Diagnosing respiratory problems in children can be difficult but there are resources available to help parents cope.
Support on hand for children with respiratory problems in the UAE
A few weeks ago my seven-year-old daughter developed a chronic, persistent cough. It got worse towards the evening when she would cough every 10 seconds, and felt sufficiently like a tic for us to alternate expressions of sympathy with polite requests that she stop it now, please, before her younger sister started copying it.
But there were other signs too that something was wrong. Scarlett seemed unusually grouchy and tired. Then one day, while she was practising her violin - an emotionally charged activity, to put it mildly - she suddenly fell to the ground and seemed to be having difficulty breathing.
Alarmed, we took her to the doctor, who listened to her chest and used a finger pulse oximeter to measure her blood oxygen. This turned out to be worryingly low: 80 per cent rather than the usual 95-100 per cent.
Observing that it was a "miracle" that Scarlett was up and running around - children are very adaptable and will often keep going even when they are feeling terrible - the doctor diagnosed asthma, and packed us off home with a three-day course of steroids (to shock the body back into working order) and a brace of inhalers.
Within a few days she was back to normal. But we were puzzled by our failure to notice earlier that something was wrong. Why had we allowed the situation to become so extreme? Wasn't asthma a fairly straightforward ailment, as easy to spot as it is to treat?
Seemingly not. While it's one of the most common diseases in the world, asthma is very hard to diagnose definitively in children, even though most of those who have it develop symptoms before the age of six. The problem is, these symptoms can be so subtle that they are often missed or mistaken for something else - bronchiolitis, say. This mimics asthma, causing the airways to swell and become blocked, but is actually caused by a viral infection.
Most people associate asthma with its trademark wheezing. But our daughter didn't wheeze at all; she just coughed. This, it transpires, is because she has "cough-variant asthma", where the main symptom is a dry cough that tries but fails to expel mucus from the respiratory tract. People with cough-variant asthma frequently have no other symptoms. But it's a particularly irritating form to have because it often strikes at night, keeping the sufferer awake.
Scarlett's doctor thought it might have been triggered by the current high pollen count in London, where we live, caused by what passes in the UK for unseasonably hot and sunny weather.
In the UAE, respiratory diseases are a particular problem, especially in larger cities such as Abu Dhabi, Dubai and Sharjah. Recent research suggests that 13 per cent of UAE schoolchildren suffer from it to some degree.
The health insurer Daman will be launching a disease management programme next month for Emirati asthma patients, to help them manage and control their illness. In the course of preparing for the launch of the programme, Daman has identified an unexpectedly large number of patients diagnosed with asthma, which has prompted it to look at how these patients are being diagnosed.
Meanwhile, earlier this month, Dr Jamal Abdul Razzaq, a specialist in chest diseases, told a public gathering at Rashid Hospital in Dubai to mark World Asthma Day that more UAE citizens than ever were being diagnosed with the condition.
"Around 800 people visited the chest diseases clinic at the hospital over the first four months of this year," he said, adding that many of the children diagnosed would eventually grow out of it, possibly by the onset of adolescence. Even so, the situation is so bad that last year the Dubai Health Authority signed a deal with the pharmaceutical company GlaxoSmithKline to establish a "centre for excellence in respiratory care", which would train nurses to care for asthma sufferers properly.
Moves have also been made to establish asthma-specific "mini-clinics" in health centres so that, instead of having their condition assessed in a 10-minute consultation with a doctor, patients can be educated in methods of treatment and prevention. (For instance it's important, once you've started using beclometasone steroid inhalers, to take them regularly, as their effectiveness builds gradually and tails off if you stop.)
Heat isn't a problem in itself, but the consequent over-reliance on air-conditioning is, making summer in the UAE especially miserable for sufferers - not just because of the shock to the lungs caused by switching between very hot and very cold environments, but because mould can build up in the ducts of AC units. If it isn't removed by regular cleaning, this black mould (Stachybotrys chartarum) is released into your home every time you switch the AC on and can cause fungal infections of the lungs as well as asthma.
Air-quality issues can also create hotspots for childhood respiratory problems. The region has been called a "global vacuum-sack", sucking up dust from construction projects, wind-blown sand, traffic fumes, industrial smog and soot from oil platforms. Widespread shisha use doesn't help. Last year, a survey by the Dubai Health Authority found that one in 10 pupils reported smoking shisha. Also - contrary to popular belief - shisha users actually ingest more tar and nicotine than cigarette smokers because of the massive amount of smoke inhaled.
Asthma can be a killer - a fact it's easy to forget now that there are so many preventive and prophylactic medicines available. Salbutamol inhalers (eg Ventolin) were only introduced in 1968. Before then, asthmatics led severely restricted lives. My father-in-law was thrilled, in the early 1960s, to win a place at Oxford University to study chemistry. But as an asthmatic he spent most of his undergraduate career languishing in bed with respiratory disorders (Oxford's climate is notoriously damp).
Watchfulness is very important, and obviously the role of schools is crucial. The Asthma Friendly School initiative, pioneered in the US, has been rolled out across the UAE since 2008 and encourages schools to adopt asthma-conscious policies and procedures. A particular goal is ensuring that asthmatic children be able to take part in physical exercise without triggering "exercise-induced asthma".
Doctors agree that the most important thing is to catch asthma young, then to manage your life so that exposure to the allergens and pollutants that can trigger it is limited. As we have found, this isn't always easy. The important thing is to make the most of the support that is available.