

more than $170 million annually.

While there are treatments for asthma, no cure exists. And we still

don't know the causes for the huge increase in the numbers of new

asthma cases.

Better recognition and diagnosis of children with asthma account for

some of the increases. Even taking this into account, however, there

are significant and real changes in the total number of afflicted

children.

The most obvious explanation for these increases must lie in our

environment, some sort of environmental " trigger " that causes

allergies and asthma to develop in people who are genetically

susceptible.

Finding and understanding these causes represents a major focus of a

landmark research study being funded by the Canadian Institutes of

Health Research (CIHR), AllerGen, a Network of Centres of Excellence

based at McMaster University in Hamilton, Ont. and partners.

With this support, a large, multidisciplinary and multi-

institutional team of Canadian researchers will design and carry out

research to examine the separate and combined effects of genes and

our surroundings, also referred to as environmental factors, on the

risk of developing allergies and asthma in the first years of life.

The " hygiene hypothesis " has received the most attention as a

possible explanation for the rise in cases of allergies and asthma.

According to the theory, children today are much less likely to be

exposed to disease-causing bacteria, viruses, and other microbes

than were children in the past.

These exposures cause illness — but they can also " program " the

immune system, similar to how vaccines program our bodies to

recognize bacteria and viruses and attack if detected again by the

immune system. Without such exposures, the immune system gets lazy,

leading to more allergies and asthma.

While this hypothesis is appealing, it cannot fully explain the

problem, especially since not every microbe or exposure acts in the

same way in every person.

The evidence is also weak, and sometimes quite confusing, linking

asthma to exposure to pets, breastfeeding, maternal smoking, or

outdoor air pollutants.

So that leaves indoor air quality.

Better insulation and increased humidification in our homes may lead

to increases in mold spores, volatile organic chemicals, dust mites

(small insects that feed off shed human skin and can cause allergic

asthma), and other biological materials, all of which may contribute

to triggering asthma in susceptible children.

These indoor environmental changes, however, have not received

thorough study.

The new research study will increase our knowledge of all of these

types of issues and, hopefully, will help provide answers and

concrete solutions to slow the rapid increase of asthma.

Children from across the country will be followed from birth into

early childhood to monitor the impact of environmental factors on

their health.

We hope to sign up as many as 10,000 families when the study begins

in 2007.

To our knowledge, no organization has ever undertaken a study of

this magnitude and depth. Its findings should help in setting

regulations for indoor air exposures and building standards, thereby

reducing those exposures that increase the risk of allergies and

asthma.

They should also lead to other clues that will help us to better

diagnose and manage these epidemic diseases, and perhaps even

prevent or cure them.

Now, that's something Canadian families would like to hear.

Dr. S. Kramer is scientific director of CIHR . Human

Development and Child and Youth Health, and professor in the

departments of pediatrics and of epidemiology and biostatistics at

McGill University. Dr. Judah A. Denburg is scientific director of

AllerGen NCE and professor of medicine at the G. DeGroote

School of Medicine at McMaster University, Hamilton.

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