Talk:Asthma/Archive 1

Listing Tobacco as a treatment
Several types of "Smoker’s Paradoxes" [29], i.e. cases where smoking appears to have specific beneficial effects, have been observed; often the actual mechanism remains undetermined. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI) [29], [30]. Smoking appears to interfere with development of Kaposi's sarcoma [31], breast cancer among women carrying the very high risk BRCA gene [32], preeclampsia [33], and atopic disorders such as allergic asthma [34]. A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an anti-inflammatory agent [35] and interfering with the disease process.http://en.wikipedia.org/wiki/Tobacco_smoking#Health_benefits_of_smoking

I would also like to point out this website, the list of the worlds oldest living smokers. http://www.forces.org/evidence/hamilton/other/oldest.htm

And this website, pointing out that tobacco contains B-vitamins http://en.wikipedia.org/wiki/Niacin

No health professional would ever advise tobacco as a treatment. It is contraindicated for asthmatics, as the smoke can and most often will trigger an inflammatory response, and therefore an attack. It should not be listed as a treatment, but maybe just as a paradox. Puresholtz 01:10, 12 April 2007 (UTC)

I'm guessing then somehow second hand smoke has a reverse effect since everytime I'm around smokers I seem to be near passing out! 20:16, 19 February 2008 (UTC) Asthmatic —Preceding unsigned comment added by 207.228.52.221 (talk)

Listing oxygen as a treatment
Anyone object to listing oxygen as a treatment? In South Australia, ambulance paramedics switch over to oxygen when inhaled bronchodilators are not working. Hospital emergency medical teams administer adrenaline, which is also being considered for use by ambulance paramedics. Also additional symptoms: sweating, panic, anoxia, unconsciousness and death. -- Lawsonsj 21 Aug 2003

Oxygen is given to alleviate the hypoxia that is the result of the asthmatic attack, and not to treat the asthma per se. It does nothing to end the episode (unlike the treatments listed). As long as the distinction between the two is made, it would be a good addition. -- Someone else 04:32, 21 Aug 2003 (UTC)


 * It does nothing directly to treat the asthma, but the reduction in hypoxia itself does reduce the panic involved, and hence adrenaline release, that is driving the attack. As such it does treat the asthma, as does calming the sufferer down, as you might someone undergoing a panic attack. | Spaully 14:27, 11 February 2006 (UTC)


 * Confusing panic attacks and asthma attacks is a very dangerous idea as one is associated with Hypoxia and the other with Hyperoxia. For "panic" please read "exercise" or "the need for laboured breathing" in place of the two words at the end of that first sentence. Brain damage has occured in someone treated for "panic" instead of asthma.

I found that having chronic coughing related to Asthma can be relieved temporally with a good hit of pure oxygen. This can be so wonderful when having coughing fits for weeks.

Revert
User:203.221.225.81 thought it would be nice to replace the whole page with a page lacking links, structure and general wiki style. Is there anything from his labors worth salvaging?? JFW | T@lk  13:52, 29 Apr 2004 (UTC)

User:Jfdwolff, what was the reason for reverting my addition of a link to a (albeit still short) list of diseases that involve gene promoter mutations? Courtland 2005-02-01 USA ~18:40 EST

Links with dermatitis
As a layman I keep coming across links between asthma and dermatitis. Anybody able to include anything on this? --bodnotbod 00:08, May 4, 2004 (UTC)


 * Dermatitis is an aspecific term, but in this context probably refers to eczema. As it happens, I've just done a major rewrite of allergy and started atopic syndrome&mdash;I hope this answers some of your questions. Generally, there is clustering of eczematous skin conditions and allergic diseases, including asthma.  JFW |  T@lk  00:12, 4 May 2004 (UTC)


 * That's interesting. As I understood it eczema and atopic dermatitis were interchangeable - but AD is more generally used in the States and eczema in the UK.  I say this as a reader, not an expert.  My source would have been fairly good.  I'll look at your links, if they don't clarify this question perhaps you could do so for me here?  Would be most grateful.  --bodnotbod 00:44, May 4, 2004 (UTC)


 * Just to add to that: eczema currently redirects to dermatitis. You seem to be implying that that is wrong?

Link Between Allergies and Asthma
There is a definite link between common environmental allergies and asthma. Although the direct connection is not known 70% of asthma sufferers also have allergic Rhinitis, also known as a runny nose.

Also asthma is not a disease. It is an immunological disorder. It is a syndrome of hypersensitivity.


 * Listen, if you think this article is wrong then be bold and make changes yourself. Asthma most certainly is a disease - it has particular symptoms and risk factors that delineate it from other conditions. Allergy plays an important role, but stressful life events contribute to many acute exacerbations. Furthermore, not all asthmatics have the atopic syndrome. JFW | T@lk  20:55, 3 Jan 2005 (UTC)


 * By "definate link", do you mean that the link with allergens is true by definition (i.e. If it isn't caused by an allergen, it isn't an asthma attack). Alec - U.K. 05:34, 28 October 2006 (UTC)

Lungs OnLine - should it be referenced or not?
I'm wondering about the Lungs OnLine link that 68.206.248.92 added back in Oct 2004 to the External Links section. I can't find information on who is responsible for maintaining the Lungs OnLine resource, and there are no authorship statements or dates associated with the information there. For these reasons I'm wondering if the Lungs OnLine link should be removed in favor of some other linkage that has better information about origin and purpose. What do you think? Or should I just shut up and delete it if I don't like it? Courtland 2005-02-01 USA 18:50 EST

Asthma is most definitely a disease. I have it, and have nearly died from it several times.

Asthma mortality
Should we mention asthma is still potentially fatal?
 * It would be quite appropriate. Please add what you think would best convey the history and present status of asthma as a cause of mortality. Courtland 07:06, 2005 Feb 12 (UTC)

Yes it would be a very appropriate paragraph to add. Let's remember that more and more children die of asthma, especially in industrialized countries, and across social levels. It is actually one of the biggest killers of children in the U.S. (I'll get the numbers later from the med library.)

Asthma Rates
? Alec - U.K. 07:58, 2 November 2006 (UTC)
 * Is it anything to do with "asthma rates" (whatever they are?)?

Theories of asthma pathogenesis
I'm thinking that, per Wikipedia practice, the theoreticals in the article should be trimmed or presented in a different manner, particularly in the Pathogenesis section. I wanted to toss this into discussion and wait a while for input before hauling out an axe and chopping away; I do realize that there is support for a plethora of theories and don't want to diminish their importance with respect to stimulation of research, but perhaps they should be presented as that ... topics for research. Comments? Courtland 07:13, 2005 Feb 12 (UTC)

Butekyo Method
I removed this section because it is obviously quackery and devoid of any merit whatsoever. Two major hallmarks of charlatanism are 1) unsubstantiated claims and more importantly 2) demand that the person pay for "classes" to learn a "natural" (in the sense of not requiring machinery or supplies) technique. Having read the writeup on Butekyo, I note further that patients who go to these classes are then required to swear not to reveal the "technique" to others. Rubbish of the worst variety. I and other members of my family have dealt with asthma all our lives, and I assure you that breathing exercises do not by any means take the place of drug therapies. If this Butekyo nonsense stays in here, then I guess we also need to mention homeopathy, naturopathy, crystals, magnet therapy, falun gong, and every other "alternative medicine" we can think of. Jeeves 15:35, 15 Apr 2005 (UTC)


 * Whilst the claims made for improved lung function have not been shown by independant research, there is some usefullness in the technique. It is long recognised that anxiety or distress aggrevate the sense of difficulty in breathing that sufferers experience during an attack (anxiety increases attempted respiration rate and the extra effort of struggling with breathing increases oxygen demand). I was always taught to be reassuring and to try and help the patient relax whilst assessing and treating acute cases in casualty. What has been shown from such techniques as Butekyo is not that lung function improves, but that patients are less anxious about their asthma and make less use of their salbutamol bronchodilating drugs for mild symptoms (use of steroid inhallers remains the same). So whilst it does little for the disease itself and I agree with your points on exagerated claims & cost, patients may report mild symptomatic benefits. David Ruben 20:48, 7 August 2005 (UTC)


 * Jeeves, you are clearly not qualified to comment on Buteyko. I also have asthma, but unlike you I have undertaken Buteyko training and now practice it daily as part of my asthma management. I assure you that it most definitely produces significant improvement in symptoms, if done properly. Don't criticize something you don't understand, as that is the hallmark of a fool. Buteyko is not quackery, if you did some research you would discover numerous medical articles explaining the physiology of lung function and how Buteyko works. Buteyko most definitely has a rightful place in the asthma article.Logicman1966 03:55, 1 August 2007 (UTC)

Vegetarianism and exercise
As an asthma sufferer, I've never heard of vegetarianism being recommended as a treatment, so I removed it. Certainly some foods can provoke allergic reactions, which may induce attacks, but just as many people are allergic to fruits/veggies as anything else. "Regular exercise" is another thing I've never heard of for treating asthma. If anything, some asthmatics must avoid certain exercises to avoid attacks. Please correct me if I'm wrong about this (there are many asthma sufferers in the world and I am only one). Jeeves 09:17, 21 Jun 2005 (UTC)


 * You're most certainly right. It's not standard medical practise to recommend vegetarianism as a treatment for asthma or being useful to help prevent asthma. As you said in the above section, charlatans abound everywhere. Alex.tan 09:03, 22 Jun 2005 (UTC)

I would be careful about throwing around the word "charlatan" before doing a search of the scientific literature. Below are references which report that vegetarians have reduced asthma exacerbations and medication use and that switching to a vegetarian diet achieves the same effect. It is also well known that regular, moderate cardiovascular exercise can reduce the number of asthma attacks. 1-Knutsen SF, Lifestyle and the use of health services. Am J Clin Nutr. 1994 May;59(5 Suppl):1171S-1175S. 2-Lindahl O, Lindwall L, Spangberg A, Stenram A, Ockerman PA, Vegan regimen with reduced medication in the treatment of bronchial asthma, J Asthma. 1985;22(1):45-55.


