There are over 5 million asthmatics in the UK and, depending on its severity, the condition can affect ratings on health protection. Fergus Bescoby explains
Asthma is a condition that affects the airways. When a person with the condition comes into contact with an asthma trigger the muscle around the walls of the airways tightens so that the airway becomes narrower. The lining of the airways becomes inflamed and starts to swell. A sticky mucus or phlegm is often produced. These reactions cause the airways to become narrower and irritated - leading to the symptoms of asthma.
Asthma cannot be cured, but it can be controlled so that attacks can be prevented. Most people with asthma who receive proper treatment, and take it correctly, can lead normal lives. They do not have to lose time from school or work, and they can enjoy full involvement in sport and other activities.
Common symptoms are:
- coughing
- wheezing or a whistling noise in the chest
- getting short of breath
- a tight feeling in the chest.
What causes asthma?
Asthma can start at any age and it is difficult to know the exact causes. They may include:
- genetics
- aspects of modern lifestyles: changes in housing and diet and a less hygienic environment can contribute to its rise
- smoking during pregnancy
- second-hand smoke
- irritants in the workplace
- stress or anxiety
- also, environmental pollution can make symptoms worse, but it has not been proven to cause it
There are three main types of treatment: reliever inhalers, preventative inhalers and oral steroids.
- Reliever inhalers - usually blue
These are medicines that are taken immediately to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again.
Relievers are essential in treating asthma attacks and a dose of reliever inhaler should be taken when asthma symptoms are present. As the name suggests, they are inhaled via a pump.
- Preventer inhalers - usually brown, red or orange
Preventers control the swelling and inflammation in the airways, stopping them from being and reducing the risk of severe attacks.
The protective effect builds up over a period of time so, unlike relievers, they need to be taken every day, usually morning and evening, even when the individual is feeling well.
Preventers do not give immediate or quick relief when a person is breathless but they do reduce long-term inflammation. They usually contain a low dose of steroid medicine. This treatment is also administered through a pump or puffer.
- Oral steroids
If the asthma symptoms become severe, a short course (three to 14 days) of steroid tablets may be required. Steroid tablets work quickly and powerfully to help to calm the inflamed airways. Short courses of steroid tablets are also used to treat acute asthma attacks and are used for essential emergency treatment the condition.
A small number of people with severe asthma find that preventer medicine and short courses of steroid tablets are not enough to control their asthma and may need to take steroid tablets for a longer period.
Asthma in the workplace
There are 4.3 million adults with asthma in the UK. In most cases their asthma is not caused by work, but there can be things in the workplace that make things worse, even to the point of triggering an asthma attack.
Some 43% of asthma sufferers report that their condition can get in the way of them doing their job and more than 18 million working days are lost to it each year.
There are many factors that can affect an employee and worsen their asthma. They include:
- dust 62%
- cigarette smoke 38%
- stress 27%
- chemicals 19%
- fumes 17%
- perfumes and air fresheners 14%.
Some interesting stats
- Over 5 million people in the UK have asthma, 1.4 million of them are children aged under 16 years.
- 2.6 million people (2.1 million adults and 500,000 children) in the UK have severe asthma symptoms including debilitating breathlessness, attacks so bad they cannot speak, fear that they may die and emergency hospital admissions.
- 8 million people in the UK have been diagnosed as having asthma at some point in their lives.
- In 2001, 55 in every 1,000 men and 45 in every 1,000 women had asthma in the UK.
- There are almost 4 million consultations and 74,000 hospital admissions for asthma each year in the UK.
- There is a person with asthma in one in five UK households.
- There were 1,381 deaths from asthma in the UK in 2004, 40 of which were children aged 14 years or under. On average, four people a day or one person every six hours dies from asthma.
However, the amount of deaths due to asthma has fallen from more than 2,000 in the 80s. It is estimated that approximately 90% of asthma deaths could have been prevented if the patient, carer or healthcare professional had acted differently.
- An estimated 492 cases of occupational asthma were seen for the first time by occupational and chest physicians who reported to the surveillance schemes in 2005, bringing the average annual incidence over 2003-5 to 571, or around two cases for every 100,000 workers per year.
Underwriters will need to ask
- When was the asthma diagnosed and what was the actual diagnosis?
- How many attacks does the sufferer get on average each year and what was the date of the last attack?
- What treatment are they currently taking? Inhalers and/or tablets and details of actual medication.
- Have they ever taken oral steroids?
- Have they ever been hospitalised for their asthma? If so the underwriter will generally need to know when and under what circumstances.
- Have they ever been off work due to their asthma? If so when was the last time and for how long?
- Smoker status - this is an extremely important factor for a life insurance company and even more important for an underwriter assessing an asthmatic. The risk is significantly greater in smokers and will certainly increase the risk of an asthma attack, potentially causing permanent damage to their airways. Smoking can also reduce the benefit of any form of treatment.
- Fergus Bescoby is underwriting manager at PruProtect
Sources: Hannover Re; Asthma UK; British Lung Foundation
UNDERWRITING IMPLICATIONS
Generally speaking, someone with a history of asthma who has not been on any treatment for two years will be accepted at standard rates for life insurance.
If the customer does not fall into the above category, they will be assessed as suffering from either mild, moderate or severe asthma:
- Mild
Short and infrequent attacks, with no hospitalisation or time off work in the past three years, which are easily controlled on non-steroid treatment. In this instance, the underwriting outcome would vary between standard rates and a small loading (+50%).
- Moderate
Constant treatment with occasional short courses of oral steroids. Occasional time off work with some physical restrictions. In this instance a substandard rating will be imposed and will vary between +50-100%.
- Severe
Frequent attacks with continuous oral steroid treatment and significant physical impairment. Someone falling into this category is deemed to be high risk and will be rated +150% upwards.
Ratings for critical illness, serious illness or disability benefit will generally be more severe than for basic life cover and will range from standard rates to decline. Terms are highly unlikely to be offered for someone falling into the 'severe category'.
In certain instances, an exclusion may be applied.
A customer smoking more than 20 cigarettes a day will have an additional rating imposed and will never receive standard rates.
Use of oral steroids greatly increases the risk.
