Mr. Letwin: To ask the Secretary of State for Health if he will assess the advantages of use in the NHS of the Buteyko breathing method for the treatment of asthma; and if he will make a statement. [58265]
Mr. Hutton: The prevention and treatment of asthma are high priority topics within the Department's research programmes. We do not currently have any plans to carry out a trial of the Buteyko method. If a research proposal on it of sufficiently high scientific quality were submitted, in response to any future open calls for research in this
3 Nov 1998 : Column: 540
area from the Departmental or National Health Service research and development programmes, such a proposal would be considered alongside all other competing bids.
A key agency through which the Government support bio-medical and clinical research is the Medical Research Council, an independent body which receives its grant-in-aid from the Office of Science and Technology. The Council is not funding any research on the Buteyko method at present but it is always willing to consider for support soundly based new scientific proposals, in competition with other applications.
10 Jun 2002 : Column 1074W
Mrs. Anne Campbell: To ask the Secretary of State for Health what assessment he has made of the effectiveness of the Buteyko method of asthma treatment. [52553]
Ms Blears [holding answer 7 May 2002]: The Department has not commissioned National Institute of Clinical Excellence to undertake a formal evaluation of the Buteyko method of asthma treatment and the Medical Research Council is not currently funding research into this treatment.
The Department recognises that some people find complementary medicine treatments helpful in relieving the symptoms of certain conditions, particularly chronic conditions for which conventional medicine cannot provide a complete solution. Complementary medicine treatments, may be provided on the national health service if those responsible for commissioning health services on behalf of patients locally (primary care trusts) consider that they are a clinically and cost effective means of meeting an identified health need.
John McDonnell: To ask the Secretary of State for Health (1) what the cost would be of providing free medication to all asthmatics irrespective of age; [56442]
(2) what plans the Government have to provide free medication for all asthmatics. [56443]
25 Jun 2002 : Column 851
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jim Murphy.]
Mrs. Anne Campbell (Cambridge): I am grateful for the opportunity to talk about this important subject—[Interruption.]
Mr. Speaker: Order. There is an Adjournment debate taking place. Would hon. Members leave the Chamber quietly?
Mrs. Campbell: Everyone in the House probably knows someone who is badly affected by asthma. Yet in 1950 fewer than one in 50 of the world population had asthma, and before the 1960s, asthma was not regarded as a fatal illness. However, there has been a massive increase since then. The National Asthma Campaign estimates that about 5 million people in the United Kingdom currently receive treatment for asthma, and 8 million people have been diagnosed as having asthma at some point in their lives.
Over the past quarter of a century, the number of first or new asthma cases has increased considerably. Compared with 25 years ago, the incidence of asthma is three to four times higher in adults and six times higher in children, and it is particularly problematic in the UK. The international study of asthma and allergies in childhood found that the highest number of children reporting asthma symptoms were in the UK, Australia, New Zealand and the Republic of Ireland. Asthma has also become more serious: in the UK, about 1,500 deaths a year have asthma registered as the cause.
This epidemic imposes a huge cost on the national health service, employers and individuals. The estimated annual cost to our health care system of treating asthma is more than £850 million a year, and those costs account for just one third of the total cost to society. There is also an enormous cost to employers, with more than 18 million working days lost to asthma each year.
I am pleased to see that The Independent on Sunday is running a campaign to get us to take the disease more seriously and to spend more money on research. I applaud the paper's sentiments and fully support its campaign to reduce traffic and other forms of pollution. However, I shall argue that pollution is a trigger, not a primary cause of asthma. Increasing levels of pollution and ozone affect existing asthmatics but do not create new ones. The medical community still does not know what fundamentally causes the disease.
It is time we admitted that the current treatments appear to be making us worse, not better, and I want to take a look at the possible causes and treatment of asthma. I shall describe the work done by a Russian doctor, Konstantin Buteyko, in the 1960s; it attempted to explain why people get asthma, and offered a management regime for the disease.
