A total of 179 Tyneside children who had suffered at least one episode of wheeze since school entry were seen at the age of 7. All but 14 had visited a doctor for chest symptoms, but a diagnosis of asthma had been offered to the parents of only 21 children, including three of the 56 -children experiencing four to 12 wheezy episodes a year and 11 of the 31 children experiencing more than 12 episodes a year. Bronchodilator treatment was rarely offered in the absence of such a diagnosis, and two thirds of the children had never received a bronchodilator. Of the children experiencing four or more episodes a year, only a third had received bronchodilator drugs regularly, though half had lost more than 50 days from school because of wheeze. School absenteeism fell 10-fold in the 31 children finally offered continuous prophylactic treatment. Although many doctors had feared that use of the word "asthma" would cause anxiety, parents were uniformly relieved when given an explanation of their child's recurrent wheeze.This study uncovered a disturbing amount of ill health in children that was easily rectified. Probably this same problem exists in other areas.

All the 7 year old schoolchildren in North Tyneside were screened for wheeze with a questionnaire followed by selective clinical assessment: 9-3% of the children had had episodic wheeze within the past year and all those followed up subsequently responded to one or more of the drugs used for asthma. A further 1-8% had had similar symptoms since starting school, though they had not wheezed in the past year. Frequency of symptoms in the 11% of children with features of asthma varied widely and correlated with bronchial reactivity on histamine challenge, but it was not possible to separate children with frequent wheeze from asymptomatic controls by their response to histamine. It was concluded that all these wheezy children had symptoms of a common basic disorder and that they should all be treated as asthmatic.

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and conclusions Thirty-four cases of asthma in children referred to outpatient clinics in Newcastle upon Tyne (16 cases) and London (18 cases) were reviewed. In both cities there was evidence of inappropriate diagnosis and treatment by general practitioners. One of the main factors seemed to be doctors' reluctance to use the word "asthma," even when a history of episodic wheezing strongly suggested the diagnosis. Freer use of the word "asthma" might help parents to cooperate in managing asthmatic children and allow them to be better prepared to cope with severe asthmatic attacks if they occur.

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