Run on the spot for two minutes. Now place a straw in your mouth and pinch your nose to hold your nostrils shut. Try breathing using only the thin straw. Inhale . . . exhale . . . difficult? Add to this discomfort feelings of panic and you will know what it is like to have an asthma attack. According to a new book from the American Lung Association, Family Guide to Asthma and Allergies, asthma, an incurable and potentially fatal disease, is on the increase. No one knows exactly why but many factors contribute. Figures for Hong Kong show that hospital admissions for asthma and emphysema, another airway-obstructing disease, increased from 8,119 in 1991-92 to almost 10,000 in 1993-94. Bronchitis, asthma and emphysema are listed collectively as the 10th biggest killer in Hong Kong, accounting for 383 deaths in 1994-95. Figures show three of those who died were aged from one to 14, and another 22 between 15 and 44. Other statistics indicate that five per cent of the territory's adults and 11 per cent of children aged between 10 and 20 are asthma sufferers. A study by the Chinese University, comparing the prevalence of asthma and allergic disease among secondary school students aged between 13 and 17 years in three Asian populations - Hong Kong, Kota Kinabalu in the Malaysian state of Sabah and San Bu, Guangdong - shows Hong Kong children the most prone to suffer asthma and allergic diseases, followed by Kota Kinabalu and the Guangdong township. Juvenile asthma rates are lower in Hong Kong than in countries such as Australia, but at about 11 per cent still much higher than in neighbouring countries. Research has shown that asthma attacks are triggered in two ways, by irritants and allergies. Tobacco smoke, air pollution, changes in weather and stress all act as irritants on the sensitive airways. Allergies to mould, house dust and pets are common, and most asthmatics get hayfever. Despite the severity of this disease it can be controlled, and most sufferers live normal, active lives. Five out of 40 dancers at the Hong Kong Ballet are asthmatics. Fiona Brockway, 33, the principal dancer, has suffered mild to medium-strength attacks. 'When I was younger I was one of the fastest runners in the school, but every time I had an event . . ,' she says, pausing to imitate a throaty wheeze. 'I can remember having to stop: my chest was very tight and I was wheezing almost at the point of passing out,' she says. Exercise is something she has always done and is now positively encouraged among asthmatics. Brockway continued studying ballet, while suffering bouts of breathlessness and wheezing, but dismissed it as just hayfever. The asthma is worsened by smoke, alcohol, hayfever and furry animals. She recalls the first time she had a reaction to cats: 'I was very young and I'd never been so uncomfortable. My eyes swelled up and I couldn't stop sneezing.' It is a difficult decision to choose between your pet and controlling your allergy, but there are ways around the problem. Ross Kennedy Smith is a vet who is asthmatic and suffers allergies to certain animals. Animal dander [small scales from animal hair or feathers] is highly allergenic and can cause chronic inflammation of the airways. Mr Kennedy Smith is a mild asthmatic but his allergic reaction can occur fortnightly, with watery eyes and an itchy, runny nose. Handling animals daily, he simply cannot avoid it. 'If I have five cats or rabbits in a morning, I can stream all day,' he says. To alleviate the symptoms he takes antihistamines but if things get very bad he has to take steroids. Pets are not the only problem: The Family Guide reveals that cockroaches can trigger attacks. Because cockroaches often live and die undiscovered, their bodies decompose and turn to dust. This dust, like house dust mites, can bring on serious asthma. Some doctors believe the most important indoor allergen in Hong Kong is house dust mites. The blind, eight-legged arachnids exist in dust in bedding, carpets and soft furnishings, and Hong Kong's humidity provides the perfect breeding ground for them. The removal of soft toys, furnishings and carpets from the bedroom, the use of occlusive bed covers, and washing bedding in hot water are ways to reduce their numbers. Doctors believe avoiding these triggers is the best solution, and until 10 years ago there really wasn't a lot of medical help anyway. But modern medicine can now effectively treat asthmatics with a variety of inhalers, steroid tablets and nebulisers (another medium of inhaling drugs direct into the lungs). Brockway had no treatment until she was 18 years old. 'Before that I was told it was psychological,' she says. This old-fashioned attitude is incorrect, as asthma is a disease and symptoms are not psychosomatic. Now she uses two types of inhaler: Ventolin for immediate relief, and inhaled steroids as a preventive. Patients are warned not to go without essential medication because of a misunderstanding about the safety of steroid treatment. They should realise that, with inhaled steroids, little goes into the bloodstream and there is less chance of the side-effects that result from taking steroids in tablet form. Brockway is totally in control of her asthma but she always has to be prepared. While dancing she keeps her Ventolin inhaler at the side of the stage. 'During one of the performances at Christmas I slipped and fell,' she says. Any shock or emotional stress can bring on an attack. 'I had 2,000 people watching and I thought: 'I've got to finish.' So I finished off the pas de deux, got off stage and just grabbed my inhaler.' It opened up her bronchial tubes and took immediate effect. Worry can make things worse so she carries two inhalers all the time. 'If I leave home and don't have them, I panic and I have to literally calm myself down.' She also has a peak-flow metre to monitor her breathing. Attacks can be worse at night as the lungs relax during sleep and are not working at full capacity. 'It can be exhausting ,' she says, referring to sleep loss caused by regular waking in the night. The only time she didn't use the drugs was when she was pregnant, although she could have used Ventolin had she been told at the time. Her years of training for ballet have given her immense self-discipline and stamina which helped her through childbirth, but many women have to keep a close watch during pregnancy. Asthma and allergies are thought to be passed genetically, but fortunately Brockway's four-year-old daughter has never had an asthma attack. She has been told it could develop later. Another myth is that children who suffer from asthma will grow out of it. Brockway says: 'I've been constantly promised that it'll get better as I get older. I've actually grown into mine.' She feels it has worsened since she came to live in Hong Kong. Mr Kennedy Smith says: 'My asthma should be better, but it isn't: I'd easily put it down to the pollution in Hong Kong.' Whether it is the pollution and dust of a city, pollen and animals in the countryside, or cockroaches and dust mites at home, doctors are treating more asthmatics than before. Awareness is the key, and breathing is something some of us can never take for granted.