This story caught me eye recently. I have had asthma for many years and I was pleased to hear, that unlike every other condition we seem to hear about, it seems that the incidence of asthma has, after over 40 years of increasing frequency, started to decline! The odd thing is that although no one disputes the figures no one seems really to know why asthma is declining.

Taking figures for the UK, asthma among children aged 13 and 14 has apparently seen a decline of about 20 per cent between 1995 and 2002, This experience was reported from Australia where in Melbourne incidence of asthma among the 6- to 7-year-olds has also fallen.

More studies, and larger ones too, will no doubt be carried out to confirm if this is a worldwide trend, but certainly early indications look very promising.

It is interesting to look at these findings in the context of old theories like environmental air pollution, second hand tobacco smoke, allergies and sensitivities, certain dietary factors, and a possible link to infections early in life. The increase or the decrease cannot be explained by the same measures. So for now it remains a mystery, but a very welcome piece of good news!

What is the best way to deal with asthma? I know someone (in her 20s) will need to use the inhaler almost every day to deal with the asthma. She is otherwise healthy except asthma. The concern is if she keep using it, will it become ineffective one day?

Asthma is very common and can have a lot of different triggers, from environmental to genetic.

Reliever inhalers, of the type that your friend probably uses, are usually blue and are taken to combat symptoms like wheezing or coughing. They work quickly by relaxing the muscles surrounding the narrowed airways making it easier to breathe. Reliever inhalers are essential in treating asthma attacks. If she needs to use her reliever inhaler 3–4 times a week, she should go back to her doctor or nurse and have her asthma reviewed so that she can keep it under control.

If she continues to need a lot of reliever medicine over a long time there is a risk that it will become less effective and the asthma may worsen.

Preventer inhalers usually come in brown, red or orange. They work by controlling the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks. The effect of preventer inhalers builds up over a period of time and they need to be taken every day, usually morning and evening, even when a asthmatic is feeling well. Preventers contain a steroid medicine. It is important to understand that the steroids contained in preventer medicines are not the same as anabolic steroids used by athletes to improve their performance.

There are other types of medicine that can be added to a reliever and preventer inhaler if needed, such as preventer tablets, long-acting relievers and combination inhalers (usually red and white or purple). For information about other medicines your friend should really speak to her doctor or asthma nurse.

Rob - the best way to treat astham is to avoid the triggers. however, if you suffer from chronic asthma it would be useful to take steroid puffer (beclomethasone) on a chronic basis to reduce inflammation and potential asthmatic attaks. In the event of an acute asthmatic episode, you can take a ventolin puffer on an as necessary basis to provide immediate relief. this is the usual approach.

That is what I said above - isn't it?