Absolutely no oxygen

Yesterday in a shop I overheard a woman saying to her friend “My doctor sent me for lung function tests which showed that I had absolutely no oxygen in my lungs whatsoever, so no wonder I couldn’t breathe.”

Aside from the impossibility of this statement, which had me laughing behind the brightly-colored-ultra-fluffy-highly-expensive towels, the incidence of asthma in Bermuda is of interest.

A seminal study in Bermuda in1986 documented the effects of weather changes on acute asthma.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1341634/

The conclusions were that a NE wind with its colder air and lower humidity will precipitate acute asthmatic attacks while a SW wind, high humidity and higher temperatures seemed beneficial.

It was known as far back as 1776 that cold dry air triggered asthma ( Philosophical Transactions of the Royal Society of London, 1776) . Dramatic increases in incidence have occurred with the passing of cold fronts and thunderstorms in New Orleans, Birmingham UK, and Melbourne (Brown and Jackson 1983 Lancet ii, 260.) But Bermuda has a sub-tropical climate with temperatures not below 16C and generally high humidity all year round so extrapolating from the 1986 study, one might expect a low incidence of asthma.

So why did I read in May this year that the prevalence of asthma in Bermuda is as high as 1:5 children and 1:10 adults, one of the highest in the world?

The Bermuda Health Council last surveyed adult health in 2011. They reported:

Overall, 15.2% of respondents had asthma at some time and 9.8% said they currently had asthma. Women (11.1%) were slightly more likely to have asthma than men (8.2%). Asian and other races (14.6%), single parent households (16.4%), and those with a household income less than $60,000 (14.8%) were more likely to currently have asthma. Those aged 65 and over were slightly less likely to have asthma than other age groups (8.5%).

Last year (2012) around 2000 people were treated for asthma at the Emergency Department of the local hospital – that excludes visitors to the island. This compares with UK figures of 1:11 children and 1:12 adults (http://asthma.org.uk ). Why?

I have just spend half a day reading research papers on asthma in sub-tropical climates, only to conclude “it’s complicated”. Clearly Bermuda does not have high levels of atmospheric pollution, at least not outdoors, but it does have high humidity and this is linked with increase in moulds and dust mites (http://www.lung.org/healthy-air/home/resources/dust-mites-and-dust.html )

It is recommended to minimize dust mites one should keep internal humidity to 50% or less. Bermuda humidity is never below 70% and often above 80% – hence the demand for air conditioners and dehumidifiers is high.

So humidity, mold and dust mites account for much of the high prevalence. But we must not forget the cockroach! Calling them “Palmetto Bugs”, as the Bermudians do, makes them seem more like friendly beetles, but their droppings contain allergens and they love warm places, especially if they can find some food crumbs. If that doesn’t trigger your obsessive cleaning then nothing will.

World Asthma day this year was May 7th and Open Airways, the asthma charity in bermuda, were giving away pillows, spacers and microfibre cleaning cloths to encourage chemical-free cleaning. Next World Asthma Day is May 8th 2014.

So, back to asthma: is there a bottom line?
Should people with asthma come to Bermuda?

Well, the prevalence has apparently “tumbled by a record 76%”
(http://www.royalgazette.com/article/20130507/NEWS06/705079966 ) – Don’t you love journalism – no reference, no figures, no timescale, just believe it!

But some people would have you warned away: http://www.bermudasucks.com/forum/general-discussion/asthma-and-bermuda-what-you-need-to-know-before-moving/
(“Bermuda-sucks” is an interesting site for an alternative view, maybe I’ll return to it in a later blog)

For short term, it would seem sensible to bring spare medication, have full travel insurance and be aware of your environment.
For those coming to reside then I would suggest a visit first, discussion with your specialist and lots of online reading in order to get a balanced view.
(disclaimer: I am not giving medical advice here, this article merely relates a few facts and my own meanderings)

 

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