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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 is currently the Medicine Collaboration of the Month.

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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

(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 are the NHLBI guideline, BTS guidelines and GINA guidelines. Axl ¤ [Talk] 08:33, 20 May 2010 (UTC)[reply]

Wikipedia's guideline regarding citations in the lead has changed. It used to be the case that the lead should not have citations, because the appropriate citations would be available in the main article. Since you think that citations are important here, I will add them. Axl ¤ [Talk] 08:42, 20 May 2010 (UTC)[reply]

First paragraph:

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

Okay, I have referenced those reports in the first couple of paragraphs. Axl ¤ [Talk] 09:48, 20 May 2010 (UTC)[reply]

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.

I have referenced the individual medications. Axl ¤ [Talk] 10:03, 20 May 2010 (UTC)[reply]

• The statement about monoclonal antibodies is referenced in the NHLBI 2007 report, but this report does not mention mepolizumab by name.

I removed mepolizumab. It shouldn't be mentioned in the lead. Axl ¤ [Talk] 10:03, 20 May 2010 (UTC)[reply]

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.

I added a reference. Axl ¤ [Talk] 15:40, 4 July 2010 (UTC)[reply]

• The number of worldwide cases is found in the GINA report listed in the General Suggestions and on the WHO website [1]. 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 [2] .

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).

Fixed. Axl ¤ [Talk] 17:38, 20 May 2010 (UTC)[reply]

• Intermittent nighttime symptoms should be less than ‘’or equal to’’.

Fixed. Axl ¤ [Talk] 17:41, 20 May 2010 (UTC)[reply]

• Intermittent and Mild Persistent %FEV1 of predicted should both be greater than ‘’or equal to’’.

Fixed. Axl ¤ [Talk] 17:44, 20 May 2010 (UTC)[reply]

First paragraph:

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

Done. Axl ¤ [Talk] 17:46, 20 May 2010 (UTC)[reply]

Second paragraph:

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

Done. Axl ¤ [Talk] 18:04, 20 May 2010 (UTC)[reply]

Table:

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

Table changed. Axl ¤ [Talk] 09:16, 9 June 2010 (UTC)[reply]

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.

I changed the reference. Axl ¤ [Talk] 09:20, 9 June 2010 (UTC)[reply]

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 [3]

I changed it to GINA. Axl ¤ [Talk] 07:10, 11 June 2010 (UTC)[reply]

• The GINA report also mentions ozone as a cause of asthma.

I added the reference. Axl ¤ [Talk] 07:15, 11 June 2010 (UTC)[reply]

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.

Done. Axl ¤ [Talk] 10:57, 16 June 2010 (UTC)[reply]

Hygiene hypothesis:

• This hypothesis is explained on page 17 of the ‘’Harvard Medical school guide to taking control of asthma’’.

I put a better reference in. Axl ¤ [Talk] 17:30, 22 June 2010 (UTC)[reply]

• There is no source listed for the link between asthma and cleaning products.

It looks like someone has removed that info from the text. Axl ¤ [Talk] 16:39, 21 June 2010 (UTC)[reply]

• This hypothesis is also mentioned in more detail below. Perhaps that section could be mentioned here.

I added a link. Axl ¤ [Talk] 10:16, 24 June 2010 (UTC)[reply]

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.

I have corrected this. I removed the statement about those unreferenced viruses. Axl ¤ [Talk] 10:22, 30 June 2010 (UTC)[reply]

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 [4]. 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. [5]
• 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 [6].
• 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 [7] 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 [8] 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 [9], 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]

Asthma is an unseen disability, so readers may be interested to know of the WikiProject group on disability,

which can be accessed on:

http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Disability ACEOREVIVED (talk) 19:22, 18 July 2010 (UTC)[reply]

Hello, Asthma article writers and editors. This article is currently a priority article for the Wikipedia talk:WikiProject Medicine/Google Project. The goal of this project to is provide a useful list of suggested revisions to help promote the expansion and improvement of this article before it is translated into other languages. I see that this article has been reviewed previously and some improvements made. It still needs some work to make it to B-class or better. I hope that by working together that we can get it there.

All contentious suggestions should be discussed here by active editors until a consensus is reached and an editor agrees to make the proposed changes. I will not be making direct edits before this review is posted and discussed unless:

• there are missing, inaccurate, or unreliable sources in the reference list or
• there is ‘medical’ information that could be harmful or misleading to the public at large.