Dr. Buteyko's methods were practised widely in Russia in the 1980s, and that may still be the case. They spread to Australia when an Australian doctor suffered an asthma attack while visiting Russia. He was admitted to hospital and was taught the Buteyko method for controlling his
25 Jun 2002 : Column 852
symptoms. He was so impressed that he took the method back to Australia, and it is now taught there and in New Zealand.
Buteyko blames hyperventilation for a number of civilisation-induced diseases. We all hyperventilate at times of stress. Indeed, the "fight or flight" response to stress is well documented. It was useful in building energy reserves when stress was likely to be caused by a wild animal or physical attack by an enemy. However, continuous over-breathing is certainly damaging and can cause disease. The importance of correct breathing is acknowledged by the National Asthma Campaign's website, which states:
"The
body needs a balance between carbon dioxide and oxygen. Oxygen is the vital
fuel for the body that we get from breathing in the air; carbon dioxide is
produced in the body and breathed out. Breathing very rapidly, usually due to
being very anxious, can lead to breathing out too much carbon dioxide. This can
cause symptoms such as tingling in the fingers and dizziness."
Buteyko's hypothesis is that it also causes asthma.
It is not only emotional stress that causes hyperventilation; anyone who is sensitive to environmental factors such as pollution, tobacco smoke, pollens—which are especially noticeable at this time of year—dog and cat hair or house mites, will experience them as stress and can start to hyperventilate as a result. Certain foods also act as a trigger for asthma, notably chocolate, red wine, cheese and even strawberries—in fact, most of the things that I like best.
Other stress factors are illness, such as chest infections, or exercise. They are all experienced as stress and cause us to breathe too quickly. The effect of that hyperventilation is to increase the amount of oxygen but also to deplete the amount of carbon dioxide, which falls below the level needed for our bodies to function efficiently.
If carbon dioxide is too low, death will ensue, so when the level falls below a certain limit, the body takes retaliatory action. The smooth muscle surrounding the airways goes into involuntary spasm and tightens, thus preventing people from breathing out and losing more carbon dioxide. At the same time, the airway inner linings become swollen or inflamed and excessive amounts of mucus are produced. That is what many of us who are asthmatics experience as an asthma attack.
Usually we try to compensate by breathing more, even though that compounds the problem. An asthmatic may also resort to using reliever medication, which can be a life saver—but it works by relaxing the muscles around the airways, allowing the asthmatic to hyperventilate even more and making the problem worse. Buteyko concluded that asthma is actually a defence mechanism, to guard against the fatal loss of carbon dioxide by over-breathing.
Patients who need reliever medication frequently are usually prescribed steroid preventer medication, which helps to reduce the swelling of the inner airway tube. That works well, but unfortunately, it also depresses the immune system, thus making the patient more vulnerable to coughs, colds and chest infections.
Buteyko's conclusion was that rather than giving people more drugs, which usually make the condition worse, it would be better to teach them how to breathe correctly. However, it is important to stress that Buteyko practitioners always instruct people to continue using their medication unless it is reduced under the supervision of a GP.
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Asthmatics whose stress response is constantly stimulated by asthma triggers will over-breathe continuously, and in the long term that can be both crippling and life threatening. There is a respiratory centre in the brain that controls our breathing rate, but hidden hyperventilation depletes the body of carbon dioxide and the respiratory centre adjusts to accept those levels as normal.
The respiratory centre has to maintain what it considers the correct levels of carbon dioxide, so it increases the breathing rate whenever the low level is exceeded. Once bad breathing habits have become established, therefore, the respiratory centre's acceptance of low levels of carbon dioxide perpetuates the problem. The good news is that respiratory centres can be retrained to accept higher levels of carbon dioxide. The aim of the Buteyko technique is gradually to reduce the asthmatic's breathing rate to normal, thus increasing the level of carbon dioxide.
The technique is simple and can be taught in periods of one and a half hours once a day over four or five days. Some follow-up work is sometimes needed, but the results can be dramatic. There are specially designed exercises for children and their parents; the technique has as much success in children aged over four as it does in adults.
