Its cause is unknown, its triggers vary from person to person, and it affects as many as ten percent of all Bermuda's children. A considerable problem, yet for many asthmatics life couldn't be easier. With greater preventative measures in place, better education and new methods of treatment, life for asthmatics should be no different than life for the average person. "Asthma is a significant problem in Bermuda,'' explained Stephen West, medical advisor to the Asthma & Allergy Support Group. "It's been quoted to affect between five and ten percent of North American children; in Bermuda, it's a little higher than that and probably has something to do with our environment, and the fact that asthma has a genetic component and Bermuda is a closed island somewhat.'' Increased sensitivity or twitchiness of the bronchial tubes is a key feature of asthma and as a result, they constrict when exposed to triggers such as cigarette smoke, dust or pollen. The constriction forces the muscles in the walls of the tubes to tighten and go into spasms, while its inner lining becomes inflamed, producing excessive amounts of mucus which plug up the airwaves. Asthma sufferers generally fall into three categories -- mild, moderate and severe. Mild asthmatics are those which only wheeze a few times a year and are not required to pay any visits to the hospital or to the emergency room. Most are able to function with just a reliever medicine on an as-you-need-it basis. Moderate asthmatics are those who experience symptoms on a weekly or monthly basis. They may have problems sleeping. In addition to the reliever medicine, which they also take on an as-you-need-it basis, they probably take preventive measures as well, administering medication daily irregardless of symptoms. Persons suffering from severe asthma are those who are frequently admitted to hospital, perhaps to the Intensive Care Unit or maybe even ventilated as a means of care. Such sufferers have symptoms on a daily basis several times a week, using their reliever for acute symptoms in addition to daily preventative medication. "We don't know what causes asthma,'' said Dr. West. "There are certain genetic components, but there are also those families where a child has been diagnosed and there had never been a history of asthma in the family before. Everyone's asthma is different, so what causes a trigger for one person may not for another.'' Certain bronchial infections early on in life can set up a genetic proposition to the ailment, he added, while breastfeeding is well recognised as a prevention against asthma. As well, asthma can best be managed in two ways -- environmental control and medication. "What you want to do is to avoid asthma triggers,'' the doctor explained. "Fifty percent of kids with asthma are allergic to dust mites so you may want to look at enclosing mattresses and pillows and so on or, in more severe cases, pulling up the carpets in the bedroom and putting down tile or wood floor. You also have to stop people from smoking in the house, and if there's an animal in the house, you might want to think about having it become an outdoor pet or getting rid of it altogether.'' Medication, the second means of management, comes in two forms -- relievers and preventers. Relievers are those medications, such as Ventolin, prescribed to handle acute symptoms. Most are bronchodilators which relax the muscles in the bronchial tubes and help them to open up. Preventers, on the other hand, come in steroid and non-steroid form. The form prescribed depends on the degree of asthma suffered. Non-steroidal preventers are taken by puffers or nebulizers and have zero side effects. Steroids, which are not the anabolic steroids taken by athletes, are usually administered through an inhaler so that the medication goes directly to the lungs and a smaller dose is needed. Side effects are seen when the dose is taken orally or when a patient is placed on a high dosage for a long period of time. "I always tell parents that if your child is not able to do the normal things that a normal child is doing, then his asthma is not being treated properly. Every asthmatic should be able to live just as normal a life as any other child. "But although we're better at diagnosis, treatment and education of patients, asthma is still a significant and serious disease. There are asthma-related deaths each year in North America. I think it's maybe that people are a bit complacent with management of their asthma.'' As such, he said, two of the most important steps in managing the illness are education, and proper monitoring once diagnosed as asthmatic. "There must be proper education of patient or parent -- they need to know about asthma, what their triggers are, what their medications are and Monitoring is the key! using, for example, a peak flow meter. This gives the patient a regular indication of how tight or open their lungs are. It also enables the asthmatic to see where his baseline is and to pick up early, through any varying from that baseline, when his asthma will flare up. It's a good idea for the moderate or severe asthmatic. They must know the warning signs. It's important to keep a good relationship with their physician and to have regular checkups so that their asthma can be monitored as best as possible.'' For those reasons, Dr. West said, he believed it essential that the Asthma and Allergy Support group hold a week of awareness. "It helps make members of the public aware that it exists and enables them to get information as well as to see what products are out there and available.'' PHOTO Dr. Stephen West C.J. Quest Richardson blows on a windmill as part of his breathing exercises at Open Airways