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	This article appeared on Wikipedia's Main Page as Today's featured article on October 5, 2005.
Article milestones Date Process Result August 11, 2005 Peer review Reviewed September 2, 2005 Featured article candidate Promoted July 9, 2008 Peer review Reviewed December 14, 2008 Featured article review Demoted Current status: Former featured article

Medicine: Pulmonology C‑class Top‑importance

This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.MedicineWikipedia:WikiProject MedicineTemplate:WikiProject Medicinemedicine C This article has been rated as C-class on Wikipedia's content assessment scale. Top This article has been rated as Top-importance on the project's importance scale. This article is supported by the Pulmonology task force (assessed as Top-importance). This article was selected on the Medicine portal as one of Wikipedia's best articles related to Medicine. This article was a past Medicine Collaboration of the Week.

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Some of the comments above are difficult to understand other than as an attempt to extend tobacco sellers' decades-old "tobacco might be healthy" controversy-tricks to Wikipedia's asthma page, and to minimize or obfusticate the causative role of tobacco smoke as a cause of asthma.

Big Tobacco's attempt to create the appearance of health "controversy" wherever it can seems to me to have extended to editing Wikipedia's "Tobacco" and "Smoking" pages, and to deleting mention of Big Tobacco's circumvention of its advertising agreements by product placement in movies from the Product Placement article.

Just as product placement in media such as movies is devastatingly effective advertising because it appears not to be advertising, misinformation planted in Wikipedia is devastatingly effective because those expecting to rely on it expect straight information, and do not expect it to be skewed for the profits of the tobacco sellers.

To the extent that the tobacco sellers succeed in extending the appearance of "controversy" to Wikipedia and depriving a new generation of the information needed to make a fully-informed decision about becoming a tobacco buyer, the tobacco sellers' direct and indirect profits will be huge and worldwide. It's censoring and throwing half-baked, off-topic studies to generate the appearance of "controversy" amount to subtle vandalism, and to the extent these tricky context tamperings are effective, are designed to suggest to impressionable preteens considering smoking -- tobacco seller's favorite marketing group -- that the health effects of tobacco use are, after all, in doubt.

Tampering with Wikipedia to dilute the fact that tobacco costs are far higher than the price per pack should be viewed as a call to Wikipedians familiar with the science on the issue to ensure that

(1) the science and facts needed to evaluate tobacco's risks and costs in context, and the insidious marketing strategies of tobacco sellers, are not allowed to be quietly deleted from the relevant pages,

(2) that tobacco sellers' smoke screen of off-topic implications that tobacco use might be healthy is addressed by full factual context, and

(3) that health professionals realize that there is a continuing need for vigilance in guarding the pages where potentially profitable young customers for Big Tobacco will come looking for presumably-accurate information -- that making sure that information is reliable -- not jimmied to increase sales -- is an ongoing public health issue. —Preceding unsigned comment added by 68.165.11.209 (talk • contribs) 17:49, 22 March 2008

It looks to me like Increase of Asthma in Children should be merged here. Could someone take care of that? Rd232 ^talk 15:11, 9 October 2009 (UTC)[reply]

• I think this is also a good idea, but perhaps we should wait a day or two to see whether anyone else has an opinion. Presumably it should be summarized into Asthma#Epidemiology. WhatamIdoing (talk) 22:25, 12 October 2009 (UTC)[reply]

• I disagree, it should redirect to "Asthmatics" —Preceding unsigned comment added by 81.152.204.44 (talk) 17:54, 16 October 2009 (UTC)[reply]

As far as I can tell, Increase of Asthma in Children contains nothing—not even a single statistic—about this purported 'increase'. It appears to be largely redundant with Asthma; I would support a merge if there's anything useable, but I'm not sure there is anything 'new' there, and much of the sourcing is poor. I have reverted Asthmatic to redirect to Asthma; it was poorly written, unsourced, and offered no additional information. Maralia (talk) 19:15, 4 November 2009 (UTC)[reply]

Simple deletion might be the best thing for it. Fences&Windows 22:32, 24 November 2009 (UTC)[reply]

Yes Merge. Doc James (talk · contribs · email) 17:02, 18 February 2010 (UTC)[reply]