There are some well documented cases of people who have been helped by the technique. I understand that Jonathan Aitken, when he was Chief Secretary to the Treasury, received treatment from a Buteyko practitioner in London. His asthma was moderately severe, but over a course of consultations and home visits he made a dramatic recovery. A newspaper article quoted him as saying:
"I
have tried plenty of treatments, but this is the only one that has really
worked. I think it is a remarkable one that could help many people."
Con Barrell, a member of the New Zealand All Black team, said after his treatment:
"I
sleep better, my pulse rate has dropped 10–12 beats on a regular basis and I
feel well. This has been a big help to me as a professional and personally. I
recommend asthmatics try it—things can only get better."
As someone who has suffered from asthma for 40 years and whose condition would have been previously described as moderate, I have given the Buteyko technique a try myself. I started with a home education pack, as described on the website, www.buteyko.co.nz. Even self-teaching is effective, as by day five I had reduced the number of times I took my reliever medication from four or five times a day to very occasional use. Later I went on a course run by a qualified Buteyko practitioner. As I continued, I discovered to my delight that the asthma symptoms were rapidly reduced. I sleep better and have more energy than I can ever remember.
What I really regret is that no one told me about the method before. This year I have not suffered from any hay fever, except for a very occasional sneeze, and I wish that someone had told me about the technique some time ago. Alone, I could have saved the national health service hundreds of pounds' worth of medication and myself a lot of needless discomfort. However, the Minister, whom I am happy to welcome to the Front Bench, will be less impressed by anecdote than by medical trials. Unfortunately, there is little evidence to quote so far.
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In referring to the effectiveness of the Buteyko method, the National Asthma Campaign remarks on its website:
"Lack
of published research makes it difficult to reach a conclusion on its
effectiveness."
Buteyko himself conducted a trial in Russia, but the results were considered to be too good, and were not believed for many years.
In December 1998 a paper by Bowler, Green and Mitchell was published in Alternative Medicine, in Australia. The paper was called "Buteyko breathing techniques in asthma: a blinded randomised trial." The trial compared the effect of the Buteyko breathing technique with a control group in 39 subjects with asthma. The control group was given instruction in general asthma education, relaxation techniques and abdominal breathing exercises. The experimenters looked at medication use, peak flow and quality of life, among other factors.
After three months, the subjects assigned to the Buteyko group had reduced their reliever medication by 904 micrograms, whereas the control group had a reduction of 57 micrograms—a highly significant result at the 0.2 per cent. level of significance. There was also a reduction in inhaled steroid use by the Buteyko subjects, although the sample sizes were too small for that to be statistically significant.
Similarly and more importantly, perhaps from my point of view, there was a trend towards greater improvement in the mean quality of life scores of the Buteyko group. I certainly think that if someone can have uninterrupted sleep, feel better and have more energy, it is worth a great deal to that individual.
I should like to mention Jill McGowan, who was awarded the carer of the year award at the Pride of Britain awards 2002. She knows a lot about asthma because she has the condition herself, and is also a nurse who has worked for many years helping other asthmatics. Like many others who have followed the course, she stopped needing her inhaler within 24 hours.
Jill is also a university lecturer with the skills to look into the theory behind Buteyko. When she decided that the method had merit, she was amazed to find that it was not more widely researched. She applied to universities for grants to allow her to fund a pilot study. When they turned her down, she sold her house and used the £55,000 proceeds to pay for the study herself.
The pilot study has shown excellent results—a more than 90 per cent. reduction in reliever medication in the first few weeks. Because of those results, a two-year clinical study of 600 asthma sufferers is under way. Jill is also helping to pay for that work by donating three quarters of her salary. That is real dedication. She hopes that the clinical study will prove the benefits of the Buteyko technique, so that one day it can become available to all on the NHS.
I very much hope that as a result of this Adjournment debate, my hon. Friend will ask the chief medical officer to examine the available evidence. In particular, I would ask him to consider the preliminary evidence from the Scottish trial, and to have further trials conducted to ascertain the method's efficacy in the UK.
