Recognition of asthmatic symptoms in the pediatric age group

Asthma produces substantial morbidity in childhood. Under-diagnosis may lead to inappropriate treatment and prolonged periods of illness and absence from school. The results of a recent International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire study in Malta showed a higher prevalence of wheezy symptoms in the Central North Region. The present study was carried out to test the null hypothesis that there is no correlation between potential exposure to pediatricians (measured as pediatric private clinics/1000 childhood population/week) and percentage of children aged 13-15 years of age responding positively in the questionnaire to having had wheezy symptoms. A significant, positive correlation was found between potential exposure to pediatricians and percentage of children aged 13- 15 years responding positively to having had wheeze in the previous year (p=0.009). A negative correlation was also found for severity of asthma (>12 attacks in the previous 12 months) and potential exposure to pediatricians (p=0.01). This is the first report of potential exposure to pediatricians influencing the regional incidence of asthma on a national basis. This skew may be caused by the greater exposure of pediatricians to patients with severe forms of asthma in a hospital setting, and hence a higher index of suspicion for the milder forms of the disease. Asthma may be less severe in regions where there are a greater number of pediatricians because of recognition of the condition with appropriate treatment and/or prophylaxis.