 * One single study in thirty-five patients done in 1985 showing an improvement for vegetarians isn't really strong evidence. And the other study merely shows a relationship, no evidence at all that is a causal relationship. Apart from these two studies I couldn't find anything useful on the subject. But moderate exercise is indeed advisable. --WS 14:45, 4 August 2005 (UTC)

Just because only one diet study has been performed doesn't mean that it shouldn't be included as an option, and just becuase it's older doesn't mean it's not good. After all, physicans don't make any money by saying "eat right and exercise" nor could a large study of that type be easily funded. Most of the currently available medical interventions don't provide relief for every patient, but their validity is not questioned. Why not put it in the alternative or complementary medicine section?


 * As a life-long vegetarian and also life-long asthma sufferer, I sincerely doubt that vegetarianism alone is enough to mitigate the effects of asthma. I would doubt the validity of the quoted study on the grounds that the sample size was much too small, and that it wasn't testing a single factor - "vegetarianism" is a much broader concept than a single scientific study can encapsulate. Each dietary variation should be studied specifically to identify just what it is about vegetarianism is thought to help alleviate asthma symptoms... I'd also like to mention that I've never heard of the correlation between a vegetarian diet and lower incidence of asthma before now, but I'm very skeptical of the connection. GHoosdum 18:55, 6 December 2005 (UTC)


 * From personal experience, not eating meat has little or no effect on asthma (my younger brothers asthma is a lot worse than mine and he rarely eats meat, whereas i eat a lot). However, regular exercise has noticably reduced the severeity and regularity of our attacks. I have no idea as to whether exersise is recommended as a treatment, so i will have to find out. Aldoliel 21:24, 29 March 2006 (UTC)

Regular exercise most certainly is recommended for asthmatics (I am one). It increases blood flow and increases lung capacity. It also helps keep down your weight, which is useful for asthma. If you cannot exercise because of asthma symptoms, your asthma is NOT well controlled at all. Puresholtz 01:18, 12 April 2007 (UTC)

Ideas
First - I think the main image is good, but not what we want for the feature image. I think the best thing would be a picture of someone using an inhaler. Having a human face to a disease is always helpful. I did a google search for government images about asthma, buit I couldn't find anything that was all that good for our purposes. Also, I downloaded a few papers to read up on the pathophysiology of asthma. I'll rewrite that section of this article - as it is, it's far too jargon-filled to be a much use to the average reader.

Things that need to be improved (an incomplete list):
 * The epidemiology section
 * Writing quality of the introduction
 * Pathology and Treatment sections should be written as real paragraphs, not big lists
 * I'll tackle this one. Mr.Bip


 * Also, I think it would be nice to have a historical perpsective on asthma - even mild asthma used to be a debilitating condition before the advent of inhalers
 * On that note, I think a list of famous asthma sufferers would be interesting. I know lots of famous athletes have had asthma, in addition to intellectuals like Marcel Proust

Mr.Bip 17:55, 4 August 2005 (UTC)

Also Dian Fossey

There used to be a picture of a child using an inhaler. Any reason why it was deleted? --Umalee 02:45, 24 January 2007 (UTC)
 * See the Loss of image section below. Lack of source information. Fvasconcellos 13:31, 24 January 2007 (UTC)

Rewrite
I sat down this afternoon and rewrote a lot of this article, as you can see in the history. Mostly, I rewrote and rearranged the introduction, played with the formatting, moved the image down to the "Pathology" section, and completely rewrote the Pathology section. Let me know what you think.
 * P.S. I did spend a considerable amount of time researching and writing the Pathology section, so if you have any issues with it, I would appreciate a note about edits you make. Mr.Bip 03:02, 7 August 2005 (UTC)

Wrong tone for wikipedia
I shall await comments (being Collaboration article of the week), before editing the overall structure... -David Ruben 21:45, 7 August 2005 (UTC)
 * This is technically very good with a detailed description of the immunological processes involved. However, as a mere GP, I struggled to understand it, got bored and started skipping; I do not think that, as an encyclopedic article, it is currently useful to a non-medical newly-diagnosed asthmatic who would be trying to learn the basics about asthma. Unlike the comment above ('Theories of asthma pathogenesis' suggesting taking an axe to the article) I do not suggest removing the technical stuff, but it urgently needs to be in a separate section at the end of the article. I would leave in their current place the general discussion bits on the theory of pathogenesis/pathology.
 * The structure of the article needs be 3-levels: the general introduction, a lay guide to cause/symptoms/diagnosis/treatment and then a technical discussion.
 * Asthma diagnosis is not via pulmonary function (spirometry) testing for the majority:
 * Children can't do the tests, diagnosis is by history taking and confirmed by response to treatment
 * In adults, diurnal-variation or reversibility to bronchodilators using Peak Flow Rate Meters is the norm (at least in the UK)
 * Spirometry was rarely performed (in UK), being largely a hospital test, although becoming a little more common in General Practice now. Spirometry is usually used if the diagnosis is in doubt or chronic obstructive airways disease is instead suspected.
 * A greater emphasis needs be made to distinguish treatments for symptom control (relievers) verses disease modification (preventers). The current passage is too alarmist, very few asthmatics are so severe as to need nebulisers. There is a ladder of treatment depending upon severity (UK NICE/SIGN) that needs adding.
 * David - I appreciate your comments. I welcome the effort to translate what I've written into more comprehensible language (and if you think that is bad you should read what was there before I edited the article). Working in a lab talking about science all day, one loses track of what a layperson can and cannot understand easily. Also, I agree that the article makes asthma seem like a death sentence. There are, of course, many different degrees of asthma, including the kind I suffer from, excercise induced asthma. I was hoping the physicians in the crowd could flesh out more of the clinical aspects of the disease. The "Signs and Symptoms" and "Diagnosis" sections are pretty fragmented - please modify it as you see fit. I think a GP's perspective is exactly what we need for those sections. Mr.Bip 22:29, 7 August 2005 (UTC)
 * P.S. I just looked over the changes you did make, and they make good sense. It would be great to have a US physician look over it and modify it for any practices that differ in America. Mr.Bip 22:34, 7 August 2005 (UTC)
 * David - actually, after second thought, I think the structure of the article should stay. Look at this template on the Clinical medicine Wikiproject. I think it makes sense, and I would like to impose a regular structure on disease articles. Mr.Bip 04:20, 9 August 2005 (UTC)
 * Ok, I agree, but can we have at least a non-professional introductory paragraph to the Mechanisms/Pathophysiology -David Ruben 07:54, 9 August 2005 (UTC)

Formatting issues
Can someone help me out with the formatting at the top of the article, with the image and the infobox? I can't get it to look right on IE and Safari. It's really bugging me. Mr.Bip 00:44, 10 August 2005 (UTC)
 * On my IE, The ICD box (floating right) sits embedded in the lead paragraph, with the text wrapped around. The image of the kiddo doesn't appear. On Firefox, the photo appears where it should in the lead section, the ICD box sits just below the photo, and the TOC sits where it should on the left. The robust conclusion that we can make from this of course is that IE is stupid.
 * Seriously though, I don't know why it's happening. I went through the histories, and note that when you view the older revisions in IE, the picture turns up fine. In fact, even when you view the revision I just made, the image is there. It's only when you return to the actual page (Asthma) does the image disappear. — Encephalon  |  &zeta;  |  &Sigma;  06:02:25, 2005-08-10 (UTC)
 * It's the cache. Clear your cache, Bip. Firefox retrieves pages differently from IE, which seems to depend a lot more on the cache at the standard settings. It looks OK on IE now.— Encephalon |  &zeta;  |  &Sigma;  06:04:50, 2005-08-10 (UTC)
 * Screenshot to your right. Was there anything else about the image and the box that bothered you, Bip? Regards— Encephalon |  &zeta;  |  &Sigma;  06:18:17, 2005-08-10 (UTC)

(Removed ss)— Encephalon | &zeta;  07:50:19, 2005-08-18 (UTC)

"Layperson's Review" of Asthma article
Hi Folks,

In response to a request by Mr.Bip, I've given the asthma article a "layperson's review." Some of the things I stumbled over and a few ideas for addressing them are listed below. I'm also willing to help implement them if there's something you want to address but aren't sure how.

I've never really done this sort of review before, but I hope you'll take these comments as they're meant -- as constructive criticism and suggestions -- rather than as any sort of complaining or insistence that anything be changed. I think you've put together a great article -- and I certainly learned a great deal reading it. --Avocado 00:21, August 13, 2005 (UTC)

So here goes....


 * It's not immediately clear from the beginning (unless, presumably, you have a medical background) that we're discussing a human medical condition. BTW, do animals other than humans ever have athsma?

Yes, horses.


 * [Inserted comment: Asthma is not an exclusively human condition. For instance, cats can also have asthma. -- Olve 01:12, 20 September 2005 (UTC)]

Dogs can also have asthma, and they are treated in boxes with albuterol pumped in with a mix of oxygen. Puresholtz 01:22, 12 April 2007 (UTC)

General stylistic notes

 * In general, I think the descriptions of athsma symptoms and causes would be easier for the layperson to understand if they explicitly compared the "normal" function with the "athsmatic" function of the organs and systems in question.


 * I think the article reads a bit like it's addressed to a first-year med student, rather than to an average high school graduate. Say you had just diagnosed a kid with asthma and were explaining the diagnosis to his distraught mother (who's no rocket scientist but not especially dimwitted either -- say she works as a receptionist in the office down the street).  How would you explain it?  That might be the appropriate sort of style and tone to use.

Technical style, jargon, etc

 * Opening of article is almost overwhelmingly technical. "Chronic inflammatory condition"?  responsiveness of airways to stimuli?  I imagine an introductory medical textbook might sound a bit like this.
 * Why not at least open the article with a simple layman's explanation that asthma is a chronic condition that can cause difficulty breathing? Then the jargon has a context that might make it easier to puzzle out.