Let me stress that the technique that I have described does not constitute alternative medicine—a term normally used to describe techniques that sometimes succeed, although no one can quite work out why. The Buteyko
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technique was derived from research carried out by Konstantin Buteyko, who devised a programme from his theory. The fact that it has worked for me, as well as for many others, must suggest that at the very least it is worth investigating further. I hope that the Minister will respond positively to that suggestion.
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I congratulate my hon. Friend the Member for Cambridge (Mrs. Campbell) on securing a debate on such an important subject, and for managing to bring with her my hon. Friends the Members for Norwich, North (Dr. Gibson), for Eccles (Ian Stewart), for Ipswich (Mr. Mole) and for Hayes and Harlington (John McDonnell). That, I think, conveys the seriousness and importance of the topic.
I must declare an interest. I am a hay fever sufferer, and as a child I suffered from eczema as well. I know that my hon. Friend recognises that the two complaints are related. The subject is dear to her heart, but it is also dear to mine, and I am pleased to have an opportunity to state the Government's policy clearly.
I know how distressing and debilitating this condition can be for people, their carers and their families. There is currently no cure for asthma, and the cause is not fully understood. Treatment is based on relieving the symptoms, and while that remains the case sufferers are bound to experience some frustration.
Asthma is the commonest chronic disease in the United Kingdom. It affects about 3.4 million people, and it affects all age groups. It causes breathing difficulties because of inflammation and swelling in the airways, which can be reversed spontaneously or by treatment.
People may become asthmatic at any time. There are two major types of asthma. There is the allergic version, caused by a bad reaction to allergens such as pollen or dust. It often results in wheezing, and makes life particularly difficult for sufferers at this time of year, especially young people. And there is the non-allergic form, which usually affects people in their 20s and 30s and older people.
We would welcome a drug-free treatment that was found to improve asthma symptoms as effectively as existing medicines. I think, however, that it would be helpful if I outlined the drug regimes currently used to relieve symptoms before turning to the drug-free methods described by my hon. Friend.
There are two kinds of asthma medicines, relievers and preventers, which work in very different ways. Relievers help to relieve asthma symptoms when they happen; preventers help to control swelling and inflammation in the airways, and reduce the chance of asthma symptoms. Relievers are safe and effective medicines that patients can take immediately to relieve their symptoms. They quickly relax the muscles surrounding the narrowed airways and allow the airways to open wider, making breathing easier. However, they do not reduce inflammation and swelling in the airways. Preventers control the inflammation and swelling, and stop the airways from being so sensitive. They need to be used daily, and it may be up to two weeks before they are fully effective.
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Although asthma has become more common in recent years, as my hon. Friend the Member for Cambridge suggested, treatments have improved. It is important to stress that the number of deaths from this very debilitating disease, which can be fatal for many people, has fallen. Since 1988, in England and Wales, the number of asthma deaths has fallen by about 25 per cent., and in 2000, the latest year for which figures are available, 1,272 died from the condition. In 2000, there were 14 deaths in young people aged 19 and under.
The management of asthma mainly takes place in the primary care arena. The chronic disease management programme, introduced in July 1993, provides arrangements for health promotion under the GP contract. Participating GPs—around 93 per cent. of the total—receive a fixed annual payment for running organised programmes of care for patients with the complaint.
My hon. Friend the Member for Cambridge spoke about the Buteyko method, which is claimed to be the most effective drug-free approach to the management of asthma and other breathing-related health problems. I commend my hon. Friend on the way in which she illustrated the effects of the approach, and of her personal account of how she has benefited over the past year or so.
The Buteyko method teaches people under stress to control their symptoms through calm, controlled breathing. My hon. Friend will be pleased to know that I spent much of this evening reading through the relevant website, and that I have the pages with me. I may well take up some of the practices to help my hay fever, as the website suggests that they may be of assistance.
If the Buteyko method proved to be as effective as is claimed, it would indeed be a breakthrough in the treatment of asthma. I should like to see robust scientific evidence to support the proposition that treatments such as the Buteyko method are effective in the treatment of asthma and provide long-term benefits for patients. I would expect that any such treatment would have to be as effective as existing drug therapies.
