Asthma Epidemiology: Principles and Methods

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9780195080162: Asthma Epidemiology: Principles and Methods

Asthma prevalence is increasing worldwide, and there is growing concern about the burden of asthma both for patients and for the health sevices. There have also been major changes in the way in which the management of asthma death in some western countries in the 1960's and again in the 1970's. Asthma epidemiology has a major role to play in investigating the causes of these global changes, and in developing preventive interventions. This is the first text on the principles and methods of asthma epidemiology. It describes the types of asthma epidemiology studies, and discusses the strengths and limitations of the various methods of measuring asthma prevalence and asthma morbidity and the major risk factors for asthma, methods of studying the causes of asthma deaths. The book will therefore be of interest not only to epidemiologists, but also to the very large number of respiratory physicians, allergist, and pediatricians who are becoming involved in asthma epidemiology.

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About the Author:

Neil Pearce, Richard Beasley, Carl Burgess, and Julian Crane are all at Wellington School of Medicine.

From The New England Journal of Medicine:

Changing patterns in the prevalence of asthma and associated morbidity and mortality are of growing public concern. There are both national and international efforts to find ways to reduce the impact of this disease. Yet, for all the concern, much about the underlying pathophysiology of asthma, the interdependency between host and environment, and the natural history of the disorder remains a mystery. These major gaps in our knowledge about asthma provide a clear opportunity for contributions from the field of epidemiology.

Although knowledge of the clinical syndrome of asthma has been documented for over 2000 years, much of the epidemiologic contribution to our understanding of asthma-related morbidity has been made in the past 30 years. Advances in this relatively new field of investigation have been hampered by the lack of both common definitions and standardized methods of case ascertainment, risk assessment, and outcome evaluation. These problems are being addressed by a rapidly growing number of scientists.

In what appears to be the first book of its kind, Pearce et al. have produced a thoughtful introduction to the epidemiology of asthma. In their preface, the authors note that their intention was to provide "a general introduction to the field not an advanced treatise for a single specialized audience." The authors offer a comprehensive overview of current knowledge in this field. The purpose of the book is to introduce key concepts, methods, and selected results to a broad readership of epidemiologists, as well as primary care physicians and specialists who may not have training in the epidemiologic sciences.

The authors' pleasing and accessible prose is apparent in the first chapter, which presents, as a bonus, a concise review of the history of asthma in the medical literature. In this chapter, the authors outline six basic problems confronting the field, each of which is explored in later chapters. The book is divided into sections according to basic principles of asthma-related epidemiology, morbidity, and mortality. One of the considerable strengths of this book is the use of examples for nearly all the key concepts. The authors provide the reader with actual studies that serve as an anchor for each concept, and nearly all these examples have been well chosen.

Overall, the authors seem to have achieved a good balance, introducing the reader to general epidemiologic methods and methods that are specific to the study of asthma. The sections on the prevalence of asthma, assessment of risk factors, and mortality are particularly strong. The section on measuring asthma-related morbidity seems somewhat abbreviated, considering the many important topics covered (e.g., use of health care services, pharmacoepidemiology, quality of life, and assessment of health status). Each of these topics, even in an introductory textbook such as this one, warrants a chapter of its own.

It would have been useful to have included a chapter on the asthma-surveillance systems used in various countries. Timeliness is also of concern. In such a rapidly advancing field, the authors may have difficulty keeping this type of book up to date. An important example of this problem is represented in their discussion of two major international studies (the International Study of Asthma and Allergies in Childhood and the European Community Respiratory Health Survey). The authors discuss the design and purpose of these landmark studies. However, a number of important findings from both studies have appeared in the medical literature since the publication of this book.

Physicians who are new to this field will find that this book is a useful introduction. For investigators in the field, Asthma Epidemiology serves as the only available compendium of work in this area. I expect that other readers may also find this book useful, especially public health and policy administrators with an interest in asthma, clinicians interested in making sense of recent findings in the epidemiology of asthma, and anyone interested in the epidemiology of chronic disease.

Reviewed by Kevin B. Weiss, M.D.
Copyright 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Pearce, Neil, Beasley, Richard, Burgess,
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Neil Pearce; Richard Beasley; Carl Burgess; Julian Crane
Published by Oxford University Press (1998)
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