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Sidrah Mohammad  (Medicine, Liverpool University)
Muhammed Siddiqui (Royal Surrey County Hospital, Guildford, UK, Liverpool University)
Published in medi.philica.com Abstract
The aim of this SSM was to explore the media’s point of view on the topic of asthma in the UK. Asthma is a chronic inflammatory disease of the lungs and affects 1 in 12 adults in the UK.
Books were obtained from the library and online journals were read to gain background knowledge on the topic. To find relevant newspaper articles, online database searches were conducted using relevant key terms related to asthma. Four articles were selected; two from broadsheet newspapers, and two from tabloid newspapers. They were then analysed to see how the media portrayed asthma, and how their reporting influenced readers. It was concluded that different authors had different views on asthma and they used a variety of methods to convince readers. Article body
Introduction The word ‘asthma’ was first used in the medical context by the Greek physician Hippocrates (460-377 BC) [1]. It is derived from the Greek verb ‘aazein’ meaning to exhale with your mouth open [2]. Asthma was first described as bronchial obstructions by Galen (130-201 AD) [3], who treated it with owl’s blood in wine [4]. From the 1930s it was seen as one of the holy seven psychosomatic illnesses 4, alongside rheumatoid arthritis, ulcerative colitis and thyrotoxicosis [5]. It was not until the 1960s that asthma was recognised as an inflammatory disease 4. Asthma affects 300 million people worldwide according to WHO estimates [6]. In 2005, asthma resulted in 255,000 deaths worldwide [7], out of which 1,318 occurred in the UK [8]. In the UK, over 5.2 million people [9] have asthma and according to the Health Survey for England (2001), the estimated lifetime prevalence of diagnosed asthma is 16% in women and 13% in men [10]. Asthma costs the UK approximately £2,237 million a year [11]. According to the WHO, asthma is “under-diagnosed and under-treated, creating a substantial burden to individuals and families and possibly restricting individuals’ activities for a lifetime 7.” Asthma is a chronic inflammatory disease of the airways [12] which is “characterised by reversible airflow obstruction and airway inflammation [13].” The classic symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, wheezing and cough [14]. The National Asthma Education and Prevention Program (NAEPP) has classified asthma into four different stages, according to the frequency of symptoms, frequency of night time awakenings, and results of lung function tests [15]. Asthma may be classified according to its severity 15. An exacerbation of the condition is known as an asthma attack 16. The table below summarises the differences between a severe and life threatening attack. | Signs | Severe | Life-threatening | | Pulse (bpm) | >110bpm | <60bpm | | Respiratory rate | >25/min | Reduced | | PEF | 33-50% of predicted | <33% of predicted | | Speech | Inability to complete sentences | Confusion | | Chest | Wheeze | Silent | Classification of the severity of an asthma attack [16]. During an asthma attack, smooth muscles around the bronchi contract resulting in bronchoconstriction 16,[17]. Atopic asthma, the most common form of asthma, is triggered by a variety of environmental factors [18]. It is associated with a family history of hay fever and eczema; along with asthma, these allergic conditions are termed the atopic triad [19]. In 90% of children and 50% of adults with asthma, a positive skin-prick test is seen, indicating that these individuals have atopic asthma [20]. Exposure to allergens such as dust mites, pollens and certain animals (especially cats and dogs) can increase the risk of developing atopic asthma [21]. This is due to a type I hypersensitivity reaction in which antigens bind to the antibody, IgE, which is found on mast cells 18. The antigens trigger IgE to release inflammatory mediators 18. The majority of asthmatic individuals who show a negative skin-prick test for allergens 18 are described as having non-atopic asthma, which is the second largest type of asthma [22]. Non-atopic asthma is commonly associated with respiratory tract infections, particularly viral infections such as those caused by the rhinovirus 22. The respiratory tract infections are thought to cause hyperirritability of the bronchial tree, which results in bronchoconstriction of the airways 22. Asthma that is triggered by inhaling work related irritants such as fumes, gases, and chemicals is known as occupational asthma 18. The irritants cause hyper-reactivity of the airways which may induce bronchospasms 18. The hyper-reactivity is thought to be due to a type I and type III hypersensitivity reaction 18. Patients who are confirmed to have asthma due to occupational related inhalation of irritants are usually entitled to statutory compensation 18. Drugs such as non-steroidal anti-inflammatory drugs, particularly aspirin, are known to induce asthma 20. The mechanism involved is thought to prevent the synthesis of prostaglandins, which then induces the overproduction of leukotrienes by mast cells, eosinophils and macrophages 18, 20. Furthermore, beta-blockers are contraindicated