 * Similarly, with terms like "Bronchial hyperresponsiveness", with no links to articles with further detail, and no explanation, the layperson is going to be easily lost.
 * The jargon is presumably important for the medical reader, but you could either use non-medical terms to describe the symptoms, with the medical terms added in parentheses, or vice-versa.
 * A bit of linking to other articles for the sake of vocabulary might help a bit (i.e. for words like "symptom", which is a common word but nonetheless outside of a lot of people's vocabulary), but isn't really a substitute for explaining terms that really are specific to the profession.
 * One symptom of the jargon problem that I noticed is a tendency to use a whole lot of nouns and noun phrases (e.g. "leads to narrowing of the airways" instead of "causes the airways to become narrower").


 * The diagnosis section is a bit better in terms of jargon, but could use proofreading.


 * The Mechanisms section is the worst jargon offender. I know that it is in fact a technical discussion, but the first paragraph could be made accessible, and the others perhaps just a bit more comprehensible.


 * The second and third paragraphs of "Pathogenesis" are IMHO the most accessible paragraphs in the article, and might be a good stylistic reference point. FWIW, this section seems to be essentially redundant with Epidemiology, and the chart showing the prevalence of Asthma is better explained by the information given in Pathogenesis than in Epidemiology.

Miscellaneous

 * What on earth is the box on the right side titled "Asthma", with a couple of bizarre codes in it?


 * I think it's great that there's a closeup photo of an inhaler. Do you think it might be more recognizable in profile?

This is a valuable criticism, Avocado. I hope you will contribute similarly to all future MCOTWs.— Encephalon |  &zeta;  |  &Sigma;  14:04:45, 2005-08-14 (UTC)


 * I add my thanks as well. I will work on modifying the article. &mdash; Knowledge Seeker &#2470; 06:42, August 15, 2005 (UTC)

Technical errors
The recent edits may have improved the readability but have introduced/highlighted several errors: David Rubentalk 00:53, 22 August 2005 (UTC)
 * 1) Peak flow meters measure the restriction of airflow through the bronchi, not 'lung capacity'; a term that has a very specific meaning in lung function measurement.
 * 2) I would dispute the term 'Many' for those asthmatics with allergy. It is generally a tiny minority of the total. Yes a few people get asthma-like bronchoconstriction in the presence of cats or dogs and a greater number find they get symptoms along with their hayfever. But for the majority of asthmatics, direct allergy is not relevent to their disease and antihistamines have NO effect. (the use of serology tests of dubious significance does not prove an allergy, merely the presence of some antibodies)
 * 3) The terms used (at least in UK) for bronchodilators and steroid inhallers is very specifically 'Relievers' & 'Preventers'.
 * DR - I corrected the first two errors you found, which are my fault. I'm not a doctor (yet), so thanks for catching those things. I actually feel like there might be several more technical inaccuracies in the language in this article, but we need doctors to look at it to be sure. I think that the UK and US terms you mention in your last comment are both used in the article. If you see a problem, feel free to change it. Mr.Bip 01:06, 22 August 2005 (UTC)
 * Sorry Mr.Bip, my internet link went paralytically slow, freezing my computer as I tried to implement the above changes myself - no intension meant to over-ride your own edits on these :-)
 * The article on peak flow meter makes the same error and I will correct too. David Rubentalk 01:45, 22 August 2005 (UTC)
 * Thanks, Dr. Ruben. Regarding the terms relievers and preventers, perhaps it is a UK thing then? I, of course, can deduce their meaning, but an average patient in the United States would not recognize the terms. I don't really care about a U.S. vs. U.K. thing, but the terms reliever and preventer sound a bit too informal to me to be section titles (perhaps I just prefer overly formal speech?). I'm going to reword them slightly; please feel free to edit it further if you think appropriate. &mdash; Knowledge Seeker &#2470; 20:18, August 22, 2005 (UTC)

Nominate for FAC?
I think this article has improved, and benefitted from the suggestions on peer review. I'd like to nominate it for featured article status&mdash;any comments/objections? I hope it's up to par, but even if not, it will give us direction on how to improve this (and future) articles. &mdash; Knowledge Seeker &#2470; 01:46, August 24, 2005 (UTC)
 * Good idea, KS. I am wondering about a couple of things though:


 * 1) References. The first two use the footnote template system, but the first doesn't work (I think the ref number in the article was removed). The second jumps to [1]. A larger issue I think we need to discuss at our MCOW or Lounge pages is what form of references should we use for our medical articles? If I recall correctly, the MoS is vague on this point. For us the matter will essentially boil down to Harvard vs. Vancouver, I should think. The footnote template on WP is essentially of the Vancouver form, and biomedical journals generally do follow that form; however, the problem with this is on WP that if any edit is made to a footnote in the article, I believe the "jumps" get screwed. More experienced users pls correct me if I'm wrong.
 * 2) Red links. Is it considered unwise to submit for FA with red links in the article? Should we start stubs on some important terms, eg. wheezing? I think I'll go ahead and get one or two started by tomorrow.
 * 3) Images. These need to be all cleared — it's the first thing they seem to look at on FAC.— Encephalon |  &zeta;   02:12:16, 2005-08-24 (UTC)
 * I've had my eyes on getting this article to FA status for a while. I think it's probably close to ready, thanks to the last push by Encephalon, KS, and DR. I've just done a another combing through the article, added a few links and corrected a few typos. To address Encephalon's concerns: I think that WP articles are quite mixed when it comes to footnotes. I think that little recent research is discussed in this article, so I feel fine about using the general reference section at the end of the article without in-line citations. I don't think the red links are a problem in themselves either, but starting stubs is never a bad idea. And lastly - the images. Since I picked all of them myself, I can promise that they are all from government or public domain sources - I made super-sure that they would be OK. Double check them please. Let's nominate this article :) Mr.Bip 05:10, 24 August 2005 (UTC)
 * PS - On second thought, I feel like this article needs a "History" section before it would really be FAC quality. I can't find any good online resources on the history of asthma, and I don't have access to a library at the moment. If someone can add a section soon, that would be great. Otherwise, I would like to nominate this to FAC to see how close we are to the featured standard. Mr.Bip 06:05, 24 August 2005 (UTC)
 * Mr.Bip and I briefly discussed the best way to do references a little while ago. I am not entirely certain what FA prefers; my feeling is to keep it this way and if the reviewers would like us to do it differently we can change it. Same for the red links&mdash;I don't think it will hurt us but we can always write stubs at least. The images should be fine&mdash;they all look properly tagged to me. Mr.Bip, a "history" section would be good, I agree. I'll see if I can scare one up, although I am not sure what I will be able to find. &mdash; Knowledge Seeker &#2470; 06:27, August 24, 2005 (UTC)
 * I threw a "History" section together, but it could use some work. One of the sources I used was the abstract from, but it would be nice to get the complete article, and looks to be a good source for history as well. If anyone has access to these articles, that'd be great; otherwise, I'll see if I can hunt them down at the hospital. I think we're ready to submit this FAC; what do you think? &mdash; Knowledge Seeker &#2470; 07:08, August 24, 2005 (UTC)

Helped needed for FAC
Hi guys, the nomination is going well, but the reviewers have brought up several things to add to the article. I will try to work on most of them, but there are a few I could use some help on. Does anyone have any information on links between smoking, COPD, and asthma? Also, any information about alternative medicine? How about athletes and asthma? See Featured article candidates/Asthma/archive1 for more. Thanks! &mdash; Knowledge Seeker &#2470; 05:29, August 26, 2005 (UTC)


 * Yep, saw that. The whole asthma-smoking issue has been quite heavily researched, and is important from several angles:


 * 1) the effects of smoking in adults with asthma,
 * 2) the effects in children inhaling 2nd hand smoke,
 * 3) relationship btwn maternal smoking during pregnancy and asthma in children, and
 * 4) the effects of smoking on the efficacy of glucocorticoids used for treatment.
 * Incredibly, and I didn't know this until I looked, Cochrane doesn't have a single MA or protocol on any of the above. Cochrane Central lists 31 RCTs to do with various smoking-asthma issues. Cochrane does have some 125 SR/MAs related to asthma, per se. I can help with writing up the smoking bit, although I can't promise a time frame at the moment. Incidentally, that was an excellent catch by Dr. deWollf - I completely missed the fact that we'd forgotten smoking. However, you're supposed to be telling us these things before we go to FAC, JFW! LOL. :) — Encephalon |  &zeta;   05:58:16, 2005-08-26 (UTC)

KS and others - I have found information on each of these topics, here are some links. I'm going to go through them and modify the article. To be honest, I'm not really sure where to fit some of this stuff in, but here goes.
 * Asthma and Smoking: Cleveland Clinic - Asthma and Smoking
 * (The influence of smoking on the treatment response in patients with asthma, Curr Opin Allergy Clin Immunol., 2005)
 * (Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and woodsmoke, Thorax, 2002)
 * Asthma and COPD: AAAAI - When Asthma and COPD Coexist
 * (Asthma and COPD: differences and similarities, Int J Clin Prac, 2005)
 * Airway remodeling in asthma: (Pharmacotherapy and airway remodelling in asthma, Thorax, 2003) Full text
 * Asthma and Athletes:
 * (Prevalence of asthma in 1996 Olympic athletes)
 * (Allergy and asthma in elite summer sport athletes)
 * Alternative medicine:
 * Alternative Therapy for Asthma - Cleveland Clinic
 * (Complementary and alternative medicine for bronchial asthma: is there new evidence?, Curr. Op. Pulm. Med. 2004)
 * (Herbal remedies for asthma treatment: between myth and reality, Drugs Today (heard of this journal?), 2002)
 * (The Buteyko breathing technique for asthma: a review, Complemen. Ther. Med., 2005)

All this in 20 minutes :) Clearly, we can bury ourselves in literature about this topic. Let's just go for an accurate overview of the topics (1-2 sentences), and refer to links as necessary. Mr.Bip 06:16, 26 August 2005 (UTC)
 * Strong work, gentlemen (apologies for the assumption if you are female, Encephalon). I will try to look these up and put them in the article. It'll take me a couple days because I am on call in the hospital tomorrow. &mdash; Knowledge Seeker &#2470; 04:01, August 27, 2005 (UTC)
 * Sorry to have created extra work for obviously busy people, but I think it will lead to a much better article in the end. Incorporating the major results from the above would lead to a significantly better than average article. I have access to some good pediatrics textbooks, but I lack the background to understand a lot of the details very well. - Taxman Talk 18:16, August 30, 2005 (UTC)
 * No need to apologize, Taxman&mdash;we're not the only busy people here. Besides we share the common goal of wanting to improve Wikipedia. &mdash; Knowledge Seeker &#2470; 05:59, August 31, 2005 (UTC)

CAUTION
Hi guys. Just wanted to urge caution when editing the article, now in FAC. Always check after you've edited that the footnote system hasn't been upset. Thanks.— Encephalon |  &zeta;   21:19:07, 2005-08-26 (UTC)

Refs
I checked out the first reference and it just referenced the fact from another article writen in 1995. So, although the cited article was writen in 2005, the information is 10 years dated. Maybe people should reference sources where the orginial data comes from. I don't believe the prevelence asthma is still 'rapidly increasing.' In some developed nations I believe the rates have declined since 1995.

