BACKGROUND: Although there is considerable evidence that the prevalence of childhood asthma has increased over the last decades, it is not clear if this trend is still ongoing. A study was undertaken to investigate whether previously observed trends in the prevalence of respiratory symptoms, physician visits, medication use, and absence from school in Dutch children aged 8-9 years persisted in 2001. METHODS: Parents of 1154 children aged 8-9 years eligible for a routine physical examination in 2001 were asked to complete a questionnaire on the respiratory health of their child. RESULTS: In 2001, 1102 children (95.5%) participated in the survey. Similarly high response rates were obtained in the surveys of 1989, 1993 and 1997, with 1794, 1526 and 1670 children aged 8-9 years participating in the respective surveys. The decreasing trend previously observed for recent wheeze between 1989 and 1997 persisted into 2001, particularly in boys. After increasing between 1989 and 1997, the prevalence of shortness of breath with wheeze decreased between 1997 and 2001. The proportion of wheezy children using medication increased between 1989 and 2001 in boys (42.9% v 64.8%; p = 0.003), but the increase was not statistically significant in girls (34.0% v 45.7%; p = 0.096). CONCLUSION: The prevalence of recent wheeze in Dutch school children has declined steadily since 1989. The rising prevalence of medication use in symptomatic children over time may reflect better asthma control and may partly explain the concurrently decreasing trend in the prevalence of asthma symptoms in our study population.