in asthmatic patients as they lead to bronchoconstriction 20. Exercise-induced asthma (EIA) usually occurs after strenuous exercise 20. Asthma is more prevalent in athletes than in the general population [23]. Nearly 22% of US athletes in the 1998 Winter Olympic Games had asthma [24]. Endurance athletes with atopy, particularly swimmers, have up to a 97-fold increase in the relative risk of asthma than non-atopic athletes [25]. There are two theories that contribute towards EIA [26]. According to one theory, the osmotic and dehydrating effects of water loss, due to humidifying large amounts of dry air by the lungs, are thought to initiate the mechanism that leads to bronchospasms 26. The second theory claims that airway cooling during exercise and the re-warming of the airways following exercise increases blood flow to the lungs 26. This increase in blood flow results in oedema of the airway wall and narrowing of the airways 26. Other factors and mechanisms may contribute towards the development of asthma in athletes[27] . Some of the causes and triggers of asthma are RSV, respiratory syncytial virus; NSAIDS, non-steriodal anti-inflammatory drugs 20. Asthma is managed with a stepwise approach 20. The patient is started with treatment at the step most appropriate to the initial severity 20. Treatment is gradually reduced over 3-6 months in patients whose symptoms are under control 20. The management guidelines are generally according to the British Thoracic Society [28].
The aim of this SSM is to evaluate the media’s current views on asthma. Method Relevant books on asthma were accessed through the University of Liverpool library and background reading was conducted. Numerous websites including Asthma UK, BBC Health, World Health Organisation and the National Institute for Health and Clinical Excellence were accessed. A range of online database searches were performed including Medline, PubMed, Scopus and Google Scholar in order to gain access to literature. To cut down the number of results produced, limits were applied to the searches. These limits included; language (English), species (Human), and type of article (Review). Furthermore, Mesh terms were applied in order to obtain only relevant articles. To obtain newspapers articles, both manual and online newspapers articles were viewed. Some of the online database searches included Lexis Nexis, News Now, and News UK. Only UK national newspaper articles published in the last six months were analysed. Articles that were deemed too short for analysis were excluded. Results Results of the searches are shown in the tables below. | Database | Search terms | Hits | Hits with limits | | Pubmed | Asthma Asthma and atopy Asthma and exercise Asthma and occupation Asthma and drugs | 112018 3440 4373 492 12450 | 5050 145 281 12 874 | | Medline via Ovid | Asthma Asthma and atopy Asthma and exercise Asthma and occupation Asthma and drugs | 91205 3431 5 261 5827 | 2425 161 0 3 273 | | Scopus | Asthma Asthma and atopy Asthma and exercise Asthma and occupation Asthma and drugs | 151776 7546 21 746 60379 | 80946 5459 8 467 33650 | Search method using Pubmed, Medline and Scopus databases. | Newspaper | Number of Articles | | Daily Mail and Mail on Sunday | 29 | | The Daily Telegraph | 6 | | The Express Newspapers | 3 | | The Guardian | 14 | | The Independent | 6 | | The Mirror and the Sunday Mirror | 27 | | News International Newspapers Information Services Ltd | 29 | | The Observer | 2 | | The Sunday Express | 1 | | The Sunday Times | 4 | | The Times | 19 | | | Article 1 [xxix] | Article 2 [xxx] | Article 3 [xxxi] | Article 4 [xxxii] | | Format | Broadsheet | Tabloid | Broadsheet | Tabloid | | Date | 30/11/09 | 04/08/09 | 27/10/09 | 26/11/09 | | Newspaper | The Times | Daily Mail | The Guardian | The Sun | | Page Number | Page 9 of the T2 features supplement | n/a | Page 14 | Pages 58, 59 | | Title of Article | The penalty you pay for not tackling asthma properly. | Why you're never too old to get asthma... | Can salt ease asthma?: The UK's first 'salt cave' is said to help relieve respiratory illnesses. Viv Groskop tries it out. | I'll kick my asthma into touch - just like Becks. | | Reporter | Mark Porter | Lisa Buckingham | Viv Groskop | Matthew Barbour | | Word Count | 962 | 1127 | 724 | 668 | The four chosen articles are shown below. Discussion Article 1 – The penalty you pay for not tackling asthma properly (The Times) 29. The headline of this article draws the reader’s attention by using a pun combining asthma and football. The two words, penalty and tackling, can be viewed as a scare tactic due to the negative connotations associated with them. It is obvious from the headline that the author is emphasising that the consequences of not managing asthma properly can be serious. Mark Porter begins by mentioning David Beckham, undoubtedly one of the most prominent footballers in the world, and the shocking pictures of him using an inhaler. He reacted positively to the pictures and “saw them as further evidence that asthma need not be a hindrance to leading a normal life.” The word “further” indicates that the author already held positive views regarding asthma. Porter then informs readers that many people have asthma including athletes and only a minority of