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If you don’t have asthma, you probably know at least one person who does.
Perhaps someone close to you carries an inhaler, often wakes up coughing or seems to be constantly in and out of hospital.
New Zealand and Australia, unfortunately, make up the global epicentre of this chronic respiratory illness, with one in eight Kiwi adults and one in nine Australians living with asthma.
On the bright side, we’re also world leaders in asthma research – and emerging science from this part of the world holds promise for the millions of adults and children whose lives are adversely affected by this long-term lung condition.
Asthma means having sensitive airways that react to triggers such as exercise, pollen, tobacco smoke or chest infections, causing the muscles around the airways to swell and narrow, making it very hard to breathe.
That’s known as a flare-up (sometimes called an asthma attack), and it can be life-threatening in some cases. There isn’t a cure for asthma, but it can be controlled to reduce symptoms.
Professor Lisa Wood and her research team at the University of Newcastle’s School of Biomedical Sciences and Pharmacy in Australia are on the trail of something that could make it easier for people with asthma to do just that.
A few years ago, they found a link between asthma control and the digestion of soluble fibre – in other words: gut health.
Buoyed by that result, Professor Wood is leading a wider-scale study to uncover a definitive link, which could significantly improve quality of life for people with asthma.
“The majority of people with asthma are looking for dietary strategies to help them manage their disease, but there hasn’t been much good-quality scientific evidence to direct them,” explains Professor Wood.
“And, for the past 20 years, we’ve been working on different projects where we’ve tested different foods and nutrients to see if they would be helpful in asthma management.”
Soluble fibre, found primarily in fruits, vegetables and legumes, is known to slow the emptying process of the stomach, helping us feel fuller, as well as lowering cholesterol and stabilising blood glucose levels.
It has also been shown to alter the body’s immune response, Professor Wood says.
“You hear of soluble fibre mentioned in relation to lots of different diseases, and that’s because in most chronic diseases, the underlying pathology is inflammation,” she explains.
“When soluble fibre is digested by bacteria in the bowel, anti-inflammatory metabolites are produced. We’re particularly interested in molecules called short chain fatty acids that suppress the inflammatory response of immune cells, and our early work suggests that this leads to an improvement in asthma control.”
Professor Wood’s initial study focused on fruits and vegetables, but she’s now testing participants with soluble fibre supplements to zero in on that nutrient.
“We’re not suggesting that people would replace their asthma medications with this type of a treatment,” she adds.
“What we’re suggesting is that this could complement people’s usual asthma medications and potentially reduce their reliance on their asthma medication.”
In her two decades of biochemistry research into asthma, it’s the most exciting development Professor Wood has uncovered.
“Asthma is a really complicated disease,” she says.
“Everybody has different triggers, and those triggers all encourage the development of different types of inflammation, and then those different types of inflammation respond to different things.
“Traditional corticosteroids [such as prednisone, to reduce inflammation] are the main therapy that’s been available. They are not necessarily effective in all individuals, but there haven’t been a lot of alternatives. And so that’s why there are so many people working in the area to try and come up with new strategies.”
Siobhan Brophy, CEO of the National Asthma Council Australia, says one of the biggest misconceptions about asthma is that it only affects kids.
“People don’t really realise that you can get asthma at any age, and even as an older adult you can have it – even if you didn’t smoke or have allergies. You can still develop it in later life.”
She says the University of Newcastle findings are great cause for optimism.
Among other significant recent scientific developments have been the development of biological agents – drugs that dampen the immune response and target individual sources of inflammation.
“It’s probably only a small number of people with asthma who are bad enough to need these ones – we’re talking about someone who’s probably in and out of hospital a couple of times a year or taking high-dose corticosteroids every day. These biological agents are kind of life-changing for these patients,” she says.
Siobhan says gaining control over asthma isn’t just about being able to go about your life without breathlessness or wheezing, it’s also about wellbeing.
“Having asthma can have an effect on your mental health,” she says. “We know there’s a higher prevalence of anxiety and depression among people with asthma than those without.”
Siobhan adds, “One of the challenging things with asthma is that the cycle of anxiety and stress that can be triggered by having an asthma flare-up can also trigger the flare-up. You can end up in a sort of a vicious circle where you’re thinking you’re going to have an asthma flare-up, so the stress and anxiety start to bring it on, which then makes you more stressed and anxious. It’s one of those things that people with asthma need to have a good chat with their doctor about.”
Asthma & Climate change
Among the many devastating effects of the climate emergency could be a worsening of asthma and other allergic attacks.
A review in the journal Public Health Research & Practice found that higher temperatures and increased carbon dioxide in the atmosphere will significantly
boost the level of soft allergens.
“There will not potentially be an increase in the number of people who get asthma in the first place, but perhaps those being affected by it,” explains Siobhan.
“For example, people who’ve been living in an area that didn’t have a particular thing they’re allergic to, if the climate’s warmer, those plants start to grow there, then you’re suddenly living in an area that’s got one of your triggers [such as pollen] in it.”
There’s also the risk of unstable weather.
In November 2016, Melbourne experienced the world’s largest, most catastrophic thunderstorm asthma event, which caused 10 deaths – and the odds of something similar happening again may increase with the climate emergency, the review notes.
“Like with a lot of climate change things, there is some uncertainty about what’s going to happen,” Siobhan says.
Using technology to control asthma
Technology is helping people control their asthma better, says Siobhan.
Here are some free apps to check out from the App Store and Google Play.
My Asthma App – this New Zealand app stores an asthma action plan and provides first-aid advice.
AsthmaMD – while the adult action template is different to those used in NZ, this is a good complementary app to MyAsthma because it offers additional features such as symptom and peak flow tracking, reminders etc.
Asthma Buddy – this National Asthma Council of Australia app keeps a record of your asthma action plan – your basic list of instructions of what you need to do to keep yourself well, eg medications, and what to do if you start to feel unwell.
Kiss myAsthma – designed for young people, this Asthma Australia app helps with things such as tracking asthma symptoms and moods, and gives reminders about preventer medications.
Asthma First Aid – in the event of an asthma emergency, this Asthma Australia app walks people through first-aid steps.
- MedicineWise – this app helps you manage medication for chronic diseases including asthma. This is handy because around 60 per cent of people with asthma also have some other chronic disease, says Siobhan.
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