HERE are few places in the world with a higher proportion of asthmatics than Bermuda.

It is estimated that at least one in five children and one in ten adults are affected by the condition. And there are likely to many people out there unaware that the reason they struggle for breath sometimes is asthma.

Genetics, the climate and our affluent society are some of the factors that make this island a perfect environment for asthma to thrive, according to Ms Boden.

But by taking the simplest of action, asthmatics can avoid the struggling for breath that can be frightening, painful and sometimes even fatal.

Asthma affects the airways ? the small tubes that carry air in and out of the lungs. People with asthma have airways that are almost always red and sensitive. These airways can become inflamed when the person has a cold or a viral infection or comes into contact with an asthma trigger.

A trigger is anything that irritates the airways and typical triggers include colds, cigarette smoke, mould, exercise, dust mites, pollen or chemicals used in the home.

Asthma not only inflames the airways, but also causes a mucus secretion and a tightening of muscles, both of which further constrict the tubes through which we breathe air.

Ms Boden, a trained asthma nurse and instructor, has been spreading the word about prevention for the past seven years and the statistics suggest she is winning her battle. In that time, hospital admissions for asthma have dropped by 65 per cent.

"The decrease in admissions is good, but the number being admitted is still terrible," Ms Boden said. "There are still hundreds if not thousands of people out there who are suffering and should not be."

Ms Boden is an asthmatic herself but said she never now suffered from attacks because she stuck to her daily dose of preventative medicine. Her personal knowledge of what it feels like to suffer from asthma ? and the stark simplicity of the solution ? spurs her on in her work to raise awareness in the community.

"Modern medications are safe and effective and doctors are giving the right treatments to people, but they are not always taking them," Ms Boden said.

"It's like telling people to put on sun block before they go down to the beach, rather than when they're already sunburnt. The preventative medicines are like a block, stopping the airways from becoming inflamed.

"The problem is that people don't like taking something every morning when they're feeling well. If they don't take the medicine, they end up with swollen airways and suffer. Yet all they have to do is take their medicine every day. It's so simple.

"If every asthmatic could understand this important message and remember to take their preventer medication every day, say before brushing their teeth ? most people remember that ? then we may see the end of hospital admissions and more importantly, no one would die from asthma and everyone would feel so much better."

Preventers provide two types of protection. Some reduce the sensitivity of the airways, thereby cutting down on inflammation. And others act as a bronchial dilator, opening up the airways.

Their protective effect builds up over a period of time, so they need to be taken every day, usually in the morning and the evening.

An improvement is usually experienced after a few days of using preventers, but they generally take seven to 14 days to become fully effective. To stop taking them is to invite asthmatic symptoms to return.

until recent years these two types of preventer were taken through two different inhalers. Now there are combination medicines available which provide both types of protection in a single daily dose of powder, which is inhaled.

"Studies have shown that not only are combination medicines easier to take, but they also work better," Ms Boden said. "They've been available in Bermuda for a couple of years now."

Symbicort is one of the combination medicines, a disc-like dispenser that serves up tiny individual doses of dry powder to be inhaled once or twice a day. Another is Seretide (known as Advair in the US), also a powder. Both medicines are suitable for those aged six years and over.

Ms Boden is director of Open Airways, an asthma registered charity that aims to improve the lives of those who suffer from asthma, through education of patients, their families, the community and health professionals.

far the charity has trained more than 120 health care professionals, including nurses, doctors, pharmacists and physiotherapists. They have been put through a six-month diploma qualification from Britain's National Respiratory Training Centre.

Ms Boden works with fellow asthma nurses Debbie Barboza and Jutta Harvey, as well as the Open Airways treasurer and vice-president Catriona Godfrey.

Ms Boden felt there was still much to be done. Next Tuesday, May 4, is World Asthma Day and Open Airways will mark the occasion by having nurses on hand in the King Edward VII Memorial Hospital lobby to discuss asthma and the medications available for it with anyone who's interested.

They will be giving out free spacers, devices that can increase the effectiveness of medicine by mixing it thoroughly with air before it's inhaled to aid its passage into the deepest airways. The following Tuesday, May 11, the nurses will take their roadshow to the Washington Mall, where they will be offering more advice between 11 a.m. and 2 p.m.

If you believe you have asthma, call Debbie Barboza at KEMH on 236-2345 (extension 1652) or Liz Boden at The Nurses Practice on 232-0264. They can sit down with you for an hour to give advice and help you form your own personal action plan.

Open Airways is in the process of setting up its own web site. In the meantime, Ms Boden recommends as an informative web site.