**, here's the deal ***s. I've spent some time going through the refs, the footnote guidleines on WP etc. I haven't been able to find a way to incorporate a footnote template that skips to the relevant reference but which does not include a number. What this means is that all our references need to be in the Vancouver style. I'm willing to work through this and clean it up, place templates at each relevant text area (eg. ) and target reference (eg., and then rearrange the refs below numerically using # to fit with the number in the text. I believe this is the best way to do it, because if we use the deplorable  system, the moment anyone comes along and adds a ref or moves the text around, the entire reference system breaks down. The first way it's considerably more stable; the only thing I'll need to adjust when there are changes is the # sequence in the references section, because each "ref" will always be tagged to its "note".

What I want is for everyone who placed references in the references section to please paste here what statements in the article are based on a reference you placed at the bottom. Just write the relevant text sentence you want the citation to go to, and name the reference. I'll give an example:


 * In the Treatment section: "The U.S. National Asthma Education and Prevention Program's Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (EPR-2) (ref: National Asthma Education and Prevention Program. Expert Panel...) and the British Guideline on the Management of Asthma (ref: SIGN document) are broadly supported by many doctors. Bronchodilators are recommended for providing short-term relief in all patients..."

Just place similar notes here as to which statements you wrote require citations to which refs, and I'll handle the rest. How's that sound?


 * Wow, sounds great, Encephalon. I'll get you the references&mdash;it'll take me a couple days, though: I'm on call tomorrow. I'll try to get them Sunday, depending if I get any sleep on call. &mdash; Knowledge Seeker &#2470; 04:38, August 27, 2005 (UTC)

As always, kind regards— Encephalon |  &zeta;   22:57:18, 2005-08-26 (UTC)


 * Thanks, Seeker. No need to rush — get your sleep Sunday. Oh, and I don't mean to jinx it or anything, but it just ain't happening, dude. Sleeping on a call night as an intern in any normal hospital on a Saturday is simply a contravention of all known Laws of The Universe &copy;. You should write it up if it happens. :) — Encephalon |  &zeta;   22:10:28, 2005-08-27 (UTC)
 * Encephalon - I want to get on top of this stuff soon too - I added several of those refs. I'm moving back to school this weekend and starting a job, so I'll be pretty busy too. I'll try to do what I can. Also, I guess I'll have to read up on Biochemistry to prepare. Mr.Bip 01:33, 28 August 2005 (UTC)
 * Don't worry about it, Mr. Bip. You deserve a barnstar for the work you've already done. Just post your info on this talk page when you have time, as above. If there are still refs unaccounted for after Seeker posts here, I'll manually go through the edit histories and locate them. I'd have gone ahead and done it over the weekend, but since I didn't place many of the refs, I thought it courteous  to ask the editors who did to say where they want them. Your point about Biochem is an important one, and something we may need to think about. Because of the Asthma FAC, I have not worked on RA; poor WS has been making improvements all by himself. I'm doing some clean up work today, but there is SO MUCH more that needs to be done on RA. We might have to rethink our timing: perhaps, MCOTW can be skipped during those weeks when there is an active push for FA status of one of our articles?— Encephalon  |  &zeta;   00:56:18, 2005-08-29 (UTC)

Bah&mdash;I came home and slept all day, woke up to eat a late dinner and study for an hour, and now am going back to bed. It's not so much call that's tiring, it's the recovery period. I'll get to this tomorrow. Yeah, I'm worried we're getting spread too thin; this is something I'll bring up on MCOTW's talk page (or you can). I'll get you your references; it'd be such a laborious task for you to sift through the history. I plan to work on RA tomorrow too if I'm lucky (I'm just optimistic). &mdash; Knowledge Seeker &#2470; 05:32, August 29, 2005 (UTC)


 * In Treatment: "For those in which exercise can trigger an asthma attack, the episode usually occurs after the exertion, not during it. Higher levels of ventilation, colder air, and drier air all tend to make the episodes worse. For instance, activities in which one breathes large amounts of cold air, such as cross-country skiing, tend to be more worse for asthmatics, whereas swimming in an indoor, heated pool, with warm, humid air is less likely to provke a response." is from Harrison's. &mdash; Knowledge Seeker &#2470; 17:28, August 30, 2005 (UTC)
 * Really? I find the first sentence hard to believe. I mean what about prolonged exercise? If the sentence were true, then for the most part asthmatics could delay symptoms simply by continuing to exercise. Myself as an example I get symptoms during prolonged exercise, even as short as 5-10min into it if I think about the last time I had symptoms. I think the author was implying short duration exercise, but never said. What do you think? The rest of that quote is golden though, and covers exactly what I had found and was thinking of adding. - Taxman Talk 18:35, August 30, 2005 (UTC)
 * I took it out, pending further confirmation. Feel free to reword the other sentences. I have a propensity to write long sentences, and the second sentence in particular ended up rather complex. &mdash; Knowledge Seeker &#2470; 05:14, August 31, 2005 (UTC)


 * In Treatment: "These include an increased severity of symptoms, more rapid decline of lung function, and decreased response to preventitive medications. Asthmatics who smoke typically require additional medications to help control their disease.  . Furthermore, exposure to secondhand smoke is detrimental as well, resulting in more severe asthma, more emergency room visits, more hospital admissions related to asthma.  . Smoking cessation and avoidance of those who smoke is strongly encouraged in asthmatics." "...most studies show that early treatment with glucocorticoids prevents or ameliorates decline in lung function as measured by several parameters. " following sentence is from Harrison's. Thanks Mr.Bip for finding all these journal articles. &mdash; Knowledge Seeker &#2470; 06:02, August 31, 2005 (UTC)


 * Awesome. Thanks for this kind gesture, Seeker. I was beginning to sort through the refs on my own anyhoo, but this is helpful.— Encephalon |  &zeta;   11:21:31, 2005-08-31 (UTC)

COLD air? You're kidding, right? It's warm air that makes you huff and puff and wheeze.. like from overheating from exercise.. well that's me anyway.. and logically everyone. <.<

Just for an extra parameter, I think humidity is a factor too. Of course 100% humidity is a function of temperature. I find a steam inhalation can sometimes help relax, dialate, allow emptying of lungs more gently. Paradoxically it is not always helpful and tends towards positive results when the weather is cold and dry.

Basic science references
The very detailed paragraph about the bronchial immune response is very sparsely referenced. What was the main reference for this work? JFW | T@lk  21:04, 30 August 2005 (UTC)
 * JFW - I mostly wrote that. My refs were (3) and (5) in the article, plus this article - Lilly CM, Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics. J Allergy Clin Immunol 2005, S526-31. . Hope this helps. Mr.Bip 20:43, 31 August 2005 (UTC)

Copy of original refs for article

 * Diagnosing Childhood Asthma in Primary Care, Patient UK PatientPlus article written for doctors
 * British guideline on the management of asthma - Scottish Intercollegiate Guidelines Network (SIGN) Online Full PDF Summary PDF
 * Alberts, W. Michael. "Irritant-Induced Asthma: Diagnosis And Management". Medscape General Medicine. http://www.medscape.com/viewarticle/408732. Accessed on August 24, 2005.
 * Asthma Prevention Program of the National Center for Environmental Health Center for Disease Control and Prevention. Asthma At-A-Glance. 1999.
 * Finotto S, Glimcher L. T cell directives for transcriptional regulation in asthma. Springer Semin. Immunopathology 2004, 25(3-4):281-94..
 * Fraser Health: Asthma: Facts. http://www.fraserhealth.ca/HealthInfo/PublicHealth/Asthma/facts.htm. Accessed on August 24, 2005.
 * Inwald D, Roland M, Kuitert L, et al. Oxygen treatment for acute severe asthma. BMJ 2001;323:98-100..
 * Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328:434..
 * Lilly CM, Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics. J Allergy Clin Immunol 2005, S526-31..
 * Maddox L, Schwartz DA. The Pathophysiology of Asthma. Annu. Rev. Med. 2002, 53:477-98..
 * Marketos SG, Ballas CN. Bronchial asthma in the medical literature of Greek antiquity. J Asthma. 1982;19(4):263-9..
 * McFadden ER, Jr. Asthma. In Kasper DL, Fauci AS, Longo DL, et al (Eds.), Harrison's Principles of Internal Medicine (16th Edition), pp. 1508-1516. New York: McGraw-Hill;2004.
 * Mujica VR, Rao SS. Recognizing atypical manifestations of GERD; asthma, chest pain, and otolaryngologic disorders may be due to reflux. Postgrad Med J 1999;105:53-55..
 * National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health pub no 97-4051. Bethesda, MD, 1997.
 * World Health Organization. Bronchial asthma: scope of the problem. http://www.who.int/entity/respiratory/asthma/scope/en/index.html. Accessed on 23 Aug 2005.
 * Blanc PD, Trupin L, Earnest G, et al. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. Chest. 2001;120(5):1461-7.
 * Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. J Paediatr Child Health. 2002;38(3):252-7.

