Oxthink

A staggering 5.4 million people suffer from asthma in the UK. Asthma is an illness that seems to be part of modern Western society, and its prevalence has been increasing since the 1970s.

Although mortality rates from asthma have been on the decline, this is only due to the fact that asthma is now better managed. The various treatments are much more effective in controlling its more extreme possibilities. Asthma remains an illness that can have a devastating impact on individual lives.

Analysis highlights some significant facets about the illness:

• Half of all cases occur in children under 10 years old.
• In this age group, it affects twice as many males as females.
• 60% of adults who suffer are female.
• If one parent has asthma, the chance of their child developing asthma is approximately double that of children whose parents don’t have asthma.
• Children born into households that use cleaners more are twice as likely to suffer persistent wheezing.

Currently, there is no clear culprit for asthma. Many suspects have been proposed: pollution, smoking, modern living, central heating, house dust, and exercise. None of these are the actual causes of asthma – they are either triggers to an asthma attack or create the environmental conditions conducive to an asthma attack. They are not the root cause of somebody having an asthmatic condition.

I would like to propose a possible culprit, one that has previously been indirectly implicated but one that has never been closely scrutinised. There is, though, a degree of suspicion hanging over it.

As part of the interrogation, I would like to look at a number of key questions.

What is the reason for somebody suffering from asthma?

A relatively recent argument about the cause of asthma notes our increased use of cleaning products and argues that our increasingly sterile homes mean we cannot develop the immunity we previously acquired through exposure to bacteria.

However, I would argue that the problem is much more direct than that.

In a nutshell, asthma arises because we put bleach (Sodium Hypochlorite) down the toilet; we leave it to do its work, sometimes overnight, and we then, too often, use the toilet without flushing it beforehand.

The mix of urine (containing ammonia) and bleach reacts to form a small amount of Chloramines, which we breathe in and which can damage our lungs.

Repeated regularly, the damage becomes significant.

Our damaged/weakened lungs become less hardy and more sensitive to our environment. Triggers that we previously did not react to suddenly begin affecting us more. For some, exposure to these triggers leads to an asthma attack.

The condition of our lungs makes us more susceptible to attack by elements in the air we breathe.

There may be a question mark as to whether the lungs are actually damaged or whether they merely develop a heightened defensive system – in other words, they react more quickly to a perceived threat. This could be a significant finding, as it would determine the remedial route for those people who already suffer from asthma. If it is the former, the lungs need physical repair; if it is the latter, retraining or rehabilitation may suffice.

Why do some people suffer more than others? Why do some people suffer, whereas others do not?

There are two basic reasons why there are different levels of suffering;

Firstly, people have different levels of exposure. Obviously, the greater the level of exposure, the higher the risk. We use more cleaning materials; we use stronger cleaning materials; we use them more widely throughout our homes. And, besides, not only do we use more household cleaners, including bleach, but also our attitude to the physical task of cleaning has changed. We spend less time cleaning, believing instead that we can clean as effectively by throwing chemicals at the problem. We will, for instance, put bleach down the toilet to clean it rather than clean it manually.

Secondly, we have different levels of sensitivity. The variation in the extent and depth of asthma is due to differences in our body mechanisms. The lung damage will increase an individual’s risk, but they must have a predisposition to that sensitivity.

Pain, hunger, the cold, and tiredness, we all feel them differently. What might be a cold room for one person might be perfectly fine for another; a night of sleeplessness might leave one person exhausted, whereas another may cope without feeling any different. Our lungs function similarly. The size, effectiveness, and sensitivity of our lungs vary. Any lung damage effectively changes the height of the bar. It reduces their performance and, consequently, may reduce the amount of exposure we need to a substance to trigger an asthma reaction.

What causes the lung damage?

Our liver converts ammonia in our bodies into urea, which is then expelled in our urine. Ammonia in our urine, when mixed with Sodium Hypochlorite (bleach), produces Chloramines, which, when inhaled, can damage our lungs.

Of course, the dose we are exposed to in our daily ablutions is minuscule, yet it will still be damaging to us.

Whatever we do, if we do it often enough, it will have an impact.

It’s like using a sun bed: too much, too often, and you risk increasing your chances of developing skin cancer. Repeated exposure to Chloramines damages the functioning of our lungs.

Why is asthma so common in children?

Obviously, children’s lungs are much smaller and more sensitive as they are still developing. They are therefore more vulnerable to any damage.

We must also consider their level of exposure to the Chloramines.

Many people leave the bleach to soak in the toilet overnight. In the morning, the first person up is six-year-old Tommy, who dutifully goes to the toilet and thereby receives a shot of Chloramine.

Also, boys being smaller and standing directly over the toilet bowl receive a much higher Chloramine dose and therefore inhale more. This supports the evidence that in children, more boys suffer from asthma than girls.

The damage is cumulative, so with age, lung damage becomes more common. As boys grow, their nasal proximity to the Chloramine gas is reduced, whereas for females, sitting on the toilet, they remain much closer. This may explain why, with age, more women than men develop asthma. It may also be relevant that, generalising slightly, as women tend to do most of the toilet cleaning, their potential levels of exposure are greater as a result.

Are there any other sources of Chloramine exposure that cause lung damage?

A similar chlorine-based cleaning material is used in swimming pools. Again, chlorine, when combined with urine and sweat, gives off chloramine gas, which people then inhale. Obviously, in a swimming pool, any urine is substantially diluted. However, it remains present, and repeated exposure can contribute to lung damage. Hence, the reason why so many swimmers suffer from asthma.

How should we be seeking to cure asthma?

We firstly need to eliminate the cause of the problem by ensuring we do not unwittingly produce Chloramines and expose ourselves to them. This will prevent lung damage and make us less vulnerable to asthma.

In terms of corrective treatment and whether or not we can cure those people who already suffer from asthma, we need treatments that either seek to strengthen the lungs or treatments that change the functioning of the lungs so that they are less reactive to asthma triggers.

Why do some treatments seem to have some success?

Treatments such as Buteyko may seemingly have some success in individual cases because they change that individual’s breathing pattern. In these cases, this suggests that the lungs are not damaged; they merely have heightened sensitivity. The defence mechanism of the lungs is set up to watch for a specific attack, but if the triggering invasion comes through a different route, it can go unnoticed. The lungs then do not go into defensive closure.

This Chloramine inhalation theory as a cause of asthma does require further investigation. We need more evidence to substantiate the theory. There are several key research questions:

How much Chloramine is produced when ammonia is mixed with bleach?

Is there a link between domestic toilet cleaning practices or toilet usage and incidences of asthma sufferers?

Does Chloramine actually damage the lungs, or do the lungs react as a defensive, preservation exercise when faced with a potential threat?

Does an individual’s diet affect the amount of ammonia in their urine and, therefore, make them more at risk of asthma? We know that asparagus has a high ammonia content. Similarly, dehydration and bacterial infection (particularly in women) can increase ammonia levels.

There is certainly a finger of suspicion pointing towards our use of bleach in the home, but more evidence needs to be gathered. We should be doing everything we can to bring this case to a close.