It did not take visiting health consultant Dr. Jonathan Shapiro long to recognise the magnitude of Bermuda?s asthma problem.

Brought to the Island for a week by Open Airways, Dr. Shapiro spoke with people in healthcare and from his observations gained an appreciation of the severity of the illness which is estimated to affect thousands of local residents.

?My preliminary impression is asthma is a very big problem here, much bigger than you might expect,? said Dr. Shapiro who left on the weekend.

?No one is quite sure why, or quite sure how big, the problem is. There are lots of theories and ideas, but one of the disappointments is there is no certain data about how many people are asthmatic, how bad it is, and that is something I suggest needs correcting.?

According to figures, an unusually large number of people with asthma have visited the Emergency Department this winter. Liz Boden of Open Airways believes there are many more who are suffering unnecessarily.

Dr. Shapiro, who hails from Birmingham in the UK, was here to analyse and offer some suggestions. It was, in his words, ?a very enlightening week?.

?I was hired by Open Airways because they want to take stock of where they are now, having made very progress over the past few years in transforming the face of asthma in Bermuda... and for them to use the opportunity to see where they go next,? explained Dr. Shapiro who was here as a freelance consultant.

The former medical doctor also worked in senior management at the NHS (National Healthcare Service). He also works at the University of Birmingham analysing how health systems work and is chairman of the board of the NHS Mental Health Trust.

?My expertise is to look at how the processes are working, how people relate to each other and give a strategic view of what is happening,? said Dr. Shapiro.

?To use a medical metaphor, it is to do a consultation and make a diagnosis and help to write the prescription for change. I?ve interviewed 15 to 20 people from all parts of the Bermuda system, including politicians, senior civil servants, hospital officials, doctors, patients, people from the insurance companies to get a sense of what is going on.?

Added Dr. Shapiro: ?Open Airways has done enormously good work on a number of levels on raising awareness. They have managed to make, not just asthmatics but the whole public here, aware of the issue.?

Dr. Shapiro noticed how many places have carpets, one of the main triggers of an asthmatic?s attacks.

?My impression is you are the only sub-tropical place I?ve ever come to where almost every house is carpeted,? said the consultant.

?Carpets in a warm, damp climate is just going to be a breeding ground for allergens. If your shoes go mouldy, your carpet will go mouldy! One of the key massages I hope gets across is the true extent of asthma needs to be measured and researched.?

He suggested Open Airways needed more help in tackling asthma and that it should be done in a more systematic way.

?Open Airways is dependent an awful lot of Liz Boden,? he stated. ?She is a finite resource and you need to capitalise on her strengths and build on them.

?One of the other things is your population is very small, so it is how much professional expertise you can have. On the downside, asthma has never had the profile of, let?s say, diabetes or cancer. But it is a problem so easy to solve, relative to some of the other things.

?You have the organisation there, but it needs to be developed. You?ve got solutions here which perhaps could be developed better, but you perhaps don?t have enough coordination between the different agencies. Doctors, the government, the hospital and the insurers all need to pull together.?

Open Airways has carried out initiatives to provide more education on asthma and the treatment of asthma. They say that the common reasons for people with asthma having ongoing symptoms include not taking regular inhalers or medication as prescribed to prevent asthma attacks.

Many people have poor inhaler technique which results in their getting only about two percent of the medication into their airways.

The space device, which Open Airways has been distributing in the schools, increases the amount of medication distributed significantly.

?I?m adamant about spacers for prevention for all ages,? Mrs. Boden stressed.

One exciting breakthrough in asthma treatment has seen asthma medications given at the same time in a combination therapy which provides much better results than when the two medications are given separately.

Relievers are medicines that one can take immediately to relieve asthma symptoms.

They quickly relax the muscles surrounding the narrowed airways.

This allows the airways to open wider, making it easier to breathe again.

However, relievers do not reduce the inflammation and swelling in the airways.

According to Mrs. Boden, many people are now free from asthma symptoms since starting combination therapy, which must be used every day to be effective.

?Asthma is the number one reason why people go to the emergency room at the hospital and used to be the leading reason for admissions, apart from maternity,? revealed Mrs. Boden who continues to stress the important of education.

?If you ask a pharmacist they would say that the ventolin inhaler is the number one prescribed drug in Bermuda for young children. They also say (asthma) is the number one reason children miss time from school.?

Said Dr. Shapiro: ?In the UK we talk about what we do in the health service is fish people out of the river, but we don?t check on why they are falling into the river in the first place.?

It is estimated that around 5.1 million people in the UK have asthma, including 1.4 million children, which is around one in 13 adults and one in eight children. Over 150 million have it worldwide.

Research shows that asthma is increasing, with one study showing that the number of children diagnosed with asthma was over four times as high in 1994 as it had been in 1964.

Asthma can start at any age. Two-thirds of people get symptoms during childhood, but some people can be over 50 before it develops.

?Our biggest message to the community is to realise that this is a disease that has modern treatments that are excellent, but you have to understand how to use them, when to use them and you have got to be able to recognise when things are getting worse,? stressed Mrs. Boden.