The view after a step back
MCOTW community and others - I haven't been able to work much on WP the past week since my life has jumped up several notches in busy-ness, but this article has improved leaps and bounds in the past four weeks. Even if we don't get FA status for some reason, we have created a quality article on a tremendously important topic. Congrats! I hope we can continue the good work for months to come. Mr.Bip 20:48, 31 August 2005 (UTC)

If this doesn't get FA, I'll eat an MDI.— Encephalon |  &zeta;   03:39:17, 2005-09-02 (UTC)
 * Can I hold you to that? More importantly, can you take a picture of you eating it and put it as the top image of the article? Mr.Bip 05:01, 2 September 2005 (UTC)

Mortality statistic question
In the "Prognosis" section, someone wrote "The mortality rate for asthma is quite low, around 0.06% per year in the United States." What is 0.06%? 0.06% of asthma sufferers? Of the United States population? Also, we should have a reference for statistic like that. Mr.Bip 14:12, 1 September 2005 (UTC)
 * I was wondering the same thing. I think Seeker might know, I was just going to ask him on his Talk.— Encephalon |  &zeta;   14:50:02, 2005-09-01 (UTC)
 * Well, just going on the numbers, if that 0.06% referred to the entire population of the USA, that would mean that, assuming a population of 300m, a total of 180,000 people die in the US every year from asthma alone. Sounds a bit high to me, so I'll put my money on 0.06% of asthma sufferers per year. Some googling found which says "5500 asthmatics died across all age-groups in 1994" and that there were 17m asthma patients in the US in 1998. Granted, the years don't match but the calculated mortality from that is around 0.03% so 0.06% is not far off. Alex.tan 16:37, September 1, 2005 (UTC)
 * Sure Alex, we can work such things out with a quick mental calculation etc. It's just that we can't stick that in the text of course - we need a cite.— Encephalon |  &zeta;   17:40:27, 2005-09-01 (UTC)
 * Sorry to have caused any confusion. There is no reference; I just made it up as it seemed like a reasonable estimate. Just kidding. It's from Harrison's. The actual quote is "The mortality rate from asthma is small. The most recent figures for the United States indicate fewer than 6000 deaths per year out of a population of ~10 million patients at risk [that is, with asthma]." I thought the percentage was more meaningful than the raw number but change it if you think that'd be better. &mdash; Knowledge Seeker &#2470; 22:22, September 1, 2005 (UTC)
 * KS - In this situation, I think the raw numbers give a better idea of the low incidence than the percentage. Mr.Bip 05:03, 2 September 2005 (UTC)
 * All right, reword it as you see fit! &mdash; Knowledge Seeker &#2470; 05:07, September 2, 2005 (UTC)

Alternative medicine rewrite
Encephalon, although the alternative medicine section looks like you have put quite some work and time in it, it has become very hard to read I think. I would suggest not talking about all the individual reviews but just summarizing the conclusions. --WS 02:06, 2 September 2005 (UTC)
 * I agree, WS. Better?— Encephalon |  &zeta;   03:31:42, 2005-09-02 (UTC)
 * Yes it is better now :-) but still very much focused on research --WS 11:22, 2 September 2005 (UTC)

I am mildly concerened about the reference for this sentence in the alternative and complimentary medicine section... "Ayurveda recommends use of herbs such as Ajwain, Harad, Hing, Ajamoda, Lavanga, Sunthi and others.[54]". It links directly to a website with commercial interests. According to Wikipedia, "Wikipedia appeals to the authority of peer-reviewed publications rather than the personal authority of experts." I imagine this includes websites of this nature. Was this a plug by the website??

Tcal 10:29, 28 August 2007 (UTC)


 * Yanked it. Someone who believes in this stuff may be able to find a cite that doesn't link to a commercial site, and restore the allegations. -- Orange Mike 14:26, 28 August 2007 (UTC)

Minor query
'It is these molecules that are responsible for the symptoms of asthma.'—This grammar emphasises that these molecules are the only agents responsible .... If you don't want to convey this meaning, please reword as 'These molecules are responsible for the symptoms of asthma.' Tony 05:56, 2 September 2005 (UTC)

Childhood asthma graph
Since the details are too small to read, could this thumbnail be further reduced in size so that the text to the left wraps a little better? Tony 00:50, 3 September 2005 (UTC)
 * Changed both as per your suggestions. &mdash; Knowledge Seeker &#2470; 15:17, September 3, 2005 (UTC)

Congratulations!
We did it! I'm proud that Wikipedia has such a well-developed article on such an important topic, and I hope our collaboration can produce some more featured articles in the future. This truly was a collaborative effort, with everyone putting in a lot of work to bring the article to where it is now (and we're not done yet!). Thank you all for all your hard work, and thanks to the reviewers who not only left us some great feedback but pitched in as well to make this article great. Let's get some more medicine articles up there, shall we? &mdash; Knowledge Seeker &#2470; 15:22, September 3, 2005 (UTC)
 * I would echo that. I'm glad I was able to play a small part in it, even though all I did was give suggestions and you guys carried them out. If the same kind of effort goes into other articles then there will be many new featured quality ones. If you guys are willing to do the same thing with the quality of research and citing and implementing suggestions, I'll commit to reviewing any of them at peer review (like I did for pneumonia's PR) so they can be in great shape for FAC. I'll contribute material where I can of course too, but my most beneficial contribution is likely to be reviewing, since I'm very familiar with the FA standards. - Taxman Talk 16:27, September 3, 2005 (UTC)
 * Hey -- how exciting is that? Congratulations, folks! -- Avocado 20:14, September 3, 2005 (UTC)

Good one! Tony 05:09, 4 September 2005 (UTC) PS Graph size better now.

Asthma mortality
McFadden ER Jr, Warren EL. Observations on asthma mortality. Ann Intern Med. 1997 Jul 15;127(2):142-7. Full text

Asthma medication
With all our September 2005 edits during WP:MCOTW to get 'Asthma' through to FAC, the treatment section naturally was improved. However there is a separate page of Asthma medication which has not been edited since July 2005. David Rubentalk 00:36, 20 September 2005 (UTC)
 * Given it seems to largely duplicate the better layout & more comprehensive description within this the main article, should it be deleted (transfering any extra information worthy of keeping) and changed to a redirect to Asthma ?
 * If people agree, can we just do this, or do we need to go through a formal WP process of Articles for deletion (what was until recently 'Votes for Deletion') ? The AfD pages actually states "If a page can serve as a useful redirect or be merged somewhere, do not list it here. Doing so only clutters AfD."


 * Just did the redirection for Asthma medication. I think it's a waste of resources to go through AfD. Not much in the other article that's not already mentioned in the main asthma article and is worth merging. Alex.tan 01:52, 5 October 2005 (UTC)

List format
When Asthma was going through the FAC process, we were very fortunate to have a profesional editor with a special interest in biomedical and scientific articles copy edit the entire article for us. His contribution is here. We concured with his editing of the lists in the article, standardizing them—no caps, use semi-colons, and an "and" before the last bullet. So I've Changed back a recent edit that altered the standadized format of one such list. Thanks. enceph alon  16:00, 5 October 2005 (UTC)

Asthma and socioeconomic status
The article notes that asthma is more common in relatively prosperous strata of society. This seems to contradict the conventional wisdom in the U.S. It's widely reported here that poor urban children are at greater risk than wealthier children. I have also read mainstream press speculation that the greater likelihood of exposure to lead based paint may be at the root of this. Any comments?


 * I don't know how the U.S. health system works (i'm british), but as far as i'm aware, if you can't pay for healthcare, you don't get it.


 * Therefore poor, urban kids would be less likely to regularly see a doctor, and so they'd be less likely to be diagnosed as asthmatic. to extend this, poorer people are unlikely to go to the doctor because their kid is a tiny bit 'wheezy', so poor people would be less likely to be diagnosed of mild asthma. i for example was diagnosed as athmatic aged 8, before then i was just assumed to be unathletic and not have fantastic lungs - nothing serious.


 * Whaddya make of that?


 * Ahkayah cuarenta y siete 18:21, 5 October 2005 (UTC)

Hi there! I'm sorry I missed this message earlier. You're absolutely right, that sentence is misleading, and I'd have re-written it if I'd seen it. There have been varying reports on how socioeconomic status correlates with asthma prevalence: some studies indicate no correlation, others a negative one, yet others a positive one. A problem with the data is that many of the earlier studies done on this issue were of a design that made it easier for spurious associations to be "found". One very large study in Europe recently found that lower socioeconomic status correlates with asthma incidence; however, a new New Zealand study that used what we call a longitudinal design found no real relation between s-e status and the risk of getting asthma, when possible confounding factors had been controlled for. So it's something of an open issue; I think there is likely, in many societies, a low s-e + asthma correlation. I'll remove that bit that seems to point to the opposite conclusion, because it's misleading. Do note, however, that it is true that the prevalence of asthma in developed countries (ie. irrespective of socioeconomic class) has shot up enormously over the last two decades. Thank you very much for your input, Jbafromny. enceph alon  13:14, 7 October 2005 (UTC)

Condition not a disease
Surely asthma is a long term condition rather than a short term disease.Danny
 * Uhmmm... Multiple sclerosis is "a demyelinating disease", according to our article. Does a disease have to be short-term? Algae 19:33, 5 October 2005 (UTC)


 * The word can apply to either short or long term conditions
 * dis·ease (d¹-z¶z“) n. 1. A pathological condition of a part, an organ, or a system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms. 2. A condition or tendency, as of society, regarded as abnormal and harmful. 3. Obsolete. Lack of ease; trouble.
 * Hope this helps. &rarr;Raul654 23:34, 5 October 2005 (UTC)


 * Asthmatics (as defined by genes) are no more the carriers or sufferers of a "genetic defect" than are the normative group, non-asthmatics. The lack of a gene can be called a gene as can a combination of genes. Alec - U.K. 21:23, 29 October 2006 (UTC)


 * I suspect a disease has been confused with asthma. Alec - U.K. 20:55, 29 October 2006 (UTC)


 * I have started a disscussion on asthma and disease futher down. It is just before where I have called for a multiple split.