I know that a pilot study, involving a small number of children, was completed by the university of Aberdeen last year. My hon. Friend mentioned the work in Glasgow, and it is interesting that much of the work on this matter is going on north of the border. I hope that we can make links.
The children in Aberdeen were placed in a Buteyko group and a control group, respectively, and the aim of the study was to pilot incorporation of Buteyko breathing technique into conventional asthma nurse training and delivery of care. This would be used to decide whether it was worth doing a randomised controlled trial on a larger scale. I understand that the pilot indicated a number of positive trends, and that the Buteyko group showed a halving of sleep disturbance due to wheezing, as well as a reduction in the average daily dose of inhaled steroids. The university has subsequently made an application for major funding from the Scottish Office to enable it to carry out an additional study.
My hon. Friend the Member for Cambridge mentioned that Australia and New Zealand have support groups for the Buteyko method, and she noted the work of Jill McGowan. I am interested in Dr. Buteyko's methods and I will ask policy officials to find out more about the Glasgow study. I will make available to the chief medical officer a copy of the record of this debate, and I will suggest that he looks further at the matter.
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The Government are involved in a broad spectrum of research and development work into the disease. It is important to put that in context. The principal body providing Government funding in this area is, of course, the Medical Research Council. The MRC receives its grant-in-aid from the Department of Trade and Industry and it spent almost £4 million in 1999–2000 on asthma research.
It may be that the Buteyko method is worthy of further research. The MRC always welcomes high quality applications for research, and clinicians with a special interest in Buteyko are able to submit applications for research funding if they wish. I am sure that my hon. Friend is aware, however, that it is a long-standing and important principle of successive Governments that they do not prescribe to the individual research councils the detail of how they should distribute resources between competing priorities. That is something that researchers and research users best decide. The MRC will take all these factors into account when it makes its decision on whether it wishes to fund particular research—alongside some that we know is going on and much that my hon. Friend has talked about—into the Buteyko method.
I should add that a major joint initiative is currently being funded by the Department of Health and the Medical Research Council into air pollution and respiratory disease generally. I listened carefully to what my hon. Friend said about pollution at least adding to the symptoms of the condition. The Department of Health's policy research programme is another source of funding in this area, and it is currently funding three projects investigating the effects of external factors on asthma.
People with chronic illnesses such as asthma have a number of common requirements including needing to deal with acute attacks, making effective use of medicines and treatment, managing pain, fatigue and depression, and having to cope with other people's responses. Both adults and children with asthma will benefit from the emerging expert patients programme that will—via the NHS—provide training in self-management skills for people with long-term chronic conditions. The first pilot phase has recently begun in selected primary care trusts, with activity to take place on a generic and a disease-specific basis.
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One of those pilots, in the Medway primary care trust in Kent, is proposing to focus self-management activity on people with asthma. The Medway PCT in Kent has a disproportionately high accident and emergency admission rate for asthma in childhood, and considers that many of those admissions might be avoided by improved self-management. The PCT's proposals will include involvement of a project manager for integrated services, health visitors, midwives and asthma management guidelines derived from those produced by the British Thoracic Society. We hope that expert patients can reduce the severity of symptoms, decrease pain and increase quality of life. I am sure that hon. Members will agree that those are important benefits.
The Department of Health also welcomes the National Institute for Clinical Excellence guidance on inhalers, which it produced earlier this year for children aged between 5 and 15, and in September 2000 for children under the age of 5. We hope that that has relieved the situation for many. We strongly support the guidance that emphasises the importance of ensuring that the device suits the individual needs of the child. I also plan to ask officials to discuss with NICE the feasibility of including the Buteyko method in their technology appraisals programme once we have a little more information about the evidence base.
In conclusion, I am interested in finding out more about the Buteyko method. I will ask policy officials and our research branch to look at the evidence that we currently have about its effectiveness and, once we know a little more, to discuss whether NICE could look at the feasibility of including it in a future technology appraisal programme. My hon. Friend may also want to consider approaching the Medical Research Council for advice about funding further research.