Done Doc James (talk · contribs · email) 18:45, 14 April 2010 (UTC)[reply]

Is there research on the side affects in using current short-acting bronchodilators (inhalers), such as Proventil? I have used these for years, but can't seem to avoid thrush;candida infection, even with great care to rinse after each use. —Preceding unsigned comment added by 67.185.24.115 (talk) 19:11, 20 March 2010 (UTC)[reply]

• http://scholar.google.com.hk/scholar?hl=en&q=allintitle%3A+asthma+pet&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--58.38.47.48 (talk) 09:34, 27 March 2010 (UTC)[reply]

• http://scholar.google.com.hk/scholar?hl=en&q=allintitle%3A+pet+allergic+asthma&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--58.38.47.48 (talk) 09:36, 27 March 2010 (UTC)[reply]

• http://scholar.google.com.hk/scholar?as_q=rhinitis+cat&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

--58.38.47.48 (talk) 09:46, 27 March 2010 (UTC)[reply]

The treatment section of this page is not the best place to discuss the LABA controversy.Doc James (talk · contribs · email) 12:50, 14 April 2010 (UTC)[reply]

Currently we use the 1997 National Asthma Education and Prevention Program rather than the 2007 ones. Time for an update with a free copy of this text here [1]. Doc James (talk · contribs · email) 18:43, 14 April 2010 (UTC)[reply]

(Part of the WikiProject Medicine effort)

A large portion of this page is based on primary research and dated secondary material. Several large reports on asthma have been published recently by the Global Initiative for Asthma (GINA) here, the National Institutes of Health: National Heart, Lung and Blood Institute (NHLBI) here, and the British Thoracic Society here. I suggest adding all of these references to the background section because they provide in depth coverage of nearly everything found in this article.

Thanks for suggesting those references. However the links that you provided don't seem to work. Here is NHLBI guideline. Axl ¤ [Talk] 08:33, 20 May 2010 (UTC)[reply]

First paragraph:

• This would be a good area to introduce the three reports mentioned in the General Suggestions.

Second paragraph:

• The medicines used to treat asthma can be cited by the Merck Medical Manual found here as well as the NHLBI 2007 report mentioned in the General Suggestions.
• The statement about monoclonal antibodies is referenced in the NHLBI 2007 report, but this report does not mention mepolizumab by name.

Third paragraph:

• The percentage of the US population affected is based on a dated report. Page 1 of the NHLBI 2007 report states that 22 million Americans suffer from asthma.
• I do not have a citation to offer for the number of British people with asthma.
• The number of worldwide cases is found in the GINA report listed in the General Suggestions and on the WHO website [2]. These reports will be more accessible than the primary literature reference that is currently being used.
• The CDC says the number of deaths in the US is actually at 3,613 [3] .

Fourth paragraph:

• The citation about asthma in urban children is a primary source that in turn cites an older primary source. Another citation would be nice, although I could not find one.

Table:

• The last column should say FEV1 variability (not FEV variability1).
• Intermittent nighttime symptoms should be less than ‘’or equal to’’.
• Intermittent and Mild Persistent %FEV1 of predicted should both be greater than ‘’or equal to’’.

First paragraph:

• FEV1 should be defined here (Forced expiratory volume in 1 second).

Second paragraph:

• The Ogorodova et al. citation is in Russian and should be removed. The other citation is sufficient for this paragraph.

Table:

• A peer reviewed or more well-established source would be better for a chart of this importance.

First paragraph:

• The statement on inaudible wheezing comes from the same source as the table in Signs and Symptoms and should be updated. The textbooks ‘’Murray & Nadel's Textbook of Respiratory Medicine’’ and ‘’Oxford Textbook of Medicine’’, both previously used in this article, would be fine to use here, and both would sufficiently cover this entire section.

General:

• Much of this section relies on primary sources or sources that require subscriptions. However, the three studies mentioned in the General Suggestions and the CDC and WHO websites contain much of the same information and can be used instead.

First paragraph:

• The citation for environmental smoke is okay, but might be difficult for some people to access. The NHLBI and the CDC website would be better sources [4]
• The GINA report also mentions ozone as a cause of asthma.

