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Bronchial Asthma: Principles of Diagnosis and Treatment FREE TO VIEW

Naim S. Bashir, MD
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University of New Mexico School of Medicine Albuquerque, NM

Chest. 2001;120(5):1757-1758. doi:10.1378/chest.120.5.1757-a
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By ME Gershwin, TE Albertson, eds. Totowa, NJ: Humana Press, 2001; 476 pp; $125.00

The importance of understanding asthma and its management for the primary care provider (PCP) cannot be overestimated, since an estimated 17 million people in the United States suffer from this disease. Bronchial Asthma: Principles of Diagnosis and Treatment is an impressive endeavor that rises to meet this challenge by presenting complex scientific data in a relatively simple manner. The book provides a framework to deal with practical issues.

The book is divided into four parts. Part 1 begins with a review of pediatric asthma, emphasizing the need to focus on childhood, wherein remarkable increases in disease prevalence have been documented. The text then proceeds to a discussion of cellular elements, their products, the role of airway epithelium and smooth muscle, as well as neural mechanisms in generating and modulating inflammation. Addition of a discussion of the mechanisms by which various anti-inflammatory agents modulate inflammation would have enhanced the utility of this chapter.

Part 2 begins by providing a helpful generic structure for the PCP on which to base the clinical and allergic evaluation of an asthmatic patient. The authors first provide a straightforward review of pulmonary function tests, which guides the assessment of asthma severity, bronchodilator responsiveness, and longitudinal response to therapy. The differential diagnoses of both childhood and adult asthma are reviewed, followed by a comprehensive discussion of pediatric asthma in which the reader is first supplied with specific questions to ask and key observations to make in the examination of the child with asthma. The reader is presented with the goals to be achieved by treatment, and then the techniques by which these can be realized during an acute exacerbation at home, at an outpatient visit, and during a hospitalization. This includes a review of various drugs, inhaler technique, and the use of nebulizers, as well as coverage of the National Institutes of Health guidelines for maintenance therapy. The discussion of long-term management of asthma includes helpful examples of asthma action plans, asthma diaries, and handouts for environmental control.

The chapter on adult asthma treatment is structured in a similar fashion, providing management algorithms, summarizing drug information, and reviewing special situations such as asthma in the elderly. Particularly interesting is a discussion of the effects of pregnancy on respiratory physiology and the impact of asthma and its therapies on pregnancy, the fetus, and the newborn, including the breast-fed infant. This part of the book ends with a discussion of alternative therapies, including traditional orthodox therapies, herbal medicine, homeopathy, and acupuncture.

Part 3 focuses on asthma under various special circumstances. The proposed role of infectious and noninfectious agents in the development of bronchial hyperresponsiveness and asthma is reviewed. An interesting discussion on exercise-induced asthma and the role of antileukotrienes follows. The authors supply an algorithm for diagnosis of food-induced asthma, and discuss food additives and aspirin-induced or nonsteroidal anti-inflammatory drug-induced asthma and the effectiveness treatment with antileukotrienes. Separate chapters are dedicated to occupational asthma and allergic bronchopulmonary aspergillosis (ABPA), the latter including useful protocols for management of ABPA. The special problems of the asthmatic patient undergoing anesthesia are presented, along with a review of anesthetic care and agents and the perioperative management of the asthmatic patient. Lastly, a separate chapter covers the implications of recreational drug abuse in the asthmatic patient, an increasingly common comorbidity.

Part 4 deals with the social implications of asthma. The important role of various health-care professionals and educators in improving disease management through self-management programs cannot be forgotten, and receives good coverage. A review of psychological considerations with respect to the nature of the disease, the treatment, the provider, and the patient as an impediment to the effective treatment of asthma follows. Part 4 ends with a chapter on legal implications of asthma, including malpractice issues, as well as medical economics, patient privacy, and the Americans with Disabilities Act.

This book is an excellent resource for the primary care provider who wishes to keep up with asthma basics, current management trends, and cutting-edge knowledge of asthma management in special situations, along with the psychosocial aspects of this increasingly common chronic illness.




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