Bermuda's high number of asthmatics is cause for concern, Monica Fletcher, Director of the National Respiratory Training Centre in England, said.

Per capita, Bermuda is up there with major countries like the United States and the United Kingdom, but more is known about the illness with more medical personnel being trained in asthma care.

Mrs. Fletcher was in Bermuda for Action Asthma Week last week and while here she participated in the many functions, including speaking to the nurses at a learning lunch at the King Edward Memorial Hospital last Thursday and then presented certificates to the nurses, physiotherapists and pharmacists who have recently passed the diploma in asthma care.

"In Bermuda in the last four years 125 people have gone through the course, with 78 graduates now working as asthma educators," explained Mrs. Fletcher. She was visiting Bermuda for the first time, though other trainers from the National Respiratory Training Centre have been here previously.

The Centre was established in 1986 and over the years have been training health care workers in numerous countries. They have two bases, one in the United Kingdom and the other in the United States and since May of last year Mrs. Fletcher has visited the US 12 times. She will be making another trip there tomorrow - this time to Atlanta - just four days after returning home to Birmingham from the Bermuda trip.

"It is a disease of the developed countries," says Mrs. Fletcher, an asthmatic herself. She noted that those living in Third World countries are also at risk.

"This year we have a trainer in Bangladesh, which is very interesting, a Third World country. We're training in South Africa, Singapore and we're training continually in Europe. And now we've got an organisation in the States. We're also converting our learning material into Russian, because we're training out there.

"We have somebody in St. Vincent and it (the Caribbean) is probably an area we need to be looking at if Bermuda is anything to go by, with the climate and lifestyle."

Those living with asthma should, with proper treatment, be able to lead active lives. Having asthma hasn't curtailed Mrs. Fletcher's activity, she runs every morning and last weekend walked the first four miles of the Middle-to-End walk and then ran the last six. Thanks to the energetic Liz Boden, her days in Bermuda were full!

"I've been here for a week to find out what's happening with the respiratory training in Bermuda and to find out a bit more about the prevalence of asthma and the whole asthma care," Mrs. Fletcher explained.

"You've got some fantastic people here with Liz and her team of nurses which we have now trained. One hundred and twenty five people have been through the course and so we have a lot of asthma educators out there. It's all very well coming here and helping you, but the most important thing is you have your local trainers and people locally who can help the population in Bermuda."

She added: "My organisation trains people across the world, we've been training in Bermuda for four years and it was time I came out here and really saw for myself as the chief executive what is happening and how things are going.

"Because it was World Asthma Day on Tuesday, and because of the Open Airways events all week, it seemed like the best week for me to come...and it certainly was! I met a lot of health professionals and also a lot of patients. I have been out on the road with Liz Boden and actually saw for myself how much asthma is here, how asthma is treated and the desperate need to continue to educate both health professionals and patients in asthma care."

Debbie Barboza, the hospital's asthma nurse and the organiser of the World Asthma Day last Tuesday, says it was a "very exciting week" and much was accomplished.

She disclosed that 984 visits to the emergency department at the hospital were made in 2001 while there were 133 admissions, down from the 365 in 1995.

"We're saying the action plan has failed if they end up in hospital," said Mrs. Barboza.

There are an estimated 100 million asthmatics around the world, with more than 17 million in the United States and five million in Britain.

"Here you have 8,000 which, for a small Island, is a large number," Mrs. Fletcher noted.

"The biggest prevalence rate appears to be in the well developed countries, which Bermuda is one of them, but also the UK, America, Australasia and Europe. When we go to countries less developed the prevalence rate is not as high, and we think lifestyle is a big issue.

"We're getting more and more advanced and know more and more about asthma. There is more money being ploughed into research, we've got better drugs than we've ever had before and yet we still have people out there whose asthma is not controlled."

The high numbers of asthmatics in Bermuda may be as a result of a number of factors, including genetics.

"In one family there was ten children with asthma," Mrs. Fletcher was told. "The chances of developing asthma as a child who has one parent with asthma is 40 percent, but if two parents have it the chance is 80 percent.

"If you have a smallish population the genes are going to mix. Air pollution and climate are other issues, with humidity making things quite damp which leads to moulds."

Another respiratory condition is Chronic Obstructive Pulmonary Disease (COPD) which is the result of smoking among other things. It goes without saying that smoking should certainly not be done by those with asthma, and even second hand smoke can trigger an attack.

"Smoking is a big, big thing. People think about smoking and lung cancer but they don't think about respiratory disease," said Mrs. Fletcher, a nurse for 26 years.

"In the spring of next year we are planning to run a large conference in Bermuda on respiratory diseases such as asthma and COPD."

"The majority of asthmatics who die really die unnecessarily, so ultimately it is life-threatening and it is a serious condition. It doesn't have to be, but it can be."

She added: "I was surprised at how much people (in Bermuda) know about asthma, and in fact they are aware of the conditions. But I'm surprised at the number of people who don't use preventative therapy, that they only use the rescue treatments like the blue inhalers.

"The message is they need to take medication on a regular basis, even if they don't think they will always need it. We now know if you don't treat your lungs long term that that can actually cause problems at an older age.

"Your airways can become fixed and that means you don't shift your air in and out properly and you get Chronic Obstructive Pulmonary Disease which is an irreversible condition. COPD is also caused by recurring asthma that is not treated and the airways that are damaged can be damaged for life. They would need to take regular therapy."

More education will be available within the next year, aimed at keeping the general public and health professionals as informed as possible.

"Our plans for the last part of the year is we're going to bring COPD training and allergy training here, and look at other things like smoking cessation because smoking is another big thing for people with asthma," said Mrs. Fletcher.

"There are plans to have a conference next spring and that will be for health professionals...Doctors, pharmacists, nurses and others, so that we can bring in people from the UK and US and have an international conference here and really get the message across about the most up to date treatment in respiratory disease, which would be fantastic."