Caesarean section paragraph:

• This citation is also a primary source. The British Thoracic Society study mentioned above covers this association and is easier to access (page 72). Because it ties in to the hygiene hyptothesis, I suggest moving this paragraph down below the antibiotics paragraph.

Hygiene hypothesis:

• This hypothesis is explained on page 17 of the ‘’Harvard Medical school guide to taking control of asthma’’.
• There is no source listed for the link between asthma and cleaning products.
• This hypothesis is also mentioned in more detail below. Perhaps that section could be mentioned here.

Viruses and Asthma:

• There was no mention of these specific viruses in any of these sources. If this sentence is to remain, a source needs to be found.

General:

• This section is very specific and completely based on one primary source. Because it is so specific, it is not likely that a secondary or tertiary source will be available for these facts. However, a more generalized assessment of how genetics are linked to asthma could be included at the start of this section, and this new material could be drawn from page 22 of the NHLBI 2007 report and the WHO website [5]. This is an important section and it would be nice to see it expanded.

General:

• This section also uses a specific example from primary literature that is not likely to be covered in a secondary or tertiary source. However, for a general overview, the NHLBI 2007 report also covers this topic on page 22.

First paragraph

• The citation takes you to the wrong section of this website. would be better.

Second paragraph

• While most of these triggers are mentioned by the above citation, the claim that viral and bacterial infections of the upper respiratory tract are triggers needs a citation.

General:

• The Mayo clinic website and page 4 of the GINA report both talk about risk factors for asthma and could be added to this section in order to make it less dependent on primary research or material that requires a paid subscription to gain access to.

First paragraph:

• The increased incidence of hay fever and asthma was not verified by the cited source.

Second paragraph:

• Exposure to dog allergens did not have an effect on asthma in any of the cited sources. Also, the opposite effect was seen when children with family histories of asthma were looked at.

Third paragraph:

• The sources linking obesity in the UK and USA to asthma are not appropriate because they do not make the link themselves. Instead, the NHLBI report (page 23) or the GINA report (page 4) could be cited. Here is another review of the subject. [6]
• The Taiwan study only found a link with girls, not boys, and seems to be overstated here.

First paragraph:

• East vs West Germany study – A secondary source should be added (http://www.ncbi.nlm.nih.gov/pubmed/11770679)
• Families with many children – This could also use a secondary source (http://www.ncbi.nlm.nih.gov/pubmed/16396953)
• Day care environments – The Celedon JC et al. reference does not support this claim. The other source (Ball et al.) is dated. The GINA report mentions this and the multiple siblings association on page 5.
• The statement that viruses often exacerbate asthma is cited by three older primary sources. All three could be replaced by ( http://www.ncbi.nlm.nih.gov/pubmed/20010482 ).
• The Illi S. et al. reference used in the last sentence could replace the Weiss et al. reference used in the second-to-last sentence.

General:

• The sources are mostly primary research papers.

Third paragraph:

• The Osman et al. reference about rates of asthma for males vs females at different ages could be replaced with the secondary reference: Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 2003
• The stat about women accounting for 65% of asthma deaths could be better cited with “New Asthma Estimates: Tracking Prevalence, Health Care and Mortality,” NCHS, CDC, 2001, which is where this data actually originated.
• The statement about missed school days is from an out-of-date source. According to page 3 of the CDC’s The State of Childhood Asthma, United States, 1980–2005, 12.8 million days are missed (http://www.cdc.gov/nchs/data/ad/ad381.pdf)

General:

• Page 366 of the NHLBI 2007 report covers this topic and could be cited in this section.

First paragraph:

• Statement about low-income neighborhoods in the Western world is not supported by the given reference (American Academy of Allergy Asthma & Immunology).

Second paragraph:

• The statement “The prevalence of "severe persistent" asthma is also greater in low-income communities than those with better access to treatment” was not directly supported by the sources given. One of these links was broken and may have contained the missing data.

Third paragraph:

• The direct relationship between asthma and both income and ethnicity is not supported by the given reference (Rauh et al.). Instead, an indirect link was found by this group.
• This paragraph needs citations. The CDC website has data showing that African Americans and Puerto Ricans are more likely to have asthma than non-hispanic whites and could be used for some of this. The following link may be helpful [7].
• The link between dump and factory sites and asthma deaths is not directly made in the given citation.