people struggle to maintain a normal daily life. However, he does not give any figures or sources which would have helped to validate his claims. The author makes an important statement by arguing that half of the five million asthmatics in the UK under-use their preventer inhaler and over-use the reliever inhaler. He claims that almost 50% of the 1,300 annual asthmatic-related deaths are due to improper inhaler use. NHS figures are used which validate the author’s opinion due to the accuracy and reliability of the source. Porter then highlights the burden that improper inhaler use has on the economy by stating that some inhalers only last a month and can cost up to £60. The author does not entirely hold patients responsible, as he blames doctors for the patient’s poor compliance to asthma treatment. By announcing “it is our job to ensure that our patients understand their asthma”, Porter points out that he is a doctor and is also to blame. The rest of the article is extremely informative and a great deal of advice is given to readers about asthma, inhalers, and their correct usage during exercise. Overall, the author raises awareness about asthma in a positive way and highlights important issues. As the author himself is a doctor, readers are reassured that the information portrayed is both accurate and reliable. The article concludes by using Beckham as an example to emphasise the importance of proper inhaler use, and claims that had Beckham used his inhaler before the game, he may not have needed puffs on the sidelines and his secret may still have been safe. Article 2 – Why you’re never too old to get asthma… (The Daily Mail) 30. The headline has deliberately been phrased in the form of a question and is aimed at a wide range of readers. The author tries to scare readers into reading further, as according to the headline, they are vulnerable to asthma. Lisa Buckingham uses scare tactics to begin her article by stating that a simple wheeze can be “more serious than you think”. She informs readers with the story of a previously healthy 35-year-old woman, Joanne, who had “a terrible cough and wheeze” following a lung infection. After ten months, Joanne had the first of many asthma attacks that resulted in her attending A&E eight times over the following 12 months. Joanne’s peak-flow test was normal and she was diagnosed through “specialist tests.” Dr Mike Thomas, chief medical adviser for Asthma UK, is quoted as saying “asthma is hard to diagnose in adults” and basic tests used in GP surgeries “aren’t sophisticated enough to detect all cases.” The use of Dr Thomas’ comments provide the author with reliable evidence to support her view; that asthma can affect anyone of any age. Inflammatory language is used by the author to send a serious message to readers by portraying undiagnosed asthma as dangerous, and that “an attack can be fatal”. In general, the author exaggerates the risks of asthma by heavily basing her article on the experiences of one woman. The article does not convey a balanced report as Joanne appears to be suffering from severe asthma. Therefore, the author’s view is highly one-sided and biased as it does not take into account milder forms of asthma. However, the author expresses an important piece of information that “could save your life” by reminding readers not to ignore symptoms that could be caused by asthma and to get tested. The author stresses this point by leaving readers with the Asthma UK website and a helpline number for more information. Article 3 - Can salt ease asthma?: The UK's first 'salt cave' is said to help relieve respiratory illnesses. Viv Groskop tries it out (The Guardian) 31. The headline indicates that the author is going to review a new treatment option for asthma alongside other respiratory illnesses. The article begins with Viv Groskop giving a description of what she perceives to be asthma according to “her asthmatic symptoms”. However, the symptoms which she describes as “blotchy face, itchy eyes and sneezing” seem to be due to hay fever rather than asthma. This indicates that the author has little knowledge of the true asthmatic symptoms and has therefore misled readers about what the symptoms actually are. The author mentions that she would do anything to get rid of her “respiratory flaw” including sitting in a room full of salt with a hairnet. Interestingly, the author then mentions that she has never had an asthma attack but finds using inhalers a burden. Groskop discusses the new Salt Cave in London and her high hopes for it, due to the drug-free relief it offers for a number of respiratory illnesses, including asthma. However, the author then describes the salt cave as “purely decorative”, which makes the readers question its therapeutic effect. The theory behind the medical benefit of breathing in air mixed with salt, that is released from a sodium chloride aerosol, is then discussed. According to the author, breathing in salt causes “mucus in the respiratory tract” to be “loosened and coughed up”. The theory described is very general and does not explain why this occurs. Considering that 56% of Guardian readers are educated to degree level, many would doubt this general theory that apparently cures asthma. She then mentions that many Western doctors