Alec - U.K. 07:23, 2 November 2006 (UTC)

Childhood asthma
** I'm not a doctor and I'm not a chemist, and I'm not by any means a great writer (But I try!) but I do and have suffered from asthma for most of my life. I read recently that......

"there does seem to be some evidence to support that chlorine does have an adverse effect on Asthma especially in young children."

And this information was like a bomb going off for me as I remember being dutifully taken to the pool as a young kid and swimming and suffering the worst asthma attacks ever! And it got worse! Despite the advice form the doctors. (Although swimming in the sea was better option)

I realize that this article has been on the front page and lots of people have put a massive amount of effort into this, but my attempt to contribute the above (I feel very valuable information) seems to be stomped on via various revisions.

Even something along the lines of .... Some current advice amounts to Swimming in chlorinated pools should probably be avoided by young children with Asthma. or a footnote or something ...... A quick google found the following links some of them quite detailed

See http://www.scienceagogo.com/news/20030428215935data_trunc_sys.shtml

http://www.ccohs.ca/oshanswers/chemicals/chem_profiles/chlorine/health_chlorine.html

http://www.irishhealth.com/?level=4&id=4949

Please let me know what yout think

--Steve Abrahall 09:57, 7 October 2005 (UTC)


 * Hi Steve, thank you very much for both asking your question and contributing to the article. I saw the sentence you'd written, and I'm the rascal who took it out. :) However, it was not because I thought it was wrong—that chlorinated swimming pools can induce asthma in some people is correct—but because I wanted it moved to a more appropriate section of the article (you'd placed it under Treatment, whereas that information is better recorded, in this article, under Pathophysiology, where we mentioned all the other things that can trigger asthma). You can see that I've added the information you wanted included by clicking on this link. I rewrote the sentence to fit the paragraph, and added a reference to a medical journal article for you (it's actually an editorial that is non-technical and quite easy to understand). If you'd like to read more about it—especially since it seems you've had personal experience—it's reference number 7 of the article. Is what I've done **? Do let me know if you'd like changes or improvements, won't ya? Thanks! enceph  alon  13:14, 7 October 2005 (UTC)

Autoimmune?
This page has a category as autoimmune disease. Is that appropriate? It's not an attack by the immune system on the body, it's more like an inappropriate/exaggerated response to external factors, like allergy. Malcolm Farmer 00:00, 8 October 2005 (UTC)


 * It is incorrect; it does not match the definition of autoimmune. What might the epitope be? I'm removing it. JFW | T@lk  08:36, 9 October 2005 (UTC)


 * Alpha-enolase appears to be an autoantigen that is associated with severe asthma. CopperKettle 05:58, 17 May 2007 (UTC)

Future treatment options?
I like how most articles on this website feature a section about the future of the subject. I think that this article should follow suit. Some examples of future treatment options/theories could include: -The Asthma Vaccine being developed at UC Davis (http://www.ucdavis.edu/spotlight/0805/asthma_breakthrough.html, http://www.immunetolerance.org/news/articles/press/article_838.html) -Theory that parasitic worms could be used to treat immune deficiency associated with asthma ( http://news.bbc.co.uk/1/hi/sci/tech/4215234.stm) -Theory of a missing protein (http://www.abc.net.au/catalyst/stories/s1325779.htm) -Minimally invasive surgery reduces asthma symptoms (http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20051119/asthma_treatment_051119/20051119?hub=CTVNewsAt11)


 * You see, Wikipedia is not a crystal ball. The best we can do is include a reference to a "forward-looking" expert review. I would not encourage writing extensively about stuff still in phase I/II trials which may still bomb at FDA level. JFW | T@lk  01:02, 22 November 2005 (UTC)

Ipratropium?
An anonymous editor added ipratropium bromide as part of the acute management of a severe asthma attack. Does anyone know whether this is in the guidelines? JFW | T@lk  21:51, 15 December 2005 (UTC)


 * The current (2005) GINA, NIH, and British guidelines all prescribe a combination of a beta-2-agonist and an anticholinergic for hospital management of moderate and severe asthma episodes. Ipratropium (as DuoNeb, with albuterol) is in common use in hospitals in the US. inkling 05:56, 16 December 2005 (UTC)

socioeconomic factors
These two sentences, near the end of the article, have problems with POV:
 * Because of insufficient regulatory control over pollution, the rate of asthma is higher among low-income populations, which are disproportionately minority, more likely to live near industrial areas. This is one of the many externalities associated with government subsidy of pollution through the provenance of free and poorly regulated atmospheric waste disposal.

In particular, "because of insufficient regulatory control" and "government subsidy of pollution" sound a little blustery. Since this is an FA, it would be nice if one of the regular editors could fix it, so I don't have to try my inept hand. –Joke 01:53, 10 January 2006 (UTC)
 * will do.Sfahey 18:06, 11 January 2006 (UTC)

Thanks, it is much improved. I came to the article wondering why the prevalance of asthma (according to the New York Times) in East Harlem is much higher than in the neighboring Upper East Side? Does it have something to do with local environmental contaminants (chemicals, smoking, cockroaches, dust mites...)? I had thought that asthma was caused by pollution (car exhaust, industrial effluent etc...) but that seems unlikely to be a principal factor in this case, since the two neighborhoods are adjacent. –Joke 18:56, 11 January 2006 (UTC)


 * Please take care with terminology - to state polution as cause of asthma is very POV. As I understood things, there is generally no proof for polution causing asthma (as the article states it has not been proved that air pollution is responsible for the development of asthma) although they are strongly correlated and seems a not unreasonable theory - but correlation is not causation.  One proven environmental cause is house dust mites. Again as I understood things, polution is a certainly a cause of asthma being exacerbated (e.g. ionisation from thunder storms results in increased hospital asthma admissions), but it is not an original cause. David Ruben Talk 00:56, 12 January 2006 (UTC)


 * Please let me ask you to take care with terminology - I am not sure if you are confusing asthma attacks with asthma (i.e. Asthmatics), but I think I should state - that "asthma attacks are caused by air pollution" is true by definition - To define either the "asthma attack" or "air pollution" as anythingelse would be P.O.V., offencive in regards to a minority group and quite frankly WRONG''' (in both the moral & the litteral sence) Alec - U.K. 08:14, 29 October 2006 (UTC)

The title of the section is "socioeconomic factors." The correlation between asthma and pollution seems well established by studies such as this one: http://www.ij-healthgeographics.com/content/4/1/14. I don't see how Hume's problem of induction applies uniquely to this correlation. It is a fact that pollution is subsidized by free waste disposal. Polluters are permitted atmospheric disposal of waste at no charge. This is a plain statement of fact. A consequence of this subsidy is increased risk factor for asthma in communities with higher pollution rates. Leaving out these facts or failing to clearly state them constitutes a bias of ommission.


 * I agree a (very) good study and some (mostly) well thought out discussion. However:
 * It only demonstrates a strong correlation, rather than provides proof of primary causation (but that is not to say a correlation is not important to take note of).
 * Even if the effect should be proven, this study does not clarrify whether polution increases the de-novo incidence of asthma, or raises the profile of asthma by exacerbating established cases (either of otherwise mild sub-clinical asthma to a state that it gets diagnosed, or of exacerbating established cases causing greater usage of medical resources).
 * Polution can not on its own be a full description of the cause of asthma (tends run in atopic families, other areas of the world have far higher polution levels than in the USA yet do not have the developed world's prevelence of asthma). So whilst polution is important (including for reasons other than asthma of course), the discussion needs to be balanced & NPOV. Medical consensus has yet to be reached, but polution is clearly a matter than should/is/must be carefully investigated - and WP of course should so discuss this.
 * So I still think the precise language used needs to be careful - but whatever clarification future research yelds, there is no disputing that environment factors have a real affect on asthma (I prefer 'environmental factors' as exacerbation due to thunderstorm ionisation is very real, repeatedly been proven, but can hardly be called polution. Likewise the effects of secondary smoking whilst significant and 'not a natural phenomena' is not what is generally understood by the word 'polution').  So yes, include the topic, but phrase carefully. David Ruben Talk 20:59, 17 January 2006 (UTC)


 * If you think you can blame air pollution on air.

And lay the responciblity there.

Please think again.

Alec - U.K. 08:41, 29 October 2006 (UTC)

I think everything you have said is fair, but again the section is "socioeconomic factors." Some effort ought to be made towards explaining the higher prevalence and greater severity of asthma in low-income populations. If the research on pollution is ongoing that's fine, but it seems to me to be highly suggestive. And if pollution causes increased health and economic costs then that's an externality. It would be a pro-polluter bias of ommission not to mention this. I propose the following: "The incidence of asthma is higher among low-income populations, which in the western world are disproportionately minority, and more likely to live near industrial areas. Research on the degree to which industrial pollution can be a principle cause of asthma is ongoing, but existing data strongly suggest that industrial pollution is amoung the environmentla factors that can trigger asthmatic episodes.  At least some of the health and economic costs related to asthma are negative externalities.  Additionally, asthma has been strongly associated with the presence of cockroaches in living quarters, which is more likely in such neighborhoods." I'll leave it to a regular editor to decide if that's fair.

