Table Of Content8ronchial Asthma
Bronchial Asthma
Principles of Diagnosis
and Treatment
Third Edition
Edited by
M. fric Gershwin
and Georges M. Halpern
University of California School of MedicineI Oavis CA
l
. . Springer Science+Business Media, LLC
© 1994 Springer Science+Business Media New York
Originally published by The Humana Press Inc. in 1994
Softcover reprint of the hardcover 3rd edition 1994
AII rights reserved.
No part of this book may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
microfilming, recording, or otherwise without written permission from the
Publisher.
Library of Congress Cataloging-in-Publication Data
Bronchial asthma : principles of diagnosis / edited by M. Eric Gershwin and
Georges M. Halpern
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4612-6697-6 ISBN 978-1-4612-0297-4 (eBook)
DOI 10.1007/978-1-4612-0297-4
1. Asthma. 1. Gershwin, M. Eric, 1946- . II. Halpern, Georges, M.
[DNLM: 1. Asthma-diagnosis. 2. Asthma-therapy. Wf 553 B8693
RC591.B753 1994
616.2'38-dc20
DNLM/DLC
for Library of Congress 93-38240
CIP
Preface to the Third Edition
Althoughthemechanismsandtriggersthatstimulateandareresponsible
forthenaturalhistoryofasthmaaresteadilybeingmoreclearlydefined,
uncertaintiesstill surroundboththegeneticbasisandtheetiologyofone
ofthe mostcommon syndromes in the world. In fact, itis ofconsider
able concern and interest thatthe incidence ofasthma today appears to
be rising. These statistical increments may only reflect an increasing
awarenessofthedisease,oritsearlierandmoresophisticateddiagnosis.
Moreimportant,however, asthmamortality appearstobeincreasing.
This increase has occurred despite the continuing expansion ofadiag
nosticandmanagementinformationbase, andthedevelopmentofnovel
andevermoreeffectivetherapeuticmodalities.Severalexplanationshave
been offered for this increase in mortality, including that it may result
from a statistical artifact [based on a change in the coding criteria for
asthmafromtheInternationalClassificationofDiseasesVersion8(ICD
8) to ICD-9], worsenedpollution, delays in seeking medical help, behav
ioral changes, deficits in the asthma education of both patients and
primarycareproviders,toxicityofbeta-agonists,andnoncompliancewith
instructions for the properuse ofmedications. Itshould also beempha
sizedthattheincreasesin bothincidenceandmortality may beareflec
tion of accumulating body burdens ofenvironmental toxicants and of
increasedoxidativedamage.Therehasclearlybeenadegradationofenvi
ronmentalquality.Andalthoughconsiderableattentionhasbeenfocused
on this possibility in both the scientific and lay press, more research in
thisareaisdefinitely needed. Thisresearch mustbeexperimentalrather
than anecdotal ifwe hope to unravel and further understand the patho
physiologyofasthma.
v
vi Preface
The historical record on asthma began with several interesting hypoth
eses. Aretaeusinthe 2ndcentury speculatedthatasthma was causedby
acuteparoxysmsoffoul andviscidhumorsinlungs.Galenbelievedthat
thebrainpouredsecretionsintolungs.VanHelmontbelievedthatasthma
wastheequivalentofepilepsyinlungs. Until several;yearsago, asthma
wasdefined bytheAmericanThoracicSociety:
"as adisease characterized by an increased responsiveness ofthe
trachea and bronchi to various stimuli and manifested by awide
spread narrowing of the airways that changes in severity either
spontaneously or as aresult oftherapy. The term 'asthma' is not
appropriateforthe bronchialnarrowing which results solely from
widespreadbronchialinfection... ;fromdestructivediseaseofthe
lung, e.g., pulmonary emphysema; or from cardiovascular disor
ders."
More recentstudies and observations have attemptedtofocus on the
emerging realization that there is a major inflammatory component of
asthma and this has led to a new operational definition by a panel of
distinguishedphysiciansandscientiststhatwasrecentlypublishedasthe
International Consensus Report on the Diagnosis and Management of
Asthma (Allergy47: Suppl.13, 1992)that:
"Asthmaisachronicinflammatorydisorderoftheairwaysinwhich
manycellsplayarole,includingmastcellsandeosinophils.Insus
ceptibleindividualsthisinflammationcausessymptomswhichare
usually associated with widespread but variable airflow obstruc
tionthatisoftenreversibleeitherspontaneouslyorwith treatment,
and causes an associated increase in airway responsiveness to a
varietyofstimuli."
Newtechnologyandclinicalresearchmustultimatelybetransferred
fromtheresearchbenchtothebedsidetoenjoyitsfullesteffect.Itisour
hopethatthisbookwillbecomeausefulresourcetothosetreatingasthma
and notsimply adusty exhibitonabookshelf. Forthisreason, thebook
isorganizedintospecific,user-orientedsections,asfollows: PartI:Defi
nitions and HostResponses toBronchospasm; PartII: PatientManage-
Preface vii
ment;Partill:SpecialClinicalProblems;andPartIV:LivingwithAsthma.
