Asthma is a disease on the rise, though a recent conference in the US has provided more insight into a condition that affects thousands in Bermuda, directly or indirectly. As The Royal Gazette's Lawrence Trott reports, while a cure has yet to be found, new knowledge and better treatment is bringing new hope to asthma sufferers.

Jenefer Brimmer, President and CEO of the Asthma and Allergy Relief Centre on Union Street, attended the annual conference last week in Seattle, Washington state, hosted by the American College of Asthma and Allergy Immunology.

She told The Royal Gazette a wide range of topics were discussed.

"Advanced registration alone was about 1500 with about 1400 physicians and the final count, by the time they had exhibitors, was 2000,'' explained Ms Brimmer.

"The topics they covered were wide ranging and my key interest was the November 2 session, when they had a whole day on environment and allergic diseases. One of the things that they came up with when they looked at the gut was that they found that the mast cells played a vital role in what's happening with asthma and allergy.

"At the same time, even though the mast cells are being identified, they said, based on the mast cell, one medication would never shut down the allergic reaction in the lung, that this cell cannot be fooled. You would have to have two medications for the asthmatics in order to start moving inflammation from the airwaves.'' Ms Brimmer provides various products at the Asthma and Allergy Centre, from odourless cleaning products to kill mould and mildew, magnetic dust cloths, air purifiers with Hepa filters to vacuum cleaners made specifically for asthma and allergy sufferers. There are also special bedding and pillows designed to minimise the exposure to dust mites.

As she is not medically trained, Ms Brimmer does not hesitate to refer customers to their doctors to have their condition checked by professionals.

Still, the centre is a good outlet for the asthma or allergy sufferer interested in making their environment more comfortable. The centre opened seven years ago and last year moved to their present location on Union Street.

"From what I've been hearing at the conference and seeing in Bermuda over the last three or four years, eczema is certainly on the increase and people need to find ways to control the disease,'' said Ms Brimmer.

"There are certain other things they can do, like looking at their laundry detergents.

"We carry a a biodegradable laundry detergent and `D-mite' product which is a dust mite eliminator that you can add to your already existing laundry detergent if you don't want to change to a different laundry detergent. "It would eliminate dust mites out of your linen and clothing and these are things patients could look at to manage their disease.'' There is also an allergen spray which neutralises animal dander, pollen, mould and dust mites in furniture, drapes and carpet as well as a powder designed for carpets.

"Most people are not fortunate enough to be able to take up the carpet; for instance they might be renting. So there has to be other solutions that they can work with,'' Ms Brimmer said.

"With the powder they can sprinkle it on the carpet, leave it for two to three hours and then vacuum it. However, they should be using a proper vacuum system and that was one area that the conference was telling people about, not to be fooled by the direct sales people who come to your house selling vacuum systems and air purifiers.

"The Hepa-type filter means that it is a high efficiency system and a true Hepa traps dust particles up to 99.97 percent or higher. You might have some systems that say it's a Hepa filter but it might by 99.9 percent and that's not good enough because you are still throwing particles back into the environment.'' Added Ms Brimmer: "The same thing with the air purifiers, it has to be a true Hepa filter, a hospital graded system that's been acknowledged and recognised by doctors worldwide.'' Many homes and most buildings rely on air conditioning units rather than fresh air through an open window.

"Indoor air is five times more polluted than the air outside,'' Ms Brimmer revealed. "Therefore you constantly need fresh air flowing all the time.

"One of the interesting things that came out on their talk about air purifiers at the conference is a study that they did and what they found out is you don't only need an air purifier for the bedroom. If you had an additional one in the living room the patient would feel 100 per cent better.

"One of the fears people have about air purifiers is the electricity cost, but it's very minimal when it comes to electricity. It's designed to run 24 hours just like your refrigerator. It defeats the purpose if it didn't run for 24 hours.'' The dust mites are also hazardous to one's health. They can't be seen by the naked eye but rest assured they are there, lying in wait.

"The bedroom is the most dangerous room in the house, the reason being that we spend most of our time in the bed,'' Ms Brimmer said.

"Dust mites survive on human skin flakes and we shed 50 million per day.

Therefore the dust mites just wait and are excited that you get into bed because now they have something to feed off.

"A regular sheet and pillow case porous, so our skin scales go straight through to the pillows and mattress. Now it has been recommended for several years that we use the dust mite-proof encasing because it fully encases the entires pillow and mattress. There is no way the dust mite faeces can escape.'' Adds Ms Brimmer, there is a level of frustration within the medical profession that the insurance industry is not supporting the prevention side of allergies.

"It was talked about at the conference that the doctors are very upset that the insurance companies today -- even though they know that these items play a vital role in managing the condition -- are still not making the advancement to cover this under the insurance plan.'' She added that the products found in her store are still not widely distributed.

"In years to come that's going to change, but when we opened our centre seven years ago, Bermuda was very fortunate to have all these products available to them,'' said the company's president.

"Before we opened up we went to the insurance companies and asked them if they would cover the medical devises for asthma suffers and were successful in doing that. We also went to Dr. (John) Cann, the Chief Medical Officer, to ask him if we would be able to bring those devises in duty free.

"All of these items, the spacers, nebulisers and peak flow meters, all of these items are duty free now and therefore it allowed us to bring our prices down for the consumer. The peak flow meter must be used if the patient is going to manage their condition.

"We always let Dr. Cann, as a courtesy, see the equipment first before we put them on the shelf, so we would be in compliance with what's acceptable in Bermuda.'' A survey conducted in January, 1999 by Dr. Leonard Gibbons for the Ministry of Health and Family Services revealed some interesting findings about asthma.

When the findings were compiled in June 1999, it showed that of 444 asthma patients survey, 44 percent were children under 10 years old and 73.3 percent were under 20.

The survey also showed a higher percentage of blacks with the disease, 68 percent to 29.7 for whites.

"Four years ago two doctors at the hospital did a survey, looking at asthma patients in Bermuda, and found that Pembroke was the parish with the most asthma sufferers...because of the dump,'' said Ms Brimmer.

Additionally, comments from last year's survey showed a perceived lack of education by school educators on asthma, no treatment plans for many students with asthma and a lack of employer support for parents who need to care for their children.

Asthma cases on the rise quality, right away the employer looks at what it's going to cost them,'' stated Ms Brimmer who is also president of Thermax Bermuda Clean Care Centre, a company founded 10 years ago.

"Dr. Susan Wynn, a moderator at the conference, spoke on how asthma guidelines make a difference. Until guidelines are met and passed on to the patients, they will continue to fail.

"Even though they have made some strides in regards to asthma and allergies, one of the key things that came out is doctors are not following guidelines put out in regards to medication and education for these patients.

"They said 18 percent of doctors were recommending peak flow meters in the United States, versus 46 percent of asthma specialists.'' Offering relief: The Asthma and Allergy Relief Centre's Jenefer Brimmer.

HEALTH HTH