are sceptical about this. For many readers, this would confirm their disbelief in the efficacy of the treatment. To try and persuade the reader, Groskop gives figures from a 1999 Lithuanian study, which claimed that nine out of ten participants felt an improvement in their respiratory problems after undergoing salt therapy for an hour every day, for two weeks. Even though the results of this study seem very promising, many readers would see this treatment option as a burden, due to the daily one hour commitment required. Considering that the study is ten years old and yet is still the most recent one conducted, the author does not leave a lasting impression upon the reader about the optimistic future of salt therapy, especially since the source is not given. The author gives the opinions of two individuals who have had a positive salt therapy experience. However, the author’s personal experience was negative, as she describes exacerbations of her ‘asthmatic symptoms’ and said that she ‘needed her inhalers more than ever before’. This confirms the doubts of the majority of sceptical readers and would certainly discourage them from undergoing the expensive salt therapy. The author ends by saying she had “fallen deeply in love with her inhalers” and would never take them for granted again, despite previously stating that she despised them. Although a balanced view on salt therapy is portrayed, the author leaves a lasting impression upon readers to stick with the conventional asthma treatment; the inhaler. Article 4 – I’ll kick my asthma into touch – just like Becks (The Sun) 32. The headline of this article is a pun that is designed to attract readers. From the headline, it is obvious that the author is expressing his view by indicating that David Beckham’s asthma is well controlled. The article begins by informing readers about Keanu Williams, a 13 year old boy who “is more determined than ever to be a top footballer” as “now he knows his idol David Beckham has asthma too.” Readers are informed that recent pictures of Beckham “puffing on an inhaler” caused genuine surprise, especially since it emerged that he has suffered from asthma since childhood. The author tries to negatively persuade readers to question why Beckham had kept his asthma a secret for so long. However, he then voices Keanu’s positive opinion by stating that Beckham’s condition does not hinder his “quest to reach the top”, and how his role model’s condition has inspired him. The author tries to reach out to sympathetic readers by describing how Keanu was bullied due to his asthma, but is now not ashamed about it since his idol, Beckham, also has it. Many asthmatic sports stars, including footballers Paul Scholes, Frank Lampard and “Olympic marathon runner” Paula Radcliffe are also mentioned. The author uses them to show that despite regular inhaler use, their asthma has not restricted their success. The author reinforces his view that asthmatics can become successful athletes, by including quotes from Asthma UK’s chief nurse, Erica Evans; a person that readers expect to be an asthma expert and give accurate advice. Erica explains that 20% of Great Britain’s 2004 Olympic squad were asthmatics, and that almost twice as many people had asthma in the Olympic team than in the general population. She also emphasises that the worst thing an asthmatic can do is give up exercise and explains that the “body and lungs can cope better with asthma if you’re physically fit.” The author then shows the serious aspect of asthma by quoting Erica as saying “1,200 people died last year of asthma.” However, these high figures are put down to people not using the right medication. attack. The author ends by saying that with the right management in place, asthmatics can follow and achieve all their dreams just like Keanu. On the whole, the author is optimistic about asthma, and by including informative quotes from a reliable source, he supports the young boy, Keanu and his aspirations of becoming the next David Beckham. Conclusion Article 4 discusses the positive aspect of asthma, in comparison to article 2 which views asthma in the opposite way, by using scare tactics and inflammatory language. In conclusion, all four articles give a good account on their perception of asthma. Article 2 discusses the negative aspect of asthma, contradicting the views of article 4, by using scare tactics and inflammatory language. However, this negative stance is questionable as the author does not voice her own opinions. Furthermore, only article 2 gave details of where to find further information on asthma. Both articles 1 and 3 give a balanced view on the condition allowing the reader to reach an informed opinion on the topic. Only articles 1 and 4 reported the news of Beckham using an inhaler, and they surprisingly viewed this in a positive manner. The media is seen to have a powerful influence upon the general public. How information is interpreted varies from reader to reader but primarily depends upon References
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The full citation for this Article is:
Mohammad, S. & Siddiqui, M. (2012). Health Care Review: Asthma in the Media. PHILICA.COM Article number 339. |
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