I reassure my hon. Friend that the Government are serious about improving the prevention and treatment of asthma. Our support for research projects and initiatives, such as the national service frameworks and the expert patients programme, and our willingness to look critically at new treatments, such as the Buteyko method, demonstrate that.
Question put and agreed to.
7. Mrs. Anne Campbell (Cambridge): What assessment he has made of the Buteyko method of asthma management. [82622]
The Minister of State, Department of Health (Jacqui Smith): Following the Adjournment debate on the Buteyko technique in June, the chief medical officer
3 Dec 2002 : Column 745
asked his special projects officer to investigate the claims made for the technique. He found that the technique was helpful for some patients with asthma, but that more research was needed into it.
Mrs. Campbell : I thank my hon. Friend for that reply. Will she look carefully at the trial in Nottingham, which is being funded by the National Asthma Campaign, and at the trial at Glasgow university? The latter has shown that asthma patients who are taught to breathe correctly can achieve a 98 per cent. reduction in reliever medication, and a 92 per cent. reduction in preventive medication. Does she agree that that is an excellent way to save on the NHS drugs bill?
Jacqui Smith: I understand that the chief executive of the National Asthma Campaign wrote to the chief medical officer in September, giving some of the preliminary results of the Nottingham inquiry to which my hon. Friend refers. The trial in Scotland, which is being undertaken by Jill McGowan, is still in progress and will not be finished until April 2003. At that stage, conclusions can be formally evaluated using peer review. I agree with my hon. Friend that, given the success that we have already achieved in reducing the incidence of asthma, we must continue to ensure that, where well-researched and successful interventions exist, they are available to patients on the NHS. What is important is that we do the research necessary to show that this method would be as clinically effective as the drug treatments that are proving effective at the moment.
Mr. David Tredinnick (Bosworth): Surely the Minister must recognise that sufficient evidence has been provided in this regard by the 1995 Brisbane trial alone. That trial showed that broncodilator use declined by more than 90 per cent., and that steroid use decreased by 49 per cent., through the Buteyko breathing technique. She has referred to other treatments that might be considered in the health service, but is she aware that some 12 complementary therapies—such as yoga, nutritional medicine and the Alexander technique, which deals with posture—could be inexpensively deployed? When will the Government take seriously such treatments, which are very effective, instead of just paying lip service to them?
Jacqui Smith: I am the lucky Minister who has to answer the hon. Gentleman's question on complementary medicines today. Obviously, approaches and techniques that give asthma patients lasting relief and greater control of their lives are to be welcomed. That includes the use of complementary therapies, which primary care trusts can commission if they consider them to be effective, in clinical and cost terms, for a particular health need. However, although techniques such as the Buteyko method and others to which the hon. Gentleman referred may have significant benefit, there is no robust scientific evidence that any complementary therapy on its own can provide a lasting cure for asthma. It would therefore be wrong to build up patients' hopes that their asthma could be cured without resort to an existing drug therapy. However, as I made clear to my hon. Friend the Member for Cambridge (Mrs. Campbell), the chief medical officer and the
3 Dec 2002 : Column 746
Medical Research Council have accepted that more research is needed. Having been an asthma sufferer for some years myself, and I hope that that research will be undertaken.
Mr. Bob Blizzard (Waveney): Should not we consider asthma in the context of chronic obstructive pulmonary diseases? Is my hon. Friend aware of the COPD patient manifesto, launched on world COPD day in November? Will she join me in congratulating the British Lung Foundation, and local Breathe Easy groups such as the one in my constituency, on their work in raising awareness of these ailments, and in providing support for sufferers? Will her Department make a formal response to the COPD patient manifesto?
Jacqui Smith: My hon. Friend makes an important point about the role of professional, voluntary and patient organisations in raising awareness of conditions, and of some of the effective techniques that patients understand can be used in treatments. I am sure that my hon. Friend will be aware of the Department's expert patient programme. By means of a series of pilot schemes, it is looking for ways to ensure that professionals and patients can work together more effectively to enable patients to manage their conditions. I shall certainly look at the patient manifesto to which my hon. Friend has referred with close interest.