ASTHMA 2 VOL SET (HB 1997)

Asthma has become a major focus of health care and research. The prevalence of asthma has risen dramatically over the past 20 years, and the bewildering diversity of hypotheses to explain this epidemic illustrates our lack of understanding. There are several recent textbooks on asthma and allergy, but the exponential increase in asthma research makes an up-to-date synthesis of all pieces of the puzzle more than welcome. The editors of this new textbook are to be congratulated for bringing together current and detailed information on all aspects of asthma from 225 leading international experts.

There are 148 chapters with extensive references up to 1995. The index is conveniently repeated in both volumes, making them user-friendly and accessible despite their size and weight. Volume 1 contains chapters on epidemiology and concentrates on the structure, function, and cellular and molecular biology of the respiratory tract. Volume 2 proceeds with inducers and triggers, respiratory physiology, clinical aspects, and treatment. All sections contain state-of-the-art reviews, and some remarkable chapters contain information on topics that cannot easily be found elsewhere, such as the history of asthma, health-related quality of life, alternative therapies, and the management of asthma in developing countries. In the clinical sections, chapters on asthma in adults are often followed by chapters on the same topics in children, making the books attractive for both adult and pediatric pulmonologists. Some authors cover their topic in remarkable detail. There is, for instance, an extensive chapter on dust mites where one can learn that Lepidoglyphus destructor produces 140 eggs. Others have contributed fine examples of conciseness -- for instance, a chapter on risk factors by Martinez, one on the genetics of asthma by Postma and Bleecker, one covering definitions and clinical classification by Woolcock, and one explaining difficult cases of asthma by Barnes and Woolcock (containing the puzzling statement that "vocal cord dysfunction is typically seen in overweight women aged 20 to 40 years, who are often employed in a paramedical position").

Despite the impressive overall quality, there is some room for improvement in a future edition. First, the sequence of chapters should be changed. Asthma is still a clinical syndrome, and one must struggle through almost 1400 pages of largely basic science before the first chapters on clinical assessment appear. The description of physiology begins on page 1253. At least from a historical point of view, clinical assessment and respiratory pathophysiology should be described first. Other chapters whose sequence might be changed are "New Aerosol Delivery Systems," which currently appears 100 pages before chapters on old delivery systems in adults and children, and perhaps "Aspirin-Sensitive Asthma," which appears 800 pages after "Drug-Induced Asthma." A lot of material is covered at least twice. As the editors stress in the preface, this sometimes helps the reader to appreciate differences of opinion between experts, but there is room for editorial streamlining. For instance, guidelines for classifying the severity of asthma appear in a number of chapters; Woolcock's popular cartoon showing mild, moderate, and severe bronchial hyperresponsiveness appears at least three times.

Second, the contents should be improved. A book's explicit claim of completeness challenges the reviewer, and indeed, some items are missing or underrepresented. The role of allergens is covered in a nine-page chapter with a single figure; not even a biphasic response to allergen challenge is shown. Less than one page is spent on the prognosis of asthma from childhood to adulthood; long-term sequelae are not discussed. The ethics of asthma research are not covered. Separate chapters on differential diagnosis, especially in children, and on similarities and differences between chronic obstructive pulmonary disease and asthma would have been helpful. The chapter "Lung Function in Asthma in Early Life" does not mention tidal-breathing analysis. These details, however, cannot detract from the general sense of completeness one gets from reading these volumes.

The editors meant the book for health professionals, academic teachers, and scientists. My feeling is that the book has the most to offer specialized clinicians who want an update on the broad field of "asthmology," for whom it provides a unique synthesis of recent information on the multifaceted "worthy foe" called asthma.

Reviewed by Johan C. de Jongste, M.D., Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Expensive, but the core resource in the field. It offers a comprehensive overview, incorporating current information related to asthma's pathobiology and clinical aspects. The 148 chapters range from the basic sciences to management of the disease in both adults and children. For medical libraries.
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