Recognition of asthmatic symptoms in the pediatric age group Grech V, Agius-Muscat H, Montefort S, Lenicker H. Recognition of asthmatic symptoms in the pediatric age group. Pediatr Allergy Immunol 2001: 12: 49±53. # Munksgaard, 2001 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 signi®cant, 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 (p50.009). A negative correlation was also found for severity of asthma (.12 attacks in the previous 12 months) and potential exposure to pediatricians (p50.01). This is the ®rst report of potential exposure to pediatricians in¯uencing 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. Victor Grech 1 , Hugo Agius-Muscat 2 , Steve Montefort 1 and Herbert Lenicker 1 1 St.Lukes Hospital, Malta, 2 Department of Health Information, Malta Key words: asthma epidemiology; asthma diagnosis; pediatric Dr Victor Grech, Paediatric Department, St.Luke's Hospital, Guardamangia, Malta Tel.:356 241 251 Ext. 1471 (Paediatric Department) Fax:356 240 176 (St. Luke's Hospital) E-mail: victor.e.grech@magnet.mt Accepted 11 July 2000 Asthma and other allergic conditions cause con- siderable morbidity as they affect a substantial proportion of the population. The principal aim of the International Study of Asthma and Aller- gies in Childhood (ISAAC) questionnaire was to provide comparable data on the prevalence and severity of allergic conditions in children, by using identical methodologies in different countries and thereby allowing the assessment of baseline trends (1). Malta is an idealcountry for such epidemio- logical studies because of the small and relatively closed natureof its population.The area of Malta is < 300 km 2 , with a totalpopulation of < 370 000 and a childhood population (j14 years of age) of < 80 000 (2). There is one large regional Hospital (St. Luke's), which serves practically allof the population except for the smaller, sister island of Gozo, which was excluded from this study. ISAAC Phase 1 was recently completed in Malta. Subjects were chosen by assigning ques- tionnaires to school classes in randomly selected church and state schools. Data was collected by means ofa questionnaire. The 13±15-year age- group completed their own questionnaire (3). Analysis of the questionnaires showed a higher rate of asthmatic symptoms in the Central North Region (3). Many Maltese pediatricians live, and also have private clinics, in this region. The aims of the present study were to determine whether private practice carried out by pediatricians in Malta in¯uencesthe prevalence or severity of perceived wheeze in childhood. This was carried Pediatr Allergy Immunol 2001: 12: 49±53 Printed in UK. All rights reserved Copyright # Munksgaard 2001 PEDIATRIC ALLERGY AND IMMUNOLOGY ISSN 0905-6157 49