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by Dr. Noel Kerin - Dec 3, 2006


Today is Chronic Obstructive Pulmonary Disease day. What better an opportunity to learn about this disease, asthma and The Asthma Society of Canada’s support of Canadians in exercising their right to breathe easily and freely?

Asthma, allergies and Chronic Obstructive Pulmonary Disease (COPD) are major health concerns for millions of Canadians across the country, and the financial impact of ineffectively treated respiratory illness on our healthcare system and economy has far exceeded the billion-dollar mark.

If nothing changes, more than 500 people will die in the next 365 days from complications due to asthma. Of these avoidable deaths, 50 will be children with asthma. Adults and children with the most severe forms of asthma will miss dozens of work and school days – on average, 34 days of work for adults and 20 days of school for kids.

Many of the more than three million Canadians with asthma and the 714,000 people with COPD will also suffer “presenteeism” – a term coined to describe impaired performance and quality of life caused by lack of sleep, illness while at work or school, and the associated anxiety parents inevitably experience when their children may be in danger of a respiratory crisis.

While the human cost is incalculable, the economic toll is not: according to some estimates, in 1998, the last year for which figures are available, health-care and disability costs relating to respiratory illness in Canada reached $8.5 billion.

Perhaps the most terrible aspect of this tragedy is that it is largely avoidable. Eighty per cent of asthma-related deaths are preventable, and most symptoms can be controlled with proper treatment, allowing children and adults to live active and symptom-managed lives.

“It is the equivalent,” says Dr. Noel Kerin, president and CEO of Kerin Occupational Health Consultants, “of watching a 747 jetliner crash needlessly each year.” In his clinical practice, Dr. Kerin has treated patients with chronic respiratory conditions for years, and the emotion in his voice is clear as he speaks of avoidable deaths and those left behind; of trying to treat patients whose prescription coverage didn’t include the medications they needed and couldn’t otherwise afford. Some 20 per cent of Canadians with asthma cannot access their medications because they can not afford them.

The causes of Canada’s respiratory crisis are complex, but the solutions are within reach – through a concerted, co-operative effort from patients, the medical community, governments and industry. The primary strategy to mitigating the damage is the optimal management of the disease. “Although we’ve had the Canadian Asthma Consensus Guidelines for a number of years now, we aren’t doing very good job at treating patients,” says Dr. Oxana Latycheva, vice president for Asthma Control Programming of the <="" a="">. Surveys conducted by the society found that almost 60 per cent of asthma patients do not have their condition under control. “People often just think that it is normal to miss school or work, to wake up during the night, to not be able to exercise. We need to work together to tell people that they don’t need to accept a lower quality of life.” (In fact, Olympic medalist Silken Laumann has asthma, illustrating the quality of health that’s possible for others with the condition.)

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Polluted air, both indoor and outdoor, has also been documented as a contributing factor to asthma and COPD exacerbations. The Asthma Society has recently introduced two new clean air initiatives – the Asthma Friendly product certification program and the “Breathe Free Canada” social marketing initiative. Breath Free Canada aims to support and champion those Canadian companies that are taking environmental action resulting in Canadians breathing cleaner air. The initiative was launched officially on October 26, 2006, by leading environmentalist Robert Kennedy Jr.

But according to Dr. Kerin, legislation is also necessary. “We know that workers in bars and restaurants showed greatly improved lung function just one month after smoking was banned in their working environments,” he says. Carbon emission controls are also an important preventative initiative, as carbon molecules have an electrostatic charge that attracts other toxins and allergens (such as the proven asthmogenic sulphur component of diesel fuel) and holds them in the air we breathe.

A new ‘best practices’ collaborative approach to treatment is vital, says Dr. Kerin. Many asthma sufferers are covered only by their provincial drug benefit plan, and many of those plans do not cover the treatments that are most effective for some patients. That’s short-sighted, he says, and doesn’t take into account the fact that it is much more expensive to provide emergency care and treat the sometimes irreversible damage that results.

“Patients have a right to breathe easy. We need to empower our patients to seek 100 per cent control of their condition,” says Dr. Latycheva, “and we need to empower our health-care professionals to provide optimal treatment to patients with asthma, allergy or COPD.”

<="" a="">Taken from: Randall Anthony, special to the Globe & Mail

by Dr. Noel Kerin - Dec 3, 2006

Mesothelioma is a most lethal cancer. It has unusual characteristics. The more I look at it the more I am convinced it does not behave like a true solid tissue cancer.

• Serosal membranes very rarely become malignant except with Mesothelioma.
• It is not asbestos fiber dose dependent.
• It is not cigarette smoking dose related.
• Probably occurs only in cases where there was prior evidence of a pleurisy (benign) usually with evidence of pleural thickening.
• Latency is different (usually longer) than any other known malignancy.
• 275 day median survival is more in keeping with an uncontrollable infection (all be it a malignant one) than a solid tumor growth pattern.
• Simian 40 virus DNA parts have been found in mesothelioma specimens.
• Rarely if ever found as a distant metastasis (e.g. brain or liver spread).

I believe it is a viral infection gone malignant e.g. HIV type malignant behavior so that it looks more like asbestos fiber activation of a common virus infection in turn causing a variety of clinical conditions. Many of these clinical conditions can be quite innocuous. In benign pleural effusions we don’t find a pleural cavity full of asbestos needles – It would appear we haven’t been culturing for the right agent.

If Mesothelioma is a rogue viral infection - then there is the possibility of developing a vaccine and offering vaccination to asbestos exposed people who are at heightened risk of developing future asbestos related malignancies.

Q: Is asbestos a co-carcinogen to a viral infection?
A: Needs to be studied...