Practical advice on getting a correct diagnosis and detecting the signs of asthma in children and adults.
Breathe easy as Team Yalla heads to Snö Asthma & Allergy Clinic in Abu Dhabi to speak to Dr Stuart Carr, CMO.
How is asthma diagnosed at Snö Asthma & Allergy Clinic?
The first thing we do at Snö Asthma & Allergy Clinic is we sit with the patient and we talk.
Let’s say somebody comes to my clinic with the label of asthma or with inhalers, I work quite hard to prove they don’t have asthma. I might think that this sounds like asthma, but I work hard to demonstrate they don’t have it.
If I’m not successful in proving that, I’m confident we’ve got the right diagnosis. However, if somebody comes to see me and they have allergic rhinitis or say a food allergy, I make an effort to see whether they have any indications of asthma, since a lot of cases of asthma go undiagnosed.
If people have allergies, does this mean they are asthmatic?
Approximately 40 per cent of people with allergic rhinitis have asthma; however, not 40 per cent of them are being treated.
If somebody were to come to my clinic and indicated they have a blocked nose, sneezing, itchy eyes, I would ask them some questions such as if they have caught a cold, do they wake in the night short of breath; if they wheeze and if yes, is it when they breathe out or breathe in, and so on. If the answers are negative then there are no indicators that point towards asthma.
Asthma is both over diagnosed and underdiagnosed. People visit their doctor with a cough and they’re often prescribed an inhaler and they might not even have asthma. This is because many never have had a lung function testing, which measures the amount of air the lungs can hold and how forcefully a person can empty air from the lungs.
How do you diagnose asthma in children?
For children under-six it’s a little trickier since a lung function test cannot be conducted.
What’s important is to listen to the patient’s story. Once we’re suspicious that a child may have asthma, we conduct therapeutic trials, which is prescribing medicine, but watching for a very specific clinical response to the medicine.
If I have a child, for example, who was coughing a lot, and I’m wondering if it might be asthma but I’m not certain, we’ll give them a certain medicine, but the key is to use it in very specific situations.
As soon as the child is coughing a lot or has noisy breathing, you prescribe an inhaler. However, a lot of people who prescribed the inhalers, don’t know what it does or what to look for.
What should parents be looking for in these cases?
Some inhalers do help with the child’s symptoms – some work fast while others don’t, but in many cases parents are not given any expectations regarding what to look for.
Here at Snö, I’ll say to the family, if the child is coughing enough that you wish you could do something about it, administer two, four or six puffs off the inhaler.
We show parents how to use it and inform them that we are looking for a rapid improvement within five to 10 minutes.
Is this a sign that the child has asthma?
If there is a significant improvement after taking the inhaler and then it wears off after three to four hours, as if the child had never taken it, this indicates a rapid significant but temporary response or relief, which is an indicator of asthma.
If the child is coughing for all the other reasons that people can cough for, the inhaler won’t do anything. We say to parents, try the inhaler generously any time that the child is coughing to see if it gives consistent, rapid temporary relief.
If it does then that’s the strongest indicator that it is asthma and we can prescribe a preventative medicine to see whether there’s an improvement over two or three weeks.
What symptoms in children should parents be looking for?
Coughing is the dominant symptom. Coughing is the dominant symptom. Frequent colds, lingering colds or if the cold always goes to the chest that leads to hospital visits are a problem that certainly warrants a conversation. It doesn’t mean that every child or person with that particular story certainly has asthma; it doesn’t mean they all need treatment or that they all need a lung function test, but questions need to be asked.
They’ll need an evaluation, an assessment to try to figure out what I think the problems might be. At Snö, we always ask the child if they have any trouble keeping up with their friends.
Studies confirm that kids are far more aware of exercise limitation than their parents are; so exercise tolerance is the most accurate clinical measure.
For more information, visit snoasthmaandallergy.com