Why a separate title "Childhood asthma"? First, the majority of asthma cases begin in childhood, making it the number one chronic pediatric illness. Second, asthma is more of a syndrome than a disease that affects adults and children differently. General physicians often fail to diagnose it in early stages and in variant forms resulting, in mismanagement, indiscriminate use of antibiotics, antitussives, and antihistamines, etc, that further complicate and prolong the illness.

Third, although many management approaches are similar, there are significant differences in diagnosis and drug handling in the case of children. It is extremely unwise to consider them as mini-adults and half or reduce the dosage of medicine.

In fact, drug doses are calculated based on the surface area of the child, the maturity of renal, liver and other metabolic systems to handle the load.

Finally, the interaction between the physician and the patient's parents is the crucial factor. It is often this relationship - the human factor on which the success or failure of treatment plan hinges. This is certainly true of all chronic illnesses but is especially true in properly managing the child with asthma and the family dynamics that result from such a disease.

The treatment of each child should be individualized and requires treating the patient, the parents and the environment. Despite the antiquated health care provider attitude that "doctor knows best", many parents are well informed through books, Internet, etc, and are keen to participate in treatment decisions. Nevertheless, clinicians have wisdom from years of experience and scientific knowledge from in-depth study. These must be used for developing a partnership approach to treat the child and the family.

The definition of asthma has changed. The emphasis should be on treatment of underlying pathology that produces symptoms rather than just the treatment of symptoms. Despite the frequency with which it occurs (5 to 22 per cent), childhood asthma is unfortunately not diagnosed correctly or soon enough. There is a tendency to relate the symptoms of asthma to infectious processes and mistreat the child with antibiotics.

There are many reasons for this; the main being that childhood asthma manifests differently than the case in adults and needs specially trained pediatricians to deal with it so that there is no delay. The majority of asthma cases occur before two years of age despite the fact that this is the time when attention to a child's care and environment is at its highest. Proper treatment at such an early age may have a great impact on the outcome of treatment. Inflammation, if left untreated early, may result in irreversible changes.

It cannot be overemphasized that on examination asthmatic children may have typical fancies and many peculiarities, but may not have typical features, which are found in adults. Therefore, they deserve specific attention by trained doctors. There are millions of children who have yet to receive the benefit of correct diagnosis and treatment. They are losing their childhood. Let us not make children "Therapeutic Orphans" due to our follies or gains.