Asthma is over-diagnosed in UAE, experts say

Specialists explain mystery of why Daman has 'horrible number' with respiratory illness.

ABU DHABI // Experts explained yesterday why 70,000 patients insured by Daman have asthma. The answer is, they don't.

"We have a horrible number of asthmatic patients, and we just didn't know why at first," said Dr Alfons Grabosch, manager of health support at the government's health insurance scheme.

"Pulmonologists told us there is a strong chance the diagnosis is simply wrong. They said patients come with a cough or with some wheezing and doctors immediately label them as asthmatics."

Using information from insurance claims, Daman found that 50,000 nationals in the emirate had been told they had asthma. A further 20,000 residents under Daman's enhanced insurance premium were also listed as asthma patients.

"Around 50 per cent of those 70,000 patients are below the age of six," said Dr Grabosch. Daman has been meeting pulmonologists and respiratory specialists to understand why the numbers are so high.

Triggers that can lead to respiratory problems including recycled air from air conditioning, dust and the incense and perfumes common in Emirati culture, said Dr Grabosch.

Dr Anwar Sallam, consultant paediatric pulmonologist and deputy chief medical officer at Mafraq Hospital, said: "A lack of sufficient education means that when anyone is wheezing, asthma is being diagnosed automatically," he said.

This is especially the case with children, who are more susceptible to viral infections that are sometimes mistaken for asthma.

"With asthma, you have to gather a lot of information, based on allergies, on family history, on other symptoms, and use that to make a diagnosis," Dr Sallam said.

"Whatever disease management programme is launched, it must educate both the doctors who are diagnosing, and the parents who shop around because they don't like to hear their kids have asthma."

Dr Asma Ali al Nuaimi, paediatric pulmonologist at Zayed Military Hospital, said that diagnosing asthma, especially in children, is challenging, which may explain the prevalence of the diagnosis.

A test called spirometry cannot be used on young children because it requires the patient to breathe into the machine in a specific way.

"You cannot instruct children below the age of six on how to breathe, so diagnosis is a challenge, and they are the ones in whom asthma is over-diagnosed," she said.

Spirometry machines are not widely available in Abu Dhabi: only Sheikh Khalifa Medical City and Zayed Military Hospital have the device and technicians equipped to operate it. Few private practices, if any, use the machine, she said.

The prevalence of asthma worldwide is usually around 12 to 13 per cent of the population, although some reports have said one in five children in the UAE is asthmatic.

Dr al Nuaimi disputes those figures. "I don't think it is as much as 20 per cent. We don't want to underestimate the problem of course, but we also don't want to exaggerate it."

Experts say doctors need more education in how to diagnose asthma and manage asthmatic patients. "We hold regular workshops and training symposiums for doctors, to raise awareness," Dr al Nuaimi said.

Dr Bassam Mahboub, consultant pulmonologist and vice president of the Emirates Allergy and Respiratory Society, believes some doctors list asthma on insurance claims to justify prescribing asthma medication, sometimes used to treat a mild or postviral cough in a child.

"This may be the problem; doctors put asthma on the claim to justify medication, but this does not necessarily mean all these patients have asthma," he said.

Daman launches a disease management programme next month for Emiratis with asthma. Dr Grabosch said efforts would be made from the beginning to ensure all the diagnoses were correct.

"We must check the diagnosis, because if patients are getting treatment for a chronic condition that they do not have, a new set of severe problems could arise."