Some parents recently voiced frustration at not being allowed to have special equipment for their asthmatic children.

Having a child with severe asthma can be taxing on parents. Seeing their children in pain or difficulty naturally raises anxiety and worry levels. Frequent hospital visits are stressful and often result in lost time at school and work for both the child and parents.

Asthma is a condition where airways become restricted and the person has difficulty breathing. If not intercepted the airways may become completely blocked and the person can suffer from lack of oxygen and even die.

Asthma is easily treated with medication and sufferers are strongly advised to always have an inhaler with their specific medication handy. Additionally there is a device called a space that is used to increase the effectiveness of the inhaler.

In cases where asthma is well managed, attacks are quickly offset with use of the inhaler or the inhaler and spacer together. In cases where the asthmatic goes to the hospital, a nebuliser is often used to offset the attack. This is a piece of equipment that is available for home use. Prescription medication is put in the machine and the dose meted out to the asthmatic.

In the Asthma Awareness Day workshop presented by the Bermuda Asthma & Allergy Support Group last month, some parents complained that pediatricians in Bermuda will not write prescriptions for children in their care to be able to use a nebuliser at home.

The workshop's organiser, Jenefer Brimmer, said she was unaware of the matter until parents spoke out at the event. She said her group gives out free nebulisers but only to those with a doctor's prescription.

She said the Asthma and Allergy Foundation of America, of which the Bermuda Asthma & Allergy Support Group is a member, recommends nebuliser use. (Body & Soul could find no evidence that the Asthma & Allergy Foundation of America recommend the use of the device for all asthmatics). She also expressed surprise that some local doctors are against its use.

One mother said she's asthmatic, has had asthma training and has two children with the condition, one more serious than the other. The serious asthmatic has suffered since the age of one. The mother, who asked not to be named, said a management plan is in place. Even with that, asthma attacks send her child to the hospital six times a year on average.

She said she could usually tell a few days before that an attack is coming. "I know the signs," she said. "Peak flows are low and there's a runny nose."

She contends that she could diminish the severity of attack on her child by administering the nebulised dose of medication sooner, if it was at home. She also believes the nebuliser could be used as a preventive measure and that she could ward off attacks by giving the medication when she sees the warning signs.

"The doctors' concern is that parents will abuse it. That when the children need to go to hospital, the parent will try to care for them instead of taking them to the hospital," she said.

"I understand that, but I wouldn't do that. I believe I am a good candidate to have a nebuliser."

Asthma educator Liz Boden of Open Airways is against home nebuliser use.

"I am totally delighted to hear that doctors did not allow parents to have a home nebuliser for their child," she said when contacted.

"Home nebulisers have been blamed for the deaths of many children at home in the US. This means our physicians are following international guidelines and understand that prevention is the key to effective management of asthma."

Body and Soul asked Peter Perinchief of Edgewood Pediatric Services why local pediatricians might not want their patients to have the device.

He cited safety reasons. He said the dose received by nebuliser can be 20 times as much as that from the inhaler and he noted that the high doses might produce low levels of potassium in the blood. Low blood potassium levels can lead to seizures or irregular heartbeats with a worst-case scenario of heart attack.

Dr. Perinchief said he also was concerned that parents could be lulled into a false sense of security with a home nebuliser. "A deteriorating (and potentially life-threatening) state could be imminent and masked by the high doses of delivered medication," he said.

Most importantly, he said that cases that require use of a home nebuliser are sufficiently serious to warrant immediate medical evaluation.

"If a nebuliser has to be used to treat or control an asthma attack, then the situation may be more serious than suspected and it would be better assessed in an emergency room where heart rate, oxygen saturation in the blood and general lung function can be monitored," he said.

Dr. Perinchief said any one of the concerns he mentioned would dissuade him from prescribing home nebuliser use for any of his patients. "When considering all concerns together it makes it inadmissible," he said.

Hospital pediatrician Eugene Outerbridge echoed his views.

He said: "I do feel very cautious about the use of this widely-used and promoted technology."

And he said there tends to be reliance, even of physicians, on technology as a quick fix instead of recognising it as a tool to help. "It is not a panacea and not for all," he said of home nebulisers. "Tragically, deaths have occurred when nebulisers have been used incorrectly, or too much reliance was placed on them when further medical advice should have been sought."

Ms Boden said she and other local asthma educators saw a film at an asthma conference in Boston three years ago that's had a lasting impact.

"They showed a slide of an airway totally closed, from an autopsy of four-year-old child who had died of asthma. The parents had stayed home thinking they could treat the asthma attack using Ventolin in the nebuliser.

"The chill which we all felt, and the sadness to think that child should never have died, is something we shall never forget. I should hate that to happen to a child in Bermuda because someone is trying to give away nebulisers or making parents believe they should have one at home," she said.

Dr. Perinchief recommended asthma sufferers and their parents receive special training available through Open Airways on how to use inhaler pumps and spacers. He said medication delivered in this way can treat most asthma attacks.

"When this fails it is an indication that more intensive treatment is required and that means the hospital Emergency Department," he said. "The safety with metered dosage delivery, albeit at lower doses (but still therapeutic) provides less chance of untoward complications and there is the added safety factor of easier and less equivocal recognition of a situation where the child is not getting better after a reasonable time of metered treatment and affords a timely decision to move up the scale of treatment at the Emergency Department [at King Edward VII Memorial Hospital]."