by Frances MacGuire

London, 7 May 2019 — World Asthma Day

It’s said that the personal is political.

May 7 is World Asthma Day. It’s not a day I usually connect with, which is odd because I’ve had asthma for nearly 50 years, experienced near death asthma attacks and my inhalers are so much part of my daily life that I forget I wasn’t actually born with them.

I was 6 when I had my first asthma attack. The initial trigger wasn’t clear but there were the usual suspects; house mites, cat allergens, family stress, London air quality. This wasn’t the pea soup smog of the 1950s, but rather the late sixties when private car use sky-rocketed and transport emissions replaced smoke from household fires as a primary pollutant.

In reality I can’t remember my first attack but I can remember life before asthma and the changes that came with living with asthma. The shift from being unaware of my own breathing to the desperate fear that my breathing might stop. The wheeze that accompanied me everywhere. The debilitating nature of the condition which saw me switch from a healthy, active kid to one that struggled to walk round the school playing field. Being unable to breathe makes it difficult to eat so I soon became skeletal and fragile. An adult cousin was convinced I would die.

Before long I was admitted to the Surrey based country wing of the children’s hospital Great Ormond Street with my brother where we were in-patients for a few months; an unlikely scenario these days for children with asthma. Back then there was little use of inhalers or nebulisers, possibly because of the rise in asthma deaths in the 1960s associated with the use of isoprenaline in the first generation of inhalers.

But there were peak flow meters and spirometry. I put my life long interest in science down to being subjected to those early tests for asthma. I was fascinated by how my breath into a long, bendy pipe was etched onto a graph. I dimly remember a lab where kind people in white coats carried out a range of tests and challenged me to improve on earlier results.

I benefited from the next generation of inhalers which used an orange plastic capsule of bronchodilator (spincaps) in what we affectionately called a whizzer; then the next generation, the Salbutamol inhalers (the blue puffer); and the next, the steroid ones (brown). These revolutionised my care. Although I can get a bit breathless, I haven’t had an asthma attack in 25 years.

When I was first diagnosed with asthma I didn’t know anybody else who had it other than my brother and my mother’s friend who used the original squeeze-bulb glass nebuliser. Over the years that has changed beyond recognition. According to Asthma UK, a staggering 5.4 million people in the UK currently receive treatment for asthma. That’s 1.1 million children (1 in 11) and 4.3 million adults (1 in 12). On average, 3 people die each day in the UK from asthma.

Globally, according to WHO estimates, 235 million people suffer from asthma and asthma is the most prevalent chronic disease among children. Asthma occurs in all countries regardless of level of development, however 80% of deaths occur in low and middle-income countries.

There is now strong evidence that air pollution is linked to the development of asthma and can trigger attacks. Unmask My City is working with health professionals to improve air quality in cities around the world and reduce the risk of asthma and other respiratory and cardiovascular conditions.

In February 2019 with the Central California Asthma Collaborative we launched Unmask Fresno in Fresno, California. Fresno’s air quality is among the worst in the US and asthma prevalence among children is double that of the national average. In the UK and US cities research suggests that traffic pollution is responsible for a quarter of all childhood asthma cases. Health organizations in Bangalore, India joined the Unmask My City initiative in April, forming the Healthy Air Coalition Bengaluru, to tackle air pollution in a country grappling with some of the most air polluted cities in the world.

The kind of changes needed to cut local air pollution – a transition to energy production and transport based on renewables, and active travel such as walking and cycling – will reduce emissions and lead to improved health through cleaner air and physical exercise. These measures will also help to address climate change pollution.

World Asthma Day is an annual event organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world. On this World Asthma Day I’d like to thank all those delivering better care for people with asthma.

Unmask My City is working with others to clean up our air and make cities places where we can all breathe easy. Now I can fight for clean air instead of fighting to breathe which feels like the right way to spend 7 May.

Frances MacGuire is the Unmask My City Programme Manager for the Global Climate and Health Alliance.