The diagnosis and initial treatment of asthma in young children in New Zealand and the United Kingdom.
OBJECTIVE
To conduct a pilot study to test methodology in ascertaining if there are differences between New Zealand and the UK in the symptom and circumstance set that influences a general practitioner in the initial diagnosis of asthma, and to ascertain the treatment prescribed at the time that the diagnosis is made.


METHODS
Questionnaires were mailed to 110 general practitioners in each country. General practitioners from the Otago region in New Zealand and from the Nottingham region in Britain were contacted. A follow-up reminder was sent to all non-responders three weeks after the initial mail out. Questions were asked about the symptoms and signs that were considered important, as well as other influences (e.g., passive smoking) when making a diagnosis of asthma in a child under the age of five years. The doctors were also asked what treatment they prescribed at the time of the actual diagnosis of asthma.


RESULTS
British doctors considered night cough (p = 0.05) and cough associated with emotion (p = 0.004) more diagnostic of asthma. New Zealand doctors rated cough associated with temperature change (p = 0.05) as being important and they had a lower threshold in diagnosing asthma with respect to history of similar attacks (p = 0.008) compared to their British counterparts. More New Zealand doctors reported using prophylactic/anti-inflammatory agents as first line therapy (59% vs 28%; p = 0.002).


CONCLUSIONS
We conclude that there are only minor differences in general practitioners' diagnostic criteria for asthma in the two countries with reference to this small sample. We believe, however, that differing diagnostic criteria could account for different reported incidences of childhood asthma in some countries. There is need for internationally accepted diagnostic criteria.
Department of General Practice, Dunedin School of Medicine. jim.reid@stonebow.otago.ac.nz
J
J
Reid
S
S
Walker
A
A
Penrose
R
R
Charlton
D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D002675:Child, Preschool; D003371:Cough / Q000175:diagnosis; D003625:Data Collection; D005194:Family Practice; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012135:Respiratory Sounds / Q000175:diagnosis; D006113:United Kingdom / Q000453:epidemiology