User:64.74.106.225 (please use 4 tildes ~ to sign your entries) I agree "effort ought to be made towards explaining the higher prevalence and greater severity of asthma in low-income populations", but also think you have hit upon an important issue more wide ranging than polution & asthma alone that needs better inclusion within wikipedia. You are obviously better versed in socioeconomic terms than myself, but the pages I could locate on a quick search were: Health disparities, Economic inequality particularly the 'Effects of Inequality - Population Health' section and Life expectancy. Of course this sort of discussion includes far more than just asthma, with rates of smoking, heart disease, infant mortality, life expectance all notable. As a doctor, I think back to discussions given at Medical School about these issues in my Medical sociology lectures, however this seems a small stub of an article.Whilst all these articles make some mention of social factors, is the real issue that wikipedia is missing a single article that puts 'socioeconomic effects on health' all together as an issue ? Please User:64.74.106.225 contine to discuss further... David Ruben Talk 04:06, 20 January 2006 (UTC)
 * 1st suggested sentance - Yes - I completely agree with this; it expands on the last sentance of the Epidemiology paragraph above and is both well phrased & NPOV.
 * 2nd suggested sentance - No - I confess to completely failing to understand (as I suspect most doctors and patients would), but then I did not understand the externalities article either :-)
 * I think (?hope) this is meant to explain that there are a wide range of 'costs' to patients & society caused by polution that is not billed to those that polute, and that if they had to bear these additional costs then they would choose not to polute (i.e. they polute because there is no cost directly payable by themselves). Or did I really misunderstand totally ?
 * Of course proof of either primary causation or secondary exacerbation then gets important as one would need to calculate both the overall 'cost' of asthma to society and then the proportion attributable to polution, and then to each type of polution/poluter. I agree with the sentiment, but its very politically contentious, difficult to write about in a NPOV, and exceeds what one can reasonably fit into an article about a single disease.... so....
 * If my understanding is correct, then this issue of your second sentance needs to move a sentance forwards to the end of the paragraph.
 * I wonder if you think it would be better to give a non-jargon (ie get rid of the word 'externalities') but brief overview of this issue, linking as approapriate to other articles that deal with this subject more fully (and also a more appropriate location for that word).

Codes
Why the article doesn't have any ICD or other codes information like other deseases articles? CG 11:04, 12 March 2006 (UTC) ```` nice interesting article

Hookworm
An anon has been making edits in favour of deliberate hookworm infection to "cure" asthma. He also charges $ 500. I am strongly against linking to http://www.asthmahookworm.com/. The site also does not contain a single academic reference. JFW | T@lk  08:50, 30 April 2006 (UTC)

Epinephrine (adrenaline) inhallation vs selective agents
An anon user 159.178.41.198 had posted seemingly uncited claims of benefits of epinephrine over selective agents (see changes):
 * "Studeis have shown over the counter inhaled epinephrine (Primatene Mist) to be nearly as effective as Albuterol for terminating an acute episode of airway obstruction, but without cardiovascular side effects..." and failure to so use epinephrine "...since physicians fear the over the counter status of this medication will cause patients to delay or avoid proper treatment from a physician"

Which I had reverted back. They have signed up as User:Iamahalfer - welcome - and gave the following details on my talk page, which I transcribe here:

I recently posted on the asthma page regarding OTC epinephrine inhaler use. You state that epinephrine when given via inhaler results in increased cardiac side effects, but this is not true if the medication is used in an appropriate manner. I refer to a study published last year:  [] Ann Allergy Asthma Immunol. 2005 Dec;95(6):530-4 Newer medications for relief are of course more selective, but to my knowledge, if used properly epinephrine via inhaler does not result in increased cardiac effects as a result of its selectivity. Please let me know your opinion on the matter. Thank you for your time. '--Iamahalfer 02:58, 19 May 2006 (UTC)'


 * Interesting, that single study indeed suggested less effect on heart rate, although seemed less helpful/larger doses needed as "6 patients were symptom free after 14 cumulative actuations of epinephrine compared with 6 cumulative actuations of albuterol.".
 * A (quick) search of PubMed showed that whilst that study included 8 patients in a cross-over study, there is a metanalaysis of 6 studies (161 adults and 121 children and adolescents) that found "there were no differences in heart rate and Pao(2) between treatments. CONCLUSIONS: There was no statistically significant benefit of nebulized adrenaline over salbutamol or terbutaline in the treatment of children and adults with moderate-severe acute asthma."
 * So issues of long-term use, duration of action etc would need to be compared to draw any conclusions over the merits of epinephrine over other agents. David Ruben Talk 10:48, 19 May 2006 (UTC)
 * So issues of long-term use, duration of action etc would need to be compared to draw any conclusions over the merits of epinephrine over other agents. David Ruben Talk 10:48, 19 May 2006 (UTC)


 * I might add that salbutamol (as used in UK), was until fairly recently available over the counter without prescription, but this was changed as a minority of people (asthmatics & non-asthmatcs) were abusing the drug, becoming dependant upon the "buzz" they obtained on taking high doses. Furthermore routine salbutamol use alone is not generally considered to reduce the incidence of deaths from severe asthma attacks (incidence dropped for use routine steroid inhallers) or reduce presence of morbidity (it may reduce wheeziness for 6 hours at a time, but that accepts that a patient gets wheezy upto 4 times a day, has to stop what they are doing to take salbutamol and feel unwell for the 20-30mins it takes to work - better never to get wheezy in the first place with preventative twice daily steroid inhallers). David Ruben Talk 11:41, 19 May 2006 (UTC)

HERE IS MY RESPONSE:

You wrote: Interesting, that single study indeed suggested less effect on heart rate, although seemed less helpful/larger doses needed as "6 patients were symptom free after 14 cumulative actuations of epinephrine compared with 6 cumulative actuations of albuterol."

''---“The pooled data showed no significant difference in pulmonary function between both drugs.”
 * What I find interesting about that statement is that even with 14 cumulative actuations of epi as compared to 6 with albuterol, epinephrine still resulted in less cardiac symptoms.
 * The meta-analysis you linked to also showed there was no difference between pulmonary function or cardiac symptoms.

---“Thus, data from this review did not show any significant difference in heart rate between groups.”''


 * I do agree that inhaled epi or inhaled salbutamol, when available OTC, could result in abuse and neither product should be used as a preventative medication for asthma. However, in the asthma article on wikipedia they are listed under the relief medication category, which is appropriate.

My problem is with the statement: “Cardiac side effects, although uncommon, occur more often with these less selective drugs.” That is not supported by current studies (including the link I posted and the meta-analysis you posted), which is why I attempted to adjust that.

My other concern is with this statement: “They also provide a shorter period of relief than the selective bronchodilators.” This statement is 100% correct if it is in reference to Salbutamol/Epinephrine being used as a maintainence/preventer medication, and in that case duration is hugely important. However, when being used as a rescue/reliever medication to abort an acute asthma attack, both drugs equally/fully resolve the attack, which makes the duration inconsequetial as the acute attack has been resolved.

Those two statements were my reason for posting. If my original wording was inappropriate let me know because I would love to try again. Let me know what you think. --Iamahalfer 17:55, 19 May 2006 (UTC)

A section on asthma in other mammals
My cat has been diagnosed with asthma, and it seems likely that this an veteriary medicine issue in other mammals. Any reason not to have a Vetereniary Asthma section? ike9898 17:12, 16 June 2006 (UTC)


 * No, but it needs to be well-sourced and reliable. The problem is that we cannot possibly have seperate information on each species. JFW | T@lk  22:30, 19 June 2006 (UTC)


 * I don't think there is any reason you need to have "seperate information on each species" in order to have a section on veterinary asthma. Even a little information would make the treatment of the overall subject more complete; as it stands the article implies that asthma is solely a human disease. ike9898 14:48, 20 June 2006 (UTC)


 * This is the wrong article for such a section. This article is already longer than normal and I suspect such an section may lead to a merger. The place for any comparision between cats and mankind in relation to members of each species being said to have asthma (whatever you mean by "asthma") is an article about cats or animals with asthma or bronchitis. Humans can be regarded as animals: Not all animals can be regarded as human. If the word "asthmatic" has been applied to cats (or come to think of it americans) then I expect that only happend long after it had been first applied to humans and therefore using the word "asthma" should promt comparision with the human condition & n as part of the human condition. If cats are mentioned in this article it should be about them a) Catching mice,  b) Making a sound more like stridor than wheezeing or  c) Causing asthma attack in susseptable humans (not that they would do so deliberatly) Alec - U.K. 05:19, 30 October 2006 (UTC)

Autoimmune disease
Asthma seems to protect against other autoimmune disease in a very large Israeli cross-sectional study. JFW | T@lk  22:30, 19 June 2006 (UTC)

Airway Remodelling
It seems to me that the article is perhaps lacking some up-to-date information about airway remodelling, which is currently viewed as a very important aspect of asthma. I see that the only two references regarding Remodelling date from 2002 and 2003, respectivelly, which might be a bit outdated.

Tang, et al, say in June 2006: "These include epithelial hyperplasia and metaplasia, subepithelial fibrosis, muscle cell hyperplasia and angiogenesis. These structural changes result in thickening of the airway wall, airway hyperresponsiveness (AHR), and a progressive irreversible loss of lung function.", in Pharmacol Ther

In the same month, Prescott states: "there is also evidence that airway inflammation and early remodelling can progress in a subclinical state. New studies suggest that early airway damage is irreversible and that subsequent lung function is 'set' in the first years of life.", in Paediatr Respir Rev

(I'd also like to point out that there seems to be no consensus in the literature whether it is remodeLing with one L, or remodeLLing with two. Is this a case of UK vs US?)83.132.98.149 03:09, 17 July 2006 (UTC)

Asthma and Allergy Foundation of America
There seems to have been a tug of war between two contributors about the Asthma and Allergy Foundation of America. Before it resumes, could people discuss whether it's a worthy organisation that deserves an external link or not. (I'm British so I don't know it.) Nunquam Dormio 07:59, 2 August 2006 (UTC)


 * I and another editor had initially removed what seemed like spamming/vanity, with link being added to multiple site by user whose name identified themselves as being of the organisation. The Asthma and Allergy Foundation of America similarly vanity created, but as seems real organisation and makes claims for role in US policies, rather than suggest a similar AfD re notability, I tagged article for an external-viewpoint cleanup. I note several new users since edited and article structure improved. uI suppose anyone can submit a case to FDA, but this fails to answer question if/how this group compares to many other asthma groups in US - likewise being British, I am realy not able to assess this.David Ruben Talk 16:51, 2 August 2006 (UTC)

I agree 80.229.241.200 15:01, 9 September 2006 (UTC)

The greek 'aazein'
I noticed that a recent article in The Lancet described the word 'aazein' differently to the definition here. The first line of the history of asthma section states that the greek word 'aazein' means 'sharp breath' - when numerous other sources state that 'the greek verb aazain means to exhale with open mouth, to pant.' Is the latter incorrect? If not, which definition of 'aazein' is correct to use in this context?