Figure: This figure may need a citation.

First paragraph:

• A medical text book such as ‘’Murray & Nadel's Textbook of Respiratory Medicine’’ and ‘’Oxford Textbook of Medicine’’ could be used for references in this section.

General:

• Much of this section draws from one website - Consultant for Pediatricians. Other available sources for diagnosing asthma include: mayo clinic and the diagnosis section of Merck Manual.

First paragraph:

• The given reference does not indicate that the BTS uses these guidelines. http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/sign101%20revised%20June%2009.pdf will tell you the BTS standards. The guidelines given here need a citation.

Capnography paragraph:

• The study cited here (Corbo et al.) states that their results still need to be confirmed, but that this procedure could work. A better source is needed to validate the claim made in the article.

Second paragraph:

• The citation used here (Hargreave, FE; Parameswaran K (August 2006)) does not include aging or family history. A better citation should be used.

Third paragraph:

• A medical text book would be a good reference.

General:

• This entire section needs to be cited. The book ‘’Prevention of allergy and allergic asthma: World Allergy Organization Project Report and Guidelines’’ By S. Gunnar O. Johansson and Tari Haahtela is a good reference for this material. The NHLBI 2007 report and the Merck Manual [8] are also good sources for the majority of this information. Page numbers for the NHLBI 2007 report and other useful studies are indicated below.

First paragraph:

• The link at the end of this paragraph is for the NHLBI 2007 report, which is already cited in this article. I recommend removing the link and replacing it with citations.

Glucocorticoids:

• In addition to the above mentioned sources, the GINA report is also useful for this section.
• The last sentence is directly from the cited NYT article. I suggest rephrasing: “In November 2007 The New York Times reported that a review of more than 500 studies found that independently-funded studies identify adverse effects of inhaled corticosteroids four times as often as studies funded by drug companies.”

Leukotriene and Mast cell stabilizers:

• These sections are directly from the Merck Manual. They need to be rephrased.
• The NHLBI 2007 report covers these drugs on page 213.

Antimuscarinics/anticholinergics:

• Smokers lung/emphysema are covered in the NHLBI 2007 report on page 248.

Methylxanthines:

• These drugs are covered in the NHLBI 2007 report on page 246 and in the GINA report on page 68.

Allergy desensitization:

• This is discussed in a CDC study on Environmental triggers of asthma - http://www.atsdr.cdc.gov/csem/asthma/docs/asthma.pdf page 35

Omalizumab:

• No information was found on regular injections. This drug is discussed on page 32 of the GINA report and page 213 of the NHLBI report.

Methotrexate:

• Use of this drug is not supported according to the NHLBI 2007 report, as indicated on page 227. The GINA report discusses side effects on page 32.

GERD:

• Discussed on page 49 of the NHLBI and in the Merck Manual

Chronic sinus disease:

• Discussed on page 63 of the GINA report.

First paragraph:

• The statement “likely due to increased inflammation” draws an additional link that is not made in that source. However, this source [9] does cover this claim.
• The Eisner et al. reference only covers smoke from stoves, not second-hand smoke. Adding the NHLBI 2007 report page 112 or the GINA report page 56 would be sufficient.
• The Asthma Society of Canada could have their website included in the references (http://www.asthma.ca/adults/).
• The multifactorial approach could be cited by http://www.asthma.ca/corp/services/certification.php

Vitamin C:

• The final citation of this paragraph is out-of-date and a new link should be used, especially considering how important this statement is. I recommend using the British Thoracic Society’s study (see General Suggestions) pages 27 and 30.

Magnesium:

• The Allam and Lucena report is a better reference for the first sentence of the paragraph about how magnesium and selenium treatments need further research.
• More up to date references for IV magnesium treatment are http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743582/?tool=pubmed and page 69 of the GINA report.

First paragraph:

• The link for the written program is incorrect. It should be http://www.consultantlive.com/pediatrics/pediatric-asthma/content/article/10162/1418640 - however, this website sites the NHLBI 2007 report for this statement.

