There’s been a marked increase in the number of asthma sufferers in need of emergency treatment at King Edward VII Memorial in recent years.According to Liz Boden of Open Airways, visits rose by 43 percent in the past four years from 1,422 in 2007/08 to 2,028 in 2010/11.Admissions to the hospital for asthma are also rising, although down 72 percent since the Island-wide asthma education programme began, she added.The best way to control asthma attacks is by controlling triggers in our homes, Mrs Boden believes.Things that often make the house more comfortable such as carpets, curtains, stuffed toys, pets and air fresheners, can be an asthmatic’s worst nightmare.Mould is one of the biggest triggers of an asthma attack. To prevent it, she says homes should have good ventilation to eliminate dampness.“Everybody has to take control of what they can control and that is their homes.“If you want to control mould in Bermuda don’t go on the internet to find out how to control mould.“The reason I say that is people will tell you to keep your children inside, don’t open the windows and to use the central air conditioning. In Bermuda we say exactly the opposite.“Use your fans, open the windows and keep the air moving. For asthma we tell people to open their windows in every room for at least 20 minutes every day. Open them, even just a little bit.”Mrs Boden arrived in Bermuda 43 years ago to work as a nurse at KEMH.Residents would then leave windows open all day for fresh air. Today they’re kept closed, largely because of air conditioning and an increase in crime.“When I first came to Bermuda we had the oscillating fan on the chest of drawers and that’s how we kept cool,” she recalled. “Then we got the ceiling fans and we thought we’d died and gone to heaven.“Then we got the air conditioners in the window and then got them in the wall.“What is bad about a country like Bermuda compared to when I first came here is we have to lock our houses because of crime.“We haven’t left all our windows open when we’ve come to work, have we? So of course the house is sealed and mould is rampant.”She added: “The first house I lived in I shared with some other nurses and when we signed the lease we asked for the key we had just come from living in London.“The landlord said, ‘I’ve never had a key for the house, you mustn’t close your house in Bermuda, you’ll have terrible mould’. Coming from London we went off looking for a locksmith and couldn’t find one.”Children don’t play outdoors like they used to, she added. It is estimated that one child in five in Bermuda has asthma.“Bermuda has become so built up that there aren’t the open spaces for children to play,” said Mrs Boden.“They are saying that the average person spends 97 percent of their lives indoors, so what are the children doing now?“They are not exercising their lungs. When you talk about the global pattern of asthma it has gone from epidemic to pandemic level.“It is such a big, big problem in countries all over the world but particularly in developed countries.“People have poor air quality because they don’t open the windows, they’ve got high levels of mould and are using spray to make it smell nice.“But there is no spray to kill mould, they are just filling the place with chemicals.“We are now really big on these microfibre cloths, we’re trying to get everybody to clean their houses without chemicals.”According to Mrs Boden, 702 children and 720 adults visited the hospital for emergency asthma treatment in 2007/08. Those numbers increase in 2010/11 to 964 children and 1064 adults.She said of the rise: “We feel these trends must be due to the present economic downturn.“With more people out of work and without adequate health insurance, they are not filling their preventer/controller medications but are relying on the less expensive quick-acting reliever (Ventolin or Airomir).“People are reluctant to visit their doctor where they have to pay up front even if they do have insurance.“Every visit to Emergency for asthma means that asthma management has failed.“Global Initiative for Asthma wants countries around the world to reduce hospital admissions for asthma by 50 percent. Bermuda did that ten years ago, however the present trend is very concerning,“I am not sure what the solution is. We can continue our Island-wide asthma education programme but without access to affordable controller/preventer medications there is little chance of helping everyone with asthma living in Bermuda, to breathe freely.”