x Abu Dhabi, UAESunday 21 January 2018

Most children with asthma not getting the right treatment

Many are being prescribed far higher drug doses than necessary, while doctors say there could be a swath of sufferers who are not being treated at all.

A child using an asthma inhaler.
A child using an asthma inhaler.

DUBAI // Most children with asthma are not getting the right treatment, according to doctors, with many being prescribed far higher drug doses than necessary. Because there are no standard guidelines for reporting the condition, it also often goes undiagnosed - meaning there could be a swath of sufferers who are not being treated at all. Instead of seeking treatment, many parents stop their children from taking part in any physical activities that could spark an attack, doctors said.

Some 13 per cent of Dubai children have been diagnosed with asthma, according to Dr Ahmad Kalban, the head of primary care at the Dubai Health Authority (DHA). The true figure could be as high as one in four, he said. A lack of specialist doctors in the primary health sector means many patients are not managing their asthma correctly. "Childhood asthma is certainly unreported here," Dr Kalban said. "Many cases are not diagnosed because either people are not aware or parents do not want the stigma of asthma."

Speaking at a World Asthma Day event in Dubai yesterday, he said the lack of awareness caused some parents to avoid seeking a diagnosis, or even treatment, for their children. "It does not help the children at all. They could live a normal life if the asthma was properly managed. But some people don't understand this so they stop their children from doing sport and playing with their friends." Last year, 53 per cent of children in the GCC were absent from school for at least one day because of asthma, according to a study conducted by an asthma group.

Dr Bassam Mahboub, head of the Emirates Respiratory Society, agreed that unless asthma was properly managed it would have a "huge impact" on the patient and their families. Children miss school, adults are absent from work and the attacks that result from people not being treated put an unnecessary burden on emergency rooms, he said. "Much like diabetes and obesity," he added, "if monitored and addressed correctly, the effect asthma has on life today can be dramatically reduced."

Jacqueline Brereton, a specialist respiratory nurse from the UK, has trained 25 doctors and nurses to work in public hospitals and clinics in Dubai. The emirate, she said, did not manage asthma in a "similar way" to the rest of the world. Doctors and nurses do not use internationally recognised guidelines. Therefore, treatments vary. One of main problems is the use of nebulizers as replacements for inhalers, she said. Nebulizers administer a much higher dose of - 25 times as much as an inhaler - and are usually used only in emergency situations.

They are no more effective than inhalers during a normal attack and should be used under the supervision of a doctor or nurse. "Twenty years ago other countries would use the nebulizer as a first line. Now it is the inhaler," said Mrs Brereton. "But here most people are still using the nebulizers, which are much stronger. It is just not necessary." A lack of thoroughness and standard guidelines, she said, meant many asthma cases were being missed.

"This is why we need trained nurses and doctors in primary health clinics," she said. "We need to identify what are people's trigger factors. Some might be affected by dust, others by pollen. Applying the same treatment to all patients is not right." She urged the DHA to follow through on its plans to create mini-polyclinics that included asthma specialists. Without them, she said, the training would have been a "waste of time".

"Everything is ready, it's about allocating their time in a way that will be most beneficial to the patients." @Email:munderwood@thenational.ae