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Bronchial Asthma, Book

Bronchial Asthma: Principles of Diagnosis and Treatment, 3rd Ed


M. Eric Gershwin; Georges M. Halpern, The Humana Press Inc, 999 Riverview Dr, Suite 208, Totowa, NJ 07512 USA, 1994, 792 pp


Interesting and comprehensive discussion of bronchial asthma, covers definitions, host responses to bronchospasm, patient management, special clinical problems, and living with asthma

Family physicians interested in asthma would find parts of this book valuable, but on the whole, it is not for family physicians. In the preface the editors declare that they hope the book will be useful to those who treat asthma, and for specialists it might well be. Although chapter authors include physicians from Australia, Japan, Portugal, Belgium, Poland, and Canada, most are from the United States. Consequently the book has a decidedly American slant.

The contents are divided into four parts: definitions and host responses to bronchospasm, patient management, special clinical problems, and living with asthma.

Part I starts with epidemiology and genetics and then moves to pathogenesis, the role of mast cells and eosinophils, and the morphologic basis of airflow obstruction. This part is very detailed, and few family physicians would find it relevant to their practices. However, the chapter on the pulmonary function laboratory is relevant, as is the chapter on how asthma, pregnancy, and lactation relate to one another. The differential diagnosis of asthma in children is good, although the weight given to the extensive list of differential diagnoses (most of which are rare in family practice) could hinder rather than help prompt diagnosis. I found the chapter on differential diagnosis of asthma in adults less useful than that on children.

Bronchial asthma

Part II starts with a well-balanced chapter on allergic evaluations by which any physician ordering allergy testing would be helped. A chapter on clinical laboratory evaluation deals with immunoassays and allergen testing in more detail. The chapter on radiology is also good with clear illustrations.

The chapter on managing status asthmaticus in children is unashamedly didactic, and I thoroughly enjoyed reading it, although its target is pediatric respirologists. The similar chapter on adults is less didactic and is also directed to hospital specialists. Treating asthma in Japan is also interesting because of success with oral (β2-agonists, theophylline, and antiallergy drugs (inhaled steroids are not used much because of physician prejudice against them). The last chapter in this part is on “international” asthma and is a European view of asthma management.

Part III contains several chapters relevant to family physicians: respiratory tract infections and asthma, diagnosis and management of exercise-induced asthma, chronic sinus disease and asthma, and drugs and food additives as precipitants of asthma. The remaining chapters on air pollution, allergic bronchopulmonary aspergillosis, and occupational asthma are of interest and are thorough.

The final part contains good chapters on asthma in school and on sports, athletes, and asthma. The chapter on prospective disease management has an action plan outline that seems to advise increasing the (β2-agonist dose rather than the anti-inflammatory dose when asthma control deteriorates. A chapter on psychological aspects is also worth reading, but the one on legal issues has a marked US bias, which limits its usefulness.

The layout of the book could be improved. There is no indication in the body of the book as to which part or chapter one is reading. The sections are not indicated anywhere other than in the table of contents, and none of the chapters is numbered.

The preface states that the book has been completely rewritten. Yet one author refers to a “recent study” dated 1982-1983. However, other chapters have references to 1991. Also in the preface the editors apologize for any errors they have not corrected. One glaring error was in the first chapter where the text refers to “Fig. 1″ showing hospital discharges for asthma. The figure does not exist. On the next page there is another reference to “Fig. 1″ showing asthma mortality rates, which does exist. Also, the dose of subcutaneous adrenaline for adult status asthmaticus is given as 0.3 to 0.5 mg of 1:1000 (the units should be in millilitres).

This book is comprehensive, but although parts of it are relevant to family physicians, it is basically for specialists.

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