Asthma in Children (Hansard, 5 May 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, we do accept that some children (and adults) who are already asthmatic may be affected by high levels of certain air pollutants. The suggestion that the rise in the number of children becoming asthmatic is linked to air pollution is not proven. There are other causes which should not be overlooked.

§ Baroness Jay of Paddington
My Lords, I thank the Minister for that reply. But with respect, I feel that it is a little complacent. The number of children being admitted to hospital over the past 10 years with acute asthma has doubled. At the same time, the emissions of nitrogen dioxide in our cities have increased by 70 per cent. There is a great deal of European evidence to suggest that there is a causal connection. Would it not at least be important for the Government to place asthma in the Health of the Nation policy, so that other government departments such as environment and transport could be consulted about what now costs the NHS over £400 million a year?

§ Baroness Cumberlege
My Lords, the Government are not complacent. They have set up the advisory group on the medical aspects of air pollution episodes to consider the need for specific advice to individuals during air pollution episodes. That group has already reported three times. A further report is to be published early in 1995 on all air pollutants. That report will be published.
The Government have also set up a committee on the medical effects of air pollutants, which has a much broader remit. That committee has set up two sub-groups which will report at the end of 1994. One 1213 report will be on asthma and air pollution; the other will be on fine particles. The Medical Research Council has 14 projects under way. There is also the Department of Health's own research programme and, those of expert committees.
Whether this should be a subject for Health of the Nation has been discussed at length. However, at this time we do not know enough about this particular disease, which affects both adults and children. Once research is complete we will consider whether it is appropriate to include this as part of Health of the Nation strategy.

§ Lord Rea
My Lords, while I agree with the noble Baroness that more research is required, does she realise that there is now widespread professional agreement that traffic fumes are responsible for the exacerbation —not necessarily the cause, but for the exacerbation —of asthma? Does she not think that that is enough to justify more strenuous efforts to cut down on motor vehicle exhaust fumes, particularly in cities, and that efforts should be made to reduce the amount of traffic in towns by road pricing and other methods?

§ Baroness Cumberlege
My Lords, although I appreciate that a medical consensus is now beginning to form, we still do not have enough information to be absolutely certain about the causes of asthma, or indeed whether the higher incidence of those who have asthma is aggravated by the environment. Increasingly we are seeing this condition increase all over the world, in rural areas as well as in urban situations, and in countries where there are very low levels of pollution. There does need to be further research.

§ Lord McColl of Dulwich
My Lords, does my noble friend agree that tobacco smoke can induce asthmatic attacks in asthmatic people? Does she therefore further agree that those who continue to smoke in the presence of those who have asthma behave in a selfish and irresponsible fashion?

§ Baroness Cumberlege
My Lords, cigarette smoke can induce asthma attacks. There are also other causes, such as cold air, exercise, emotion and even domestic house dust mites. I am quite an expert in house dust mites. Alas, I believe that they are eating my wallpaper at home.

§ Lord Ennals
My Lords, does the Minister agree that while, of course, more research is needed, this is a situation in which some real action is needed? Will she recognise that there is a crisis in regard to asthma? With 3 million cases at present, and with the rising rather than falling levels of nitrogen dioxide emissions, is this not a time to tighten up on the level of emissions rather than simply doing no more than continuing with research?

§ Baroness Cumberlege
My Lords, I do not think that the number of asthma sufferers is 3 million. My information indicates that there are 2 million asthma sufferers in the UK. That includes 700,000 children and adolescents. On the substantive part of the noble Lord's question, I believe that it would be very wrong for the Government to pursue a policy until they had firm evidence that that was the right way to go. The research 1214 will come through towards the end of the year. Clearly we shall want to consider those results and then decide what best should be done.

§ Lord Avebury
My Lords, can the noble Baroness say whether any epidemiological studies are being commissioned by her department to pinpoint the differences in the incidence of asthma in children between rural and urban areas respectively? Will she place in the Library of the House a list of all the studies she has mentioned today that are in the course of being completed?

§ Baroness Cumberlege
Yes, my Lords, I will certainly do that—not only the ones that were mentioned, but a more comprehensive list of all the research that is being done. The Department of Health commissioned research includes that at King's College, London, which is a randomised control trial in general practice; St. Bartholomew's Hospital medical school, which is an evaluation of medical guidelines for asthma management; the Social Medicine and Health Service's comprehensive research at St. Thomas's Hospital, where several studies are going on; research at St. George's medical school; at University College, London, medical school; at the University of Teesside; and various other programmes. So a lot is being done at present.

§ Lord Stoddart of Swindon
My Lords, will the noble Baroness confirm that as the incidence of tobacco smoking has reduced, the incidence of asthma has increased? Will she therefore agree that there must be some other cause and that the Government and their research establishments should be searching for that cause? Will she further agree that in relation to traffic pollution —air pollution—there is also another great danger; namely, from particulates from diesel vehicle emissions? Will her department also pay a lot of attention to that?

§ Baroness Cumberlege
My Lords, all those areas are being looked at. We work very closely with the Department of the Environment, which is also commissioning some research. With regard to smoking, we understand that asthma is a very complex condition. We believe that there are many things in the atmosphere that trigger it off and perhaps even cause it. At this moment we cannot say that it is a single pollutant such as cigarette smoke. The condition is very complex and there are a number of other factors to be considered.

§ Lord Molloy
My Lords, will the Minister accept that, from a scientific point of view, what she said is very encouraging and very good indeed? She mentioned three hospitals which are working on this problem. Is she aware that it is somewhat distressing to contemplate that all those hospitals might be shut down by the Government? Is not that a. terrible kind of policy? In addition to scientific information, will the department consider obtaining evidence from not only the British Medical Association but also the Health Visitors' Association which takes note of these matters, 1215 particularly when some aspect of asthma arises in a certain geographical area? Does she agree that such evidence could be well worth examining?

§ Baroness Cumberlege
My Lords, I am very confident that the research that is being undertaken will continue. After all, those hospitals will be in existence for some time yet. If any of those hospitals finally close, some of that work will be transferred to other medical schools. There is no suggestion at all that the medical schools at St. George's or King's College, London, should close. It is scaremongering to suggest that all those hospitals will close.
With regard to the health visitors working in the field, much of the research being done includes general practice and therefore includes other members of the primary health care team.