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."
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INDIA SQUADS
India squad for third Test against Sri Lanka
Virat Kohli (capt), Murali Vijay, Lokesh Rahul, Shikhar Dhawan, Cheteshwar Pujara, Ajinkya Rahane, Rohit Sharma, Wriddhiman Saha, Ravichandran Ashwin, Ravindra Jadeja, Kuldeep Yadav, Mohammed Shami, Umesh Yadav, Ishant Sharma, Vijay Shankar
India squad for ODI series against Sri Lanka
Rohit Sharma (capt), Shikhar Dhawan, Ajinkya Rahane, Shreyas Iyer, Manish Pandey, Kedar Jadhav, Dinesh Karthik, Mahendra Singh Dhoni, Hardik Pandya, Axar Patel, Kuldeep Yadav, Yuzvendra Chahal, Jasprit Bumrah, Bhuvneshwar Kumar, Siddarth Kaul
The Pope's itinerary
Sunday, February 3, 2019 - Rome to Abu Dhabi
1pm: departure by plane from Rome / Fiumicino to Abu Dhabi
10pm: arrival at Abu Dhabi Presidential Airport
Monday, February 4
12pm: welcome ceremony at the main entrance of the Presidential Palace
12.20pm: visit Abu Dhabi Crown Prince at Presidential Palace
5pm: private meeting with Muslim Council of Elders at Sheikh Zayed Grand Mosque
6.10pm: Inter-religious in the Founder's Memorial
Tuesday, February 5 - Abu Dhabi to Rome
9.15am: private visit to undisclosed cathedral
10.30am: public mass at Zayed Sports City – with a homily by Pope Francis
12.40pm: farewell at Abu Dhabi Presidential Airport
1pm: departure by plane to Rome
5pm: arrival at the Rome / Ciampino International Airport
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
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- Olympic-size swimming pool with a split bulkhead for multi-use configurations, including water polo and 50m/25m training lanes
- Premier League-standard football pitch
- 400m Olympic running track
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- An elevated football field that doubles as a helipad
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In numbers: PKK’s money network in Europe
Germany: PKK collectors typically bring in $18 million in cash a year – amount has trebled since 2010
Revolutionary tax: Investigators say about $2 million a year raised from ‘tax collection’ around Marseille
Extortion: Gunman convicted in 2023 of demanding $10,000 from Kurdish businessman in Stockholm
Drug trade: PKK income claimed by Turkish anti-drugs force in 2024 to be as high as $500 million a year
Denmark: PKK one of two terrorist groups along with Iranian separatists ASMLA to raise “two-digit million amounts”
Contributions: Hundreds of euros expected from typical Kurdish families and thousands from business owners
TV channel: Kurdish Roj TV accounts frozen and went bankrupt after Denmark fined it more than $1 million over PKK links in 2013