Isle Of Man, Western Europe

Why was this centre selected for ISAAC?

Evidence suggested that the prevalence of respiratory and related disorders increased in the British Isles over the past six decades. The Isle of Man was no exception. Hay fever and allergic symptoms have caught the attention of health professionals, not only in their own right, but also as an indicator of their association with asthma. To address these problems, a major international research project, The International Study of Asthma and Allergies in Childhood (ISAAC), was established in 1991. The Steering Committee is based in New Zealand at the University of Auckland, and a range of countries, including the United Kingdom, began their research in 1995 when Phase One was carried out. The Isle of Man and the Channel Islands, although linked to the UK, carried out their surveys independently, also known as the offshore arm of the British study.

The Isle of Man is a Crown Dependency and lies in the middle of the Irish Sea. It has its own Government and the Parliament, Tynwald, is a Parliament with the longest continuous activity in the world. In 2009 this was established at 130 years. It has a population of about 80,000 inhabitants (last interim Census in 2006) and enjoys a varied economy with financial services and e-commerce, agriculture, fisheries and tourism being the most important economic activities. The Isle of Man is mostly known for the motorbike open road race TT (Tourist Trophee). This is unique in the world and annually visitors travel from all parts of the globe to watch the races and also enjoy festivities. Since 2009 a ‘Green’ race has been added to the race schedule, allowing for electric motorbikes to compete in the famous circuit race.

The Island’s geography is stunning and the countryside is beautiful regardless the weather. Most population (about 50%) lives in the South-East, in the capital town of Douglas and surrounding villages. The highest peak is Snaefell and on a clear day “all surrounding kingdoms can be seen from the top of it: England, Scotland, Northern Ireland, Republic of Ireland, Wales, and the Kingdom of Mann.

Our Experience of ISAAC

The aim of Phase One in the Isle of Man was to describe the prevalence and severity of asthma and related disorders in 13/14 year-old children. Results were released in 1996 and revealed the distribution and frequency of asthma and related disorders. These rates were very similar to those observed elsewhere in the UK and the Channel Islands at the time. Results were used in service planning and considered a baseline to benchmark against any new surveys. Four out of the six secondary schools took part in this round. In Phase Two of the Study the Island took part with data collection aimed at environmental factors, particularly linked with air quality. Data for the Island on daily air temperature, annual rainfall and the prevalence of chemicals such as Nitrogen Dioxide and Sulphur Dioxide in the air were collected in 1998 specifically for this phase of the Study. The results were again similar to the readings reported in the UK and the Channel Islands, as reported at the time. Such readings were considered a ‘baseline’ and these would be again considered in the future. It is after all that emerging climate change and other environmental monitoring will be crucial in assisting the Isle of Man government with ensuring clean air for this small country which lays in the middle of the Irish Sea.

ISAAC Phase Three was carried out in October 2001. The main objective was to identify changes that may have occurred in the last six years in the frequency of respiratory and allergic conditions in children, to evaluate any association with air quality and other environmental factors and to assess the present situation. The Study was extended to younger children (6-8 year olds) to enable long-term comparisons to be made. The 6-8 year old survey was unique to the Isle of Man of all areas in the British Isles and results were published separately in the 6-8 year olds report. The Isle of Man study was carried out as an offshore-arm of the UK study and was led by Dr David Jeffs, Director of Public Health in Guernsey. Locally, the Principal Investigator for the Isle of Man obtained LREC approval for the study and used an opt-out consent form. The 6-8 year old study was a self-responding questionnaire for parents of primary school children. The 13-14 year olds self-responded to the questionnaire. There was no sampling carried out and all children of the right age were targeted to take part: in 34 primary schools and six secondary schools. They all took part with 1,086 (6-8 years) and 1,917 (13-14 years) students. A small team of researchers carried out delivery of questionnaires and return envelopes for parental responses in the 34 primary schools and almost 60% of the 6-8 year old target population and over 80% of the 13-14 year old target population were returned for processing. All forms, over 3,000 were posted to the UK Centre at St George’s Hospital Medical School and were processed in standard format along with the other centres in the British Isles. National reports were published and a paper led by Prof. Ross H Anderson and co-authored by all British centres was published in the BMJ in 2004¹. The Principal Investigator supplemented the study results with other information for this paper, such as hospital admissions and GP visits recorded during the same year the survey took place. The Isle of Man has not used any of the videos in the data collection.

The burden of self reported asthma and related disorders among adolescents has changed for the better in the recent years throughout the British Isles and the Isle of Man is no exception. ISAAC has provided much needed information for policy purposes, for example establishing the need for first aid and inhalers available in all schools. Methodologically the 6-8 year old questionnaire asked parents about the administration of paracetamol to their children and the approach in the Isle of Man was to include in the questionnaires as many as known brand names of this over the counter drug. Pharmacies and supermarkets were approached and the most frequently sold paediatric brands were included in the questionnaire. The Island’s data were used in the publication of a paper in the Lancet in 2009².

Acknowledgements

We gratefully acknowledge the financial support of the Isle of Man Government, Department of Health and Department of Local Government. We gratefully acknowledge the invaluable assistance of the offshore British Coordinator Dr David Jeffs, the UK Coordinators Prof. Ross H Anderson and David Strachan for their continuous support. As the Isle of Man Principal Investigator I am grateful for the invaluable assistance of the database management provided by the St George’s Medical Hospital School Team for their help with the timely database setting and a continuous dialogue in assisting with the publication of our reports and indebted to all the children, parents and school staff who participated in the surveys. I wish to thank my fieldwork team for their enthusiasm and motivation throughout Phase Three of the Study.

Dr Andreea Steriu, Isle of Man ISAAC Phase Three Principal Investigator

References

1. The Anderson, H.R., Ruggles, R., Strachan, D.P., Austin, J.B., Burr, M., Jeffs, D., Standring, P., Steriu, A. And Goulding, R. “Trends in prevalence of symptoms of asthma, hay fever, and eczema in 12-14 year olds in the British Isles, 1995-2002: questionnaire survey". BMJ 2004; 328:1052-53.
2. Beasley R, Clayton T, Crane J, von Mutius E, Lai CKW, Montefort S, Stewart A, for the ISAAC Phase Three Study Group. Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme. Lancet 2008; 372(9643): 1039-48.