Opinions differ among doctors

Press, 2 November 1989, Page 11

Opinions differ among doctors

Asthma is misunderstood even in the medical profession, Ken Dawson says. Of 200 children with moderate or severe asthma who attended a children’s asthma clinic, 58 per cent had been prescribed antibiotics regularly for asthma attacks. This concerns Dr Dawson, because there is no evidence that bacterial infection is related to asthma attacks. Not only are the antibiotics inappropriate, they may well be counterproductive. Many people already fail to keep up their asthma medication properly; to be given multiple medicines may make them even less likely to comply. “Any medicine must be fully justified before it is prescribed for children with asthma,” he says. Almost half the children the team studied had also had their lives dis-

rupted by regular attendance at physiotherapy for specific breathing exercises. “In view of the total lack of scientific evidence to support this time-consuming activity it is hard to support its continuance,” he feels. One problem is that there is still considerable confusion in the minds of parents and health professionals as to what actually constitutes asthma, particularly in young children. “Part of this difficulty arises from the impossibility of clearly defining asthma and the absence of a single laboratory test or clinical sign which denotes the presence of the condition,” Dr Dawson comments. “This is exacerbated by the wide variety in severity, the intermittent nature of attacks, and the range of symptoms and triggers of attacks.” Another problem, he says, is the old perception among many doctors that a diagnosis of asthma carries a stigma or invokes excessive worry in the parents, so they avoid using the name. For these reasons euphemistic terms such as ‘wheezy bronchitis’ and ‘recurrent bronchitis’ were coined. Old attitudes die hard. In a study of • asthmatic children in Britain in 1983, only 21 were told they had asthma, 18 were told they had wheezy bronchitis or a ‘chest allergy,’ 126 had nonspecific diagnoses, and 14 had never been seen by a doctor. There is no purpose in avoiding the term asthma, Dr Dawson believes. It is much better to say ‘your child has asthma’ and then spend time explaining that it is almost surely of the mild episodic type and that with time it will improve. Without this approach, these children may have continued episodes of illhealth quite unnecessarily and go from one episode of so-called ‘wheezy bronchitis’ to the next. “The legacy of these actions has led to concerns about widespread underdiagnosis and underrecognition of asthma in childhood,” Dr Dawson says. “Fortunately, many of the misconceptions have been laid to rest by widespread publicity and the term ‘asthma’ is being used and the real problem recognised.”