The changing picture of childhood asthma.

Although the last four decades have seen substantial progress in the understanding of the pathophysiology of asthma, the working clinician's main tool in establishing the diagnosis of asthma is a good and accurate clinical history. In the older child, the history is complemented by pulmonary function tests, including measures of bronchial lability. After nearly three decades of increasing hospital admissions for childhood asthma, the 1990s have seen a small reduction in overall admissions. The increase in hospital admissions is explained only partly by the rising prevalence of asthma. The associated morbidity due to the disease has increased quite considerably over the last three decades. International studies assessing asthma prevalence across different parts of the globe using identical methodologies has shown considerable differences in asthma prevalence between the East and the West as well as within countries. The burden of paediatric asthma on the child, the family and society is increasing as we move into the new millennium.