These parts include notonly separate chapters on asthmain childhood,
and asthmain adults, butalsoon thepregnantasthmatic, asthmainath
letes, asthma and anesthesia, and the problems ofstatus asthmaticus in
childrenandadults.Thisthirdeditionhasbeencompletelyrewrittenand
includesanentirelynewsectiononlivingwithasthma,describingmany
ofthe things thatwill make thelivesofourpatientseasier.
A special note of appreciation to Nikki Phipps, who organized and
typedthetext.Wealsoowethanks toTomLanigan,ourpublisher,who,
like thesenioreditorsuffers from asthma.
As with any book, there are going to be errors, including omissions.
Wehaveattemptedtoeliminatetheseinsofaraspossible. Theflaws that
remaininthis textareoursalone,andwewelcomecorrespondencefrom
ourcolleagues and patients in full confidence it will prove constructive
toward the nextedition someyears hence.
M. EricGershwin
GeorgesM. Halpern
Contents
Preface • v
Contributors • xi
PART I: DEFINITIONS AND HOST RESPONSES TO BRONCHOSPASM
1 The Genetics and Epidemiology ofAsthma. 1
Niels G. Waller, Suzanne Teuber, and M. Eric
Gershwin
2 Pathogenesis of Asthma:
Mediators and Mechanisms • 23
Thomas B. Casale and Stephen j. Smart
3 The Role of Mast Cells and Eosinophils
in Asthma • 57
judy Anderson, William Anderson, and Stephen I.
Wasserman
4 Morphologic Basis ofAirflow Obstruction • 75
Adam Wanner andAndrew T. Mariassy
5 The Role ofthe Pulmonary Function Laboratory in
Patients with Bronchial Asthma • 93
Richard E. Kanner and Suetaro Watanabe
6 The Interrelations Between Asthma, Pregnancy,
and Lactation • 119
GaryA. Incaudo and Michael Schatz
ix
x Contents
7 Differential Diagnosis ofAsthma in Children:
BronchialAsthma, OccultAsthma,
and Pseudoasthma • 141
Richard B. Moss
8 Differential Diagnosis of Asthma In Adults:
Bronchial Asthma, OccultAsthma,
and Pseudoasthma • 171
Glen A. Lillington and Hsiu-wei Lin
PART II: PATIENT MANAGEMENT
9 Allergic Evaluations and Management
Considerations of Patients with Asthma. 189
Stephen M. Nagy, jr.
10 Clinical Laboratory Assessment of the Bronchial
Asthma Patient. 219
Robert C. Hamilton
11 Radiological Considerations in Asthma • 237
Philip E. S. Palmer
12 Treatment of Asthma in Children • 273
Frank s. Virant and Gail C. Shapiro
13 The Pharmacological Treatment of Asthma
in Adults. 299
Romain Pauwels
14 Management of Status Asthmaticus in Childhood
• 311
Herbert C. Mansmann, jr.
15 ManagementofStatusAsthmaticus inAdults • 341
Hillary Don
Contents xi
16 Role of Immunotherapy in Asthma • 365
Roger W Fox and Richard F. Lockey
17 Management of the Pregnant Asthmatic • 399
Helen Mawhinney and Sheldon Spector
18 Unconventional Therapy in Asthma • 413
Irwin Ziment
19 Treatment Aspects ofAsthma in Japan • 443
Takemasa Nakagawa
20 Treatment Aspects of "International" Asthma:
Europe • 457
A. G. Palma-Carlos andA. Lorena jordao
III:
PART SPECIAL CLINICAL PROBLEMS
21 Respiratory Tract Infections and Asthma • 481
Ketan K. Sheth and William W Busse
22 Diagnosis and Management of Exercise-Induced
Asthma • 513
Sandra D. Anderson
23 Chronic Sinus Disease and Asthma • 549
Raymond G. Slavin
24 Aspirin, Related Nonsteroidal Anti-Inflammatory
Agents, Sulfites, and Other Food Additives
as Precipitating Factors in Asthma • 563
Andrew Szczeklik and KrzysztofSladek
25 Air Pollution and Asthma • 581
Manuel Lopez andjohn E. Salvaggio
26 Allergic Bronchopulmonary Aspergillosis • 603
jordan N. Fink and Viswanath P. Kurup
xii Contents
27 Occupational Asthma • 619
Marc B. Schenker and Sverre Vedal
PART IV: LIVING WITH ASTHMA
28 Anesthetic Considerations in Asthmatic Patients •
639
Dennis Fung, Leland Hanowen and N. Ty Smith
29 Use of Prospective Disease Management
to Minimize Asthma Symptoms
and Maximize Potential • 661
Robert C. Strunk, Edwin B. Fishe" Jr., Susan Green
Davis, and Linda Sussman
30 Asthma in School Children: Reducing the Impact
on Education • 691
David Evans
31 Sports, Athletes, and Asthma: Winning the Fame
with Asthma • 713
RogerM. Katz
32 The Psychology ofAsthma: Implications
for Treatment • 723
Edwin L. Klingelhofer
33 Disability/Legal Issues for Asthmatics • 735
Michael Davidson
Index • 753