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

• Lemanske RF Jr, Busse WW. Asthma: clinical expression and molecular mechanisms. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S95-102. Review. PMID: 20176271
• Hancox RJ, Le Souëf PN, Anderson GP, Reddel HK, Chang AB, Beasley R. Asthma: time to confront some inconvenient truths. Respirology. 2010 Feb;15(2):194-201. Review. PMID: 20199640
• Moore WC, Pascual RM. Update in asthma 2009. Am J Respir Crit Care Med. 2010 Jun 1;181(11):1181-7. Review. No abstract available. PMID: 20516492
• National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute; 2007.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
• World Health Organization Fact Sheet Fact sheet No 307: Asthma (2009) http://www.who.int/mediacentre/factsheets/fs307/en/print.html, Accessed 08-05-10

BSW-RMH (talk)

There are four priority issues for this article:

• Improve the introductory material
• Fix broken citation links and add references for missing citations
• Expand the History section subtantially
• Expand most other sections to be comprehensive

I will focus my review on these issues. I will list fixed/added citations and comments by section.

BSW-RMH (talk)

I removed the pathophysiology section because it was unreferenced and consisted of a definition of asthma. BSW-RMH (talk) 01:12, 11 August 2010 (UTC)[reply]

Citations added:

• World Health Organization Fact Sheet Fact sheet No 307: Asthma (2009) http://www.who.int/mediacentre/factsheets/fs307/en/print.html, Accessed 08-05-10

I added the WHO reference (above) for the worldwide prevalence data to replace the citations needed tag. However, I recommend limiting references in the introductory paragraph unless the material is not repeated later in the article (which it should be) or it is a quote, controversial, or likely to be challenged.

Over all, this intro would be improved by rewriting to make it more of an overview of the article and accessible to reader. I recommend that an editor interested in improving this section refer to the: Wikipedia:Manual of Style (lead section) for guidance like “The lead section should briefly summarize the most important points covered in an article in such a way that it can stand on its own as a concise version of the article. It is even more important here than for the rest of the article that the text be accessible. Consideration should be given to creating interest in reading the whole article. (See news style and summary style.) This allows editors to avoid lengthy paragraphs and over-specific descriptions, because the reader will know that greater detail is saved for the body of the article.”

“Although asthma is a chronic obstructive condition, it is not considered as a part of chronic obstructive pulmonary disease as this term refers specifically to combinations of bronchiectasis, chronic bronchitis, and emphysema. Unlike these diseases, the airway obstruction in asthma is usually reversible; however, if left untreated, asthma can result in chronic inflammation of the lungs and irreversible obstruction.[15] In contrast to emphysema, asthma affects the bronchi, not the alveoli.”—This section seems too technically detailed to be in the introductory paragraph. I recommend moving it to the classification section. Y This paragraph was moved. BSW-RMH (talk) 23:39, 10 August 2010 (UTC)[reply]

Key points to include:

• Asthma is a chronic inflammatory disorder of the airways.
• The onset of asthma for most patients begins early in life..
• On of the key features of asthma is the migration ofinflammatory immune system cells into lung tissue
• This causes inflammation of the airways that interferes with airflow and results in hyperesponsiveness of the airway tissue that manifests as spasms (bronchospasm).
• In some patients, persistent changes in lung airway structure occur that increase the severity of the disease symptoms.
• Anti-inflammatory therapy is the most common treatment for asthma, but does not prevent the worsening of disease symptoms over time.
• Risk factors include having allergic disease, recurrent wheezing symptoms, and/or a parental history of asthma.
• The strongest risk factor is having [[Atopy’], the genetic predisposition for the development of an immunoglobulin E (IgE)-mediated response allergic response

See: National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute; 2007.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

This section should be expanded to explain that while Asthma is classified based on severity, at the moment there is no clear method for classifying different subgroups of asthma beyond this system, though it is clear there that different subgroups exist. Finding ways to identify these groups is a current critical goal of Asthma research:

• “Taken together these studies emphasize that there is a heterogeneous group of patients with severe asthma, not all of whom can be controlled with the current medication arsenal that is endorsed by the guidelines.”
• ”In the fall of 2009, the new NHLBI-sponsored multicenter asthma clinical trials network AsthmaNet began designing novel protocols to . . . identify novel composite asthma phenotypes that will impact clinical asthma care in the future. Understanding asthma heterogeneity is crucial to allow development of responder profiles or to identify patients at risk for individual medications in the future. After all, the challenge is to find the right medication for your severe asthma patient in the future.”
• Moore WC, Pascual RM. Update in asthma 2009. Am J Respir Crit Care Med. 2010 Jun 1;181(11):1181-7. Review. No abstract available. PMID: 20516492

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

Y Information incorporated. BSW-RMH (talk) 00:11, 11 August 2010 (UTC)[reply]

This section is overly detailed and does not convey, in an accessible way, how Asthma is diagnosed.

“Presently, no precise physiologic, immunologic, or histologic characteristics can be used to definitively make a diagnosis of asthma, and therefore the diagnosis is often made on a clinical basis related to symptom patterns (airways obstruction and hyperresponsiveness) and responses to therapy (partial or complete reversibility) over time.”- This quote gives a clear overview of the diagnostic approaches for Asthma.

