When Should a Child See a Pediatric Pulmonologist in Dubai?

Parents usually arrive at a specialist clinic after months of uncertainty, often having been told several times that it is just another virus. The useful question is not whether a cough is serious, but whether the pattern still fits something ordinary. This page explains when it does not, and what happens next.

What a pediatric pulmonologist actually does

A pediatric pulmonologist is a children's doctor who has done further specialist training in the lungs and airway. The job is not simply to treat asthma. Much of it is working out why a child's breathing problem has not behaved the way a common condition should — why the cough has lasted four months, why the wheeze has not responded to inhalers, why the same part of the lung keeps getting infected.

Most children with a cough or a wheeze never need to see one. A general pediatrician manages the great majority perfectly well. Specialist referral earns its place when the pattern stops fitting, when the tests needed are not available in a general clinic, or when a child has a condition that affects the lungs long term.

When specialist assessment is appropriate

These are the situations where I would want to see a child rather than wait:

• Cough lasting more than four weeks that is not clearly settling — see chronic cough in children
• Repeated chest infections, especially more than one pneumonia in a year, or infections that keep affecting the same area of the lung — see recurrent chest infections
• Asthma that is not controlled despite regular treatment, or a child needing oral steroids more than once or twice a year
• Diagnostic doubt — a child labelled asthmatic who has never had objective testing, or whose symptoms do not fit
• Noisy breathing present from early infancy, or stridor — see wheeze and noisy breathing
• A wet, productive cough that never fully clears between illnesses
• Poor growth alongside respiratory symptoms
• Suspected inhaled foreign body, even weeks after the event
• Known conditions affecting the lungs — cystic fibrosis, primary ciliary dyskinesia, immune deficiency, or neuromuscular conditions such as SMA and Duchenne muscular dystrophy

What an evaluation involves

The first appointment is mostly conversation. The history usually tells me more than any test: when the symptoms happen, what makes them worse, what has already been tried and whether it helped. I will then examine your child fully, not just listen to the chest.

Depending on what that suggests, the investigations available include:

• Spirometry with reversibility testing — lung function, achievable in most children from about five or six years
• FeNO — a simple breath test measuring airway inflammation, which helps confirm or exclude asthma rather than guessing
• Allergy testing — skin prick testing or specific IgE blood tests
• Chest imaging — and I will always want to see previous films, because a shadow recurring in one place is often the single most useful clue
• Sweat test where cystic fibrosis is possible, and nasal nitric oxide where primary ciliary dyskinesia is suspected
• Immune bloods where infections are recurrent or unusual
• Flexible bronchoscopy — looking directly inside the airway and sampling it, which identifies exactly which organism is present instead of treating empirically
• Sleep studies where breathing during sleep is part of the picture

Not every child needs all of this. A good assessment narrows the possibilities before testing, rather than ordering everything and hoping something explains it.

Respiratory problems that present differently in Dubai

Practising here for five years has changed what I look for first. Several things are genuinely different from the UK.

Indoor allergen load is high

Dubai’s coastal humidity sustains house dust mite populations year round, without the seasonal break a temperate climate gives. Mite sensitisation has been reported in around 46% of tested individuals in one Dubai cohort, though rates vary widely across the Gulf and are much lower in dry inland cities. Mould around air-conditioning units and in bathrooms adds to it. This is why allergic cough is such a common final diagnosis here.

Air conditioning itself

Cold, dry, recirculated air dries the nasal passages, encourages mouth breathing and irritates the airway. Children move repeatedly between 45°C outside and heavily cooled indoors, which many airways do not tolerate well.

Desert dust and shamal winds

Dust events raise particulate levels sharply and are associated with clusters of asthma presentations over the following days — see dust storms and children's asthma.

A highly mobile population

Families arrive from everywhere, and newborn screening programs differ between countries. A child who moved here at three may never have had a heel-prick screen that would have picked up cystic fibrosis. Previous records are often in another language or another country. It is worth gathering them before an appointment.

What I offer

I am a Consultant Pediatric Pulmonologist and Sleep Physician with dual UK board certification (CCT) in Pediatrics and in Pediatric Respiratory Medicine, FRCPCH, and an MSc from King's College London. I trained and worked for 16 years in the UK's NHS, latterly as Consultant at Royal Manchester Children's Hospital — one of Europe's largest children's hospitals — where I led the bronchoscopy, sleep and long-term ventilation services. I have practised in Dubai since 2021 and hold an Honorary Associate Professorship at the University of Sharjah, with 57 peer-reviewed publications. Over that time he has cared for children and families from more than 70 countries, across the UK, the Middle East and beyond.

In practice that means diagnostic assessment for chronic cough, recurrent infection and difficult asthma; flexible bronchoscopy and airway sampling; full sleep diagnostics; and long-term ventilation and home NIV, including respiratory care for children with neuromuscular disease and gene-therapy follow-up in SMA and Duchenne.

About Dr Omi Narayan

Consultant Pediatric Pulmonologist and Sleep Physician based in Dubai. Trained for 16 years in the UK's NHS, including as Consultant at Royal Manchester Children's Hospital. Dual UK board certification (CCT) in Pediatrics and Pediatric Pulmonology. 57 peer-reviewed publications.

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