John Peel’s contemporaries at Shrewsbury have different memories of their schooldays from those recorded in the recent biography of the popular disc jockey and presenter. Memory becomes unreliable by the time someone reaches my age, or even the age that Peel reached — 65 — and most of the idiosyncrasies of schoolfellows have faded.

A few memories retain a place in some corner of the cerebral cortex. Usually these are of the outstandingly clever or athletic, or those who were remarkably unpleasant or contemptible. My generation can also remember one group of boys who were neither great academics nor rugby players of note. They were the boys who suffered from asthma.

At that time asthma was rare enough for the names of those who suffered from periodic wheezing, chest tightness and coughing to have been imprinted indelibly on our memories. We can still remember them sitting bolt upright in bed, struggling for breath with that peculiarly anguished expression that a bad attack of asthma induces — an expression that was portrayed by Francis Bacon, another asthma sufferer.

We can also recall the useless treatments used in the 1940s in a vain search for relief. Little good did the impotent nebulisers and strange herbal cigarettes do them. Too breathless to play games, too often absent from class to shine in exams, they are remembered because of the unrelieved spasm in their bronchial tubes.

The prevalence of asthma has changed. In 50 years’ time few will be able to recall the names of school contemporaries who had asthma, as the list would be too long. Asthma is no longer an occasional problem: one child in ten and one adult in twelve suffers from it. Its prevalence has increased by 500 per cent in the past 25 years and is still growing. In the UK, 20,000 people a week see their medical advisers about asthma.

At the same time, though, asthma is better treated. The weird, useless cigarettes have made way for the — by comparison — near-magical Symbicort turbohalers, Seretide inhalers and Serevent aerosols. Patients are treated more efficiently, in line with a national protocol. A patient’s lung function is no longer estimated by a doctor but measured precisely by a peak flow meter.

The death rate from asthma has tumbled — but now a graph displaying this has levelled off. Part of the problem is that among the severe asthmatic patients is a group who are less responsive than most to standard treatment. These are the patients at greater risk of developing severe attacks, who are more likely to need regular hospital treatment or even to die.

There are 5.2 million people with asthma in the UK. About a million of them are classified as having severe asthma, and of this group about half are additionally designated as being poor responders to treatment, whose asthma is difficult to control.

Help is at hand: Xolair (omalizumab), manufactured by Novartis, has been introduced to attack the root cause of asthma in half of all severe cases. Xolair does not treat the symptoms but interrupts the sequence of events that induce the physical signs and symptoms of asthma. It targets the antibody IgE, which is present in excess in those people who are allergic to the proteins found in animal dust, house mites or pollen.

Xolair binds to the IgE antibodies, blocks their action and prevents bronchial tube inflammation, and so spasm. It also has a small, specific anti-inflammatory action.

Xolair is an add-on therapy. Patients who need it don’t give up their standard high-dose inhaled corticosteroids (these keep the asthma at bay), nor do they abandon the long-acting beta 2 agonists that improve control of the symptoms, but in addition they have a subcutaneous injection of Xolair every two or three weeks.

Xolair is indicated for use only in patients over the age of 12 who have severe, persistent allergic asthma with worrying exacerbations. The patient should have positive skin tests to an allergen, and the allergic asthma must be affecting their ability to breath easily.

When given to correctly selected patients, Xolair halves the number of severe exacerbations and the rate of emergency visits or admissions to hospital, as well as improving the patients’ quality of life.

While the changes in the airways responsible for an asthmatic patient’s breathing problems are well known, and the variability in symptoms because of health and environmental factors is appreciated, the actual causes of asthma are multiple and not all are fully understood. The introduction of Xolair has emphasised the importance of analysing each case of resistant asthma carefully, as the drug is useful only when the cause is essentially allergic.

British Lung Foundation: 08458 505020