• Lemanske RF Jr, Busse WW. Asthma: clinical expression and molecular mechanisms. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S95-102. Review. PMID: 20176271

The information on how the British Thoracic Society determines a diagnosis of Asthma should be clarified as a ‘response to therapy’ approach to diagnosis. If the patient responds to treatment, then this is considered to be a confirmation of the diagnosis of asthma. A response is determined by the criteria in the given list, though it is not clear as written as response means hthatat all or at least one of the criteria was satisified.

Y This information was added, and the Pinnock et al. citation was verified. BSW-RMH (talk) 00:31, 11 August 2010 (UTC)[reply]

In addition to the BTS diagnostic criteria. I would recommend adding a ‘symptom patterns’ approach such as the US National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma:

KEY INDICATORS FOR CONSIDERING A DIAGNOSIS OF ASTHMA: Consider a diagnosis of asthma and performing spirometry if any of these indicators is present. These indicators are not diagnostic by themselves, but the presence of multiple key indicators increases the probability of a diagnosis of asthma. Spirometry is needed to establish a diagnosis of asthma.

• Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lackof wheezing and a normal chest examination do not exclude asthma.)
• istory of any of the following:
  • Cough, worse particularly at night
  • Recurrent wheeze
  • Recurrent difficulty in breathing
  • Recurrent chest tightness
• Symptoms occur or worsen in the presence of:
  • Exercise
  • Viral infection
  • Animals with fur or hair
  • House-dust mites (in mattresses, pillows, upholstered furniture, carpets)
  • Mold
  • Smoke (tobacco, wood)
  • Pollen
  • Changes in weather
  • Strong emotional expression (laughing or crying hard)
  • Airborne chemicals or dusts
  • Menstrual cycles
• Symptoms occur or worsen at night, awakening the patient.

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

YInfo added.BSW-RMH (talk) 01:01, 11 August 2010 (UTC)[reply]

This section needs to be expanded.

• Infants and Children
  • Upper airway diseases
    • Allergic rhinitis and sinusitis
  • Obstructions involving large airways
    • Foreign body in trachea or bronchus
    • Vocal cord dysfunction
    • Vascular rings or laryngeal webs
    • Laryngotracheomalacia, tracheal stenosis, or bronchostenosis
    • Enlarged lymph nodes or tumor
  • Obstructions involving small airways
    • Viral bronchiolitis or obliterative bronchiolitis
    • Cystic fibrosis
    • Bronchopulmonary dysplasia
    • Heart disease
  • Other causes
    • Recurrent cough not due to asthma
    • Aspiration from swallowing mechanism dysfunction or gastroesophageal reflux
  • Adults
    • COPD (e.g., chronic bronchitis or emphysema)
    • Congestive heart failure
    • Pulmonary embolism
    • Mechanical obstruction of the airways (benign and malignant tumors)
    • Pulmonary infiltration with eosinophilia
    • Cough secondary to drugs (e.g., angiotensin-converting enzyme (ACE) inhibitors)
    • Vocal cord dysfunction

See: National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute; 2007.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

Y This info was added. BSW-RMH (talk) 01:08, 11 August 2010 (UTC)[reply]

This sections requires expansions to be comprehensive. An overview of disease management before jumping into details of medications would be useful here.

• Assessment and monitoring, obtained by objective tests, physical examination,

patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained

• Education of patient about the condition
• Control of environmental factors that affect asthma
• Pharmacologic therapy

See: National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute; 2007.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

This reference has an extensive section on the history of Asthma:

• National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute; 2007.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

This section should be either written or the section head removed until an editor chooses to write it. The statement here is not ‘research’. It is a suggestion of a potential treatment.

BSW-RMH (talk) 04:19, 6 August 2010 (UTC)[reply]

Y Removed it. --WS (talk) 15:08, 2 September 2010 (UTC)[reply]

No mention of ISAAC or its questionnaire? The study itself is notable for a number of reasons, and the questionnaire has become a popular research instrument. Fvasconcellos (t·c) 14:07, 2 September 2010 (UTC)[reply]

I'm going through checking and tidying references. As the density of references is quite high, would it be acceptable for me to move to list-defined references, putting all the reference definitions in the References section, thus removing a lot of the clutter from the main text? --RexxS (talk) 14:31, 2 September 2010 (UTC)[reply]

Seems like a good idea, it would make editing the article text much easier. --WS (talk) 15:07, 2 September 2010 (UTC)[reply]

You've stated "list-defined references" but given link to TLA LDR, you meant the wikipedia shortcut WP:LDR.David Ruben ^Talk 21:08, 2 September 2010 (UTC)[reply]