Asthma's Down the Pan

taggering 5.4 million people suffer from asthma in the UK. Asthma is an illness that seems to belong to modern, Western society and its prevalence has been on the increase since the 1970's.

Although mortality rates from asthma have been on the decline this is only due to the fact that asthma is now better managed. The various treatments are much more effective in controlling its more extreme possibilities. However, asthma remains an illness that can have a devastating impact on individual lives.

Analysis highlights some significant facets about the illness:

• Half of all cases occur in children under 10 years old.

• In this age group it affects twice as many males as females.

• 60% of adults who suffer are female.

• If one parent has asthma the chance of their child developing asthma is approximately double that of children whose parents don't have asthma.

• Children born into households that use cleaners more are twice as likely to suffer persistent wheezing.

Currently, there is no clear culprit as to the cause of asthma. Many suspects have been proposed: pollution, smoking, modern living, central heating, house dust, exercise. None of these are the actual causes of asthma - they are either triggers to an asthma attack or create the environmental conditions conducive to an asthma attack. They are not the root cause of somebody having an asthmatic condition.

There is though a possible culprit with a degree of suspicion hanging over it; one that has previously been indirectly implicated but one that has never been closely scrutinised. As part of the interrogation I would like to look at a number of key questions.

What is the reason for somebody suffering from asthma?

A relatively recent argument as to the cause of asthma observes our increased use of cleaning materials and argues that our increasingly sterile homes mean that we cannot develop the immunity that we previously used to acquire through exposure to bacteria.

However, I would argue that the problem is much more direct than that.

In a nutshell, asthma arises because we put bleach (Sodium Hypochlorite) down the toilet; we leave it to do its work, sometimes overnight, we then, too often, use the toilet without flushing it beforehand.

The mix of urine (containing ammonia) and bleach reacts to give off a small dose of Chloramines which we breathe in and which causes the damage to our lungs.

Repeated regularly the damage becomes significant.

Our damaged/weakened lungs become less hardy and more sensitive to our environment. Triggers that we would not previously have reacted to suddenly begin to affect us more. For some, exposure to these triggers leads to an asthma attack, the affected condition of their lungs making them more susceptible to attack from elements within the air that they breathe.

There does remain a question mark as to whether the lungs are actually damaged or whether they merely develop a heightened defensive system - in other words, they react more quickly to a perceived threat. This could be a significant finding, as it would determine the remedial route for those people who already suffer from asthma. If it is the former then the lungs need to undergo physical repair; if it is the latter then retraining or rehabilitation may suffice.

Why do some people suffer more than others? Why do some people suffer whereas others do not?

There are two basic reasons why there are different levels of suffering;

Firstly, people have different levels of exposure. Obviously, the greater the level of exposure then the higher the risk. Households use differing quantities of cleaning materials; different strengths of cleaning materials, different ways of using those cleaning products. Our levels of exposure varies.

It is also worth noting that, not only do we use more household cleaners, including bleach, but also our attitude to the physical task of cleaning has changed. We spend less time cleaning, believing instead that we can clean as effectively by throwing chemicals at the problem. We will, for instant, put the bleach down the toilet to clean it rather than actually cleaning it manually.

Secondly, we have different levels of sensitivity. The variation in the extent and the depth to which people suffer from asthma is due to our different body mechanisms. The lung damage will heighten an individual's level of asthma risk but they must have a pre-disposition to that sensitivity.

Pain, hunger, the cold, tiredness we all feel them differently. What might be a cold room for one person might be perfectly fine for somebody else; a night of sleeplessness might leave one person exhausted whereas somebody else may cope without feeling any different. Our lungs function similarly. The size, effectiveness and sensitivity of our lungs vary. Any lung damage effectively changes the height of the bar. It reduces their performance and, consequently, may well reduce the amount of exposure we need to a substance in order to trigger an asthma reaction.

We should also consider that an individual's diet may affect the amount of ammonia in their urine and therefore make them more at risk from asthma? We know that asparagus has a high ammonia content. Similarly, dehydration and bacterial infection (particularly in women) can increase ammonia levels.

What causes the lung damage?

Our liver converts ammonia in our bodies into urea which is then expelled in our urine. This ammonia in our urine when mixed with Sodium Hypochlorite (bleach) produces Chloramines which when inhaled causes the damage to our lungs.

Of course, the dose we will be exposed to in our daily ablutions is minuscule yet it will still be damaging to us. Whatever we do, if we do it often enough, will have an impact.

It's like using a sun bed: too much, too often and you risk increasing your chances of developing skin cancer. Repeated exposure to Chloramines damages the functioning of our lungs.

Why is asthma so common in children?

Children's lungs are much smaller and more sensitive as they are still developing. They are therefore more vulnerable to any damage.

We must also consider their level of exposure to the Chloramines.

Many households leave the bleach to soak in the toilet overnight. In the morning, the first person up is six-year-old Tommy who dutifully goes to the toilet and thereby receives a shot of Chloramine.

Also, boys being smaller and standing directly over the toilet bowl receive a much higher Chloramine dose and therefore inhale more. This supports the evidence that in children more boys suffer from asthma than girls.

The damage is cumulative so, with age, lung damage becomes more common. As boys grow their nasal proximity to the Chloramine gas is reduced whereas for females, sitting on the toilet, they remain much closer. This may explain why, with age, more females develop asthma than males. It may also be of relevance that, generalising and stereotyping slightly, as women tend to do most of the toilet cleaning their potential levels of exposure are greater through doing this.

Are there any other sources of Chloramine exposure that cause lung damage?

A similar chlorine based cleaning material is used in swimming pools. Again, the chlorine when combined with urine and sweat gives off a Chloramine gas which people then inhale. In a swimming pool any urine is substantially diluted. However, it is still there and repeated exposure can contribute to lung damage. Hence the reason why so many swimmers suffer from asthma.

How should we be seeking to cure asthma?

We firstly need to eliminate the cause of the problem by ensuring we do not unwittingly produce Chloramines and expose ourselves to them. This will prevent lung damage and make us less vulnerable to asthma.

In terms of corrective treatment and whether or not we can cure those people who already suffer from asthma we need treatments that either seek to strengthen the lungs or treatments that change the functioning of the lungs so that they are less reactive to asthma triggers. The defence mechanism of the lungs is set up to watch for a particular attack but if the trigger invasion comes