Talk:Asthma

Big Tobacco still up to its "health effects are controversial" tricks

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

External Review Comments

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)

Useful references & links

• 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)

General comments

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)

Introduction

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)

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)

Classification

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)

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

Diagnosis

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)

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)

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

Differential diagnosis

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)

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

Management

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)

History

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)

Research

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)

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

ISAAC

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)

References

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 referenceslist-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)

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

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)

Oops, thank you, David – I've struck & inserted so that this makes sense. I'll make a start on the LDRs, and work through the sections until I get tired. --RexxS (talk) 21:44, 2 September 2010 (UTC)

GA

I think we should be able to get this one to GA status by the end of the month. I will get upload the sound of wheezing as soon as I get a good case. Edited the treatment section.Doc James (talk · contribs · email) 13:06, 3 September 2010 (UTC)

Tables

We should format the tables so the are all similar.Doc James (talk · contribs · email) 13:42, 3 September 2010 (UTC)

Lancet

The Lancet has two interesting reviews this week (4 Sept. issue); one about asthma in older adults and one about management of severe asthma in children. --WS (talk) 15:09, 6 September 2010 (UTC)

Management

Since we're talking sources, this 2009 review published in NEJM (already cited as ref 103) could be very useful for expansion of the Management section. Unfortunately, I don't think I can spare the time to work on the article right now, but perhaps Doc James or Wouterstomp can have a look? :) Fvasconcellos (t·c) 21:48, 6 September 2010 (UTC)

Can I help?

How can I help out, I noticed that this was the MCOTM, so I came over to ask. Ronk01 talk 00:34, 19 September 2010 (UTC)

Certainly. I have gone over the treatment section so far. The rest of the sections could use improvement in referencing. Would be nice to get this too GA status.--Doc James (talk · contribs · email) 00:53, 19 September 2010 (UTC)

The refs above noted by FV and WS could be added into the article where ever appropriate.Doc James (talk · contribs · email) 00:54, 19 September 2010 (UTC)

The only thing that I could see of value in the review articles for addition to the article would be enhancing the section on COPD. Panel 2 of the older person review article has an interesting table on common comorbidities with associated mechanistic associations with asthma that might be useful as well. I'll work on that. Kallimachus (talk) 10:47, 19 September 2010 (UTC)