Second paragraph:

• According to the [10], the term fast-acting should be quick relief.

Fast-acting:

• These should be called “quick relief.”
• The Merck Manual, GINA report, and the NHLBI 2007 reports will be able to fill many of the missing citations, but a medical textbook might be the best source for this entire section.
• Everything in the first bullet needs to be cited.
• The citations in the second bullet do not include Ephedrine.
• The material in the third bullet needs to be cited.

Long-term control:

• The combination treatment of beclomethasone and albuterol is referenced with a very technical primary source. A review of this research can be found here (http://www.medscape.com/viewarticle/558651).
• The LABD paragraph needs more citations. The FDA health advisory link is broken.

General:

• Much of this section is un-cited. A medical text book might be the best source here. The NHLBI 2007 report and the Merck Manual both discuss a large number of treatments and could also serve as excellent references for this section.

First paragraph:

• The citation used here does not cover loss of consciousness. The Merck Manual does include this symptom.

First paragraph:

• The statement that 50% of asthma patients use unconventional therapy is based on a 9 year old study. The NHLBI 2007 report puts the number around 33%.
• Buteyko is also supported in the British Thoracic Society report.

Second paragraph:

• The statement on acupuncture is also supported by the more recent reports: Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database Syst Rev 2005(2):CD001002 and the NHLBI 2007 report.
• Air ionizers is also covered by page 34 of the British Thoracic Society report.
• Another review with a plain-language summary that could replace the White et al. study is http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000353/frame.html
• The NHLBI 2007 report and British Thoracic Society report both find that there is a lack of evidence that Yoga is helpful in treating asthma. The Nagendra et al. report used to support yoga in this article is from 1986 and only represents one study. The Manocha et al. study is more recent and does support the use of Sahaja yoga to treat asthma, but not other forms. The citation used for the “new religious form of yoga” is incorrect and has nothing to do with yoga.

First paragraph:

• Two good sources for asthma’s good prognosis are the CDC’s pamphlet “You can control your Asthma” http://www.cdc.gov/asthma/pdfs/asthma_brochure.pdf and the CDC page on asthma treatment http://www.cdc.gov/asthma/management.html
• Airway remodeling is also covered on pages 15 and 16 of the NHLBI 2007 report.

Chart:

• I could not find this chart using the citation.

Second paragraph:

• The increased prevalence in westernized countries is also covered on page 21 of the NHLBI 2007 report.

Third paragraph:

• The statistic about 9% of children having asthma can be updated to the 2008 figure (9.4%) found on the CDC’s website (http://www.cdc.gov/nchs/fastats/asthma.htm).
• The numbers about the Swiss population used in the last sentence are not found in the citation.

Fourth paragraph:

• The citations used for migrating populations are old and may be out-of-date. Similar studies that might be useful in rewriting this section can be found in the report Prevention of allergy and allergic asthma: World Allergy Organization on Page 43 and in the NHLBI 2007 report on page 185.

Fifth paragraph:

• The updated figures of the missed school days (12.8 million) can be found here: http://www.cdc.gov/HealthyYouth/Asthma/
• The Heyden and Merrill citation link is broken. Similar data can be found on the CDC’s website. http://www.cdc.gov/asthma/asthmadata.htm

I've cleaned up the cites somewhat, if someone else can now rework the text. LeadSongDog come howl! 21:37, 14 May 2010 (UTC) [reply]

General:

• The only citation used in this section did not work.
• Much of this seems to have been taken from the website http://www.medicalnewstoday.com/info/asthma/asthma-history.php and in some cases it was taken word-for-word. The section should be rephrased, but this is a good source.
• Hippocrates may have coined the term asthma, but it is not certain that he was really talking about the same condition we now call asthma (http://www.aafasocal.com/asthma_history.php). Just a small technicality.
• The two websites listed above could be used to expand this section.

General:

• The term treatment should be used instead of cure.
• The CDC study on Environmental Triggers of Asthma (http://www.atsdr.cdc.gov/csem/asthma/docs/asthma.pdf) mentions this treatment on page 35.
• This section could be expanded or merged in with treatments.

I hope this helps improve this article. Bioc06 (talk) 16:20, 4 May 2010 (UTC)[reply]