A quick google search brings up these this link for "aazein" as a verb.

http://www.aafasocal.com/asthma_history.php

--Spathi 12:39, 13 September 2006 (UTC)

Please remove
The reference to the greek 'aazein' should be removed completely from the encyclopedia article as '"asthma"' is defined in english (a language that did not exist in ancient times) & the term was coined only after WWII as far as I know. Perhaps it could be replaced by information on whether "asthma" was defined by the british or in the "new world" or the combination of both.

Alec - U.K. 21:25, 29 October 2006 (UTC)

eNO as means for asthma management?
I read several claims of monitoring exhaled NO (eNO) being useful for adjustment of drug dosage and prediction of asthma crises. eNO measurement is a technique known from environmental science and since '99 applied to lung inflammation detection, monitoring etc.. Probably the best known device for asthma eNO measurement is the Aerocrine MINO, which is offered to professionals substituting a part of the spirometry.

Would it be useful to mention this methods? It would highlight the cause of asthma (inflammation) compared to the current focus on the symptoms (as assessed by PEF or spirometry). Since I'm not an MD and english is not my mother tongue, I will leave the decisison and execution to the experts.

OUTSTANDING: I am very impressed with this article. I sometimes have disagreements with Wikipedia but than Wikipedia has moments of sheer genius. The articles about Hungarian are also first class.

"Disease"
Asthma is not a disease. Discuss... Alec - U.K. 05:44, 28 October 2006 (UTC)


 * What's to discuss, nuisances of meaning of the terms "disease" "illness" or "condition" ? Or are you suggesting that asthma should be perceived as a healthy normal state of being ? David Ruben Talk 13:09, 28 October 2006 (UTC)


 * You left out "trait", "Syndrome", "Cline", "Mallady", "Susseptablity", "Cultural Background", "Minority"...
 * You should be careful not to imply that it is not normal for people with asthma to be anything other than healthy: That is, you should be careful not to imply that asthmatics are not normally healthy. I am not sure whether you know the meaning of the word "asthma" or not. Alec - U.K. 07:35, 2 November 2006 (UTC)


 * This is just being needlessly pedantic - hypertension is a disease, in as much as an abnormal condition to have, but no one would suggest that a person whose blood pressure is well controlled need not feel entirely well. I think you are trolling, as ArmadilloFromHell has already pointed out on your talk page:
 * "'Asthma is not a trate - there is no such article (and it would not be a trait either, there is no article asthma triggers. You may want to call it a disability and it certainly can be disabling, but http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html says Asthma (Az-muh) is a chronic disease that affects your airways. -- http://www.aafa.org/display.cfm?id=8&cont=5 Asthma is a disease of the lungs in which the airways become blocked or narrowed causing breathing difficulty. Your change to the page Asthma was determined to be unhelpful, and has been reverted.'" David Ruben Talk 18:12, 2 November 2006 (UTC)

Asthma Disease Confusion
The article seems to be confusing asthma with a disease or two. Alec - U.K. 07:15, 2 November 2006 (UTC)

Split
The article should be split into about five articles, all with different names. Alec - U.K. 06:45, 28 October 2006 (UTC)


 * Disagree - This is a very good article - indeed a Featured article. It covers the main aspects of the condition as per the medical Manual of Style (WP:MEDMOS). What aspect of the article did you think needs expanding upon to the extent it needs its own separate article ? David Ruben Talk 13:06, 28 October 2006 (UTC)

I am sorry that I did not put the list of things to split it into on here before the first comment was made.

Here is the list of what I might like it split into:

*"Asthma Attack", which the other articles should link to *"Asthmatic", a minority group defined by susseptablity *"Bronchial Pneumonia" or whatever the term is for what asthma is being confused with *"Asthma Pneumonia", a twin condition in the same way as AIDS Tb. *"Asthma related epidemiology"

I think there was a 6th but I forget what it was. Alec - U.K. 18:29, 29 October 2006 (UTC)


 * re "Asthmatic, a minority group " - so are we suggesting that the majority who have asthma do not have a suseptablity, and if not that they all are reacting to external environmental causes ?
 * Whose is confusing asthma with "Bronchial Pneumonia" ? - there already is an article Pneumonia.
 * re "Asthma Pneumonia, a twin condition" - do you mean pneumonia occuring in someone who has asthma or really a new separate condition of "Asthma Pneumonia" - the latter has no hits in PubMed.
 * Epidepemiology seems an appropriate topic to keep within this article.
 * I welcome comments from other editors, but User talk:Alec - U.K. suggests that several other editors feel this person is not working collaboratively with the rest of us. David Ruben Talk 18:27, 2 November 2006 (UTC)
 * By "the rest of us." I supose David Ruben means not all wickpedian but rather just a minority of them that have collaborated to form the article simply entitled "Asthma", which at present is one that I stongly suspect is not generaly regarded as being up to the usual stanards of wickipedia, and one that I have been rather upset by, as I am not a non-asthmatic myself, and as a child have needed hospital admision to survive allergennic air pollution into adulthood (something that would not happen now in my part of the world).
 * —The preceding unsigned comment was added by Alec - U.K. (talk • contribs). 04:05, 3 November 2006


 * Alec, stop being disruptive please and take a careful look at all those tags at the top of this talk page. Asthma is well regarded as an article - it has been Peer_reviewed and awarded Featured_articles status, meaning it has been identified as one of the best articles produced by the Wikipedia community. It was a featured article on the Main Page in October, has been selected as one of the best articles on the Medicine Portal. Out of a current total of 1,463,937 articles in English wikipedia, this is one of just 705 top featured articles selected for Version 0.5. If you wish to promote "allergennic air pollution" as the cause of asthma, you will find this is a minor point already briefly covered in Pathogenesis section. David Ruben Talk 03:36, 3 November 2006 (UTC)

Merge proposal from Allergic Asthma
Allergic Asthma seems to have nothing of additional information to that already covered in rather more detail in this article. Much of Allergic Asthma is taken up with a duplication discussion of the various medication used.
 * Merge - as per suggestion above. David Ruben Talk 03:59, 3 November 2006 (UTC)


 * Encephalon redirected page to Asthma 03:22, 7 November 2006 - Thanks, good to have you back from your apparent (?) wikibreak David Ruben Talk 04:25, 7 November 2006 (UTC)

Merge proposal from Asthma medication
User:Regan123 It has been proposed merging Asthma medication into this Asthma article.
 * Merge - Asthma medication not only covers the exact same topics, but is rather less detailled than that already covered in Asthma. Indeed it makes some unsubstantiated claims and I doubt anything much will actually need be added across.David Ruben Talk 03:59, 3 November 2006 (UTC)

Just to clarify I have not made a proposal to merge the articles. The tag for merge into was here and I simply added the merge to tag on the other page. I have no opinion one way or another. Regan123 22:12, 3 November 2006 (UTC)
 * Appologies - David Ruben Talk 00:09, 4 November 2006 (UTC)
 * None required. Good luck sorting this out!Regan123 00:13, 4 November 2006 (UTC)

From a little way up in this talkpage already a previous thread of Asthma medication, I copy the following:David Ruben Talk 13:57, 5 November 2006 (UTC)
 * Just did the redirection for Asthma medication. I think it's a waste of resources to go through AfD. Not much in the other article that's not already mentioned in the main asthma article and is worth merging. Alex.tan 01:52, 5 October 2005 (UTC)

I see the merge tag is still on Asthma medication. Is this now dropped or is the merge going ahead? Regan123 10:37, 24 November 2006 (UTC)
 * Seems to entirely duplicate, so I would suggest merge. Have not time (now) to do, will return later... David Ruben Talk 20:17, 5 December 2006 (UTC)

Merge done & 'Asthma medication' redirected to 'Asthma#Treatment' - Asthma medication had very little not covered in more detail in Asthma and missed out entirely whole classes of drugs. David Ruben Talk 02:57, 7 December 2006 (UTC)

What asthma is not
Alec - U.K. 20:46, 22 November 2006 (UTC)
 * A mental illness
 * An allergen
 * A contagion
 * The umbrella term for all respiratory conditions]]
 * The term for all conditions of one part of the anatomy
 * An asthma attack
 * To blame for asthma attacks (See the eggshell skull rule)
 * A condition that can spread
 * Pneumonia
 * Anaemia
 * A form of Cerebral palsy
 * A tendency to have panic attacks
 * The essence that unites those that might claim to be spastics
 * P.S. I put many of the items on the list above on the main page. I did not include "mental illness". They seem to have been deleted on the grounds that they were "twaddle". Alec - U.K. 20:49, 22 November 2006 (UTC)


 * This list seems to be nonsense and un-encyclopaedic. Asthma is not an awful lot of things, but we don't need to specify everything (eg its not cancer, vascular nor psychiatric). Unless this list is a real collection of what asthma is consistantly mistaken for (WP:Cite from WP:Reliable sources), then this seems like your continued idiosyncratic trolling Alec. Please engage, discuss and then follow consensus as is required on this and other topics (e.g. Tulse hill, Dulwich etc.) Reported for admin comment. David Ruben Talk 20:56, 22 November 2006 (UTC)

Loss of image
Is it just my creaking computer failing to load pictures, or has the Infobox Disease picture of Image:Inhaler girl.png now just a red link - if the image has gone, then where too - I can't seem to find it at en.wikiped, so ?commons image? David Ruben Talk 03:06, 12 December 2006 (UTC)


 * The image seems to have gone, but this sems to indicate it was deleted some time ago, not in the last day or so. I don't understand. -- Armadillo From Hell GateBridge  03:14, 12 December 2006 (UTC)


 * Ok, I found it was deleted from commons  (deleted "Image:Inhaler girl.png" (missing essential source information) -- Armadillo From Hell GateBridge  03:17, 12 December 2006 (UTC)

I think this is one of those copyright problems. There have been a lot of pics going missing from wikipedia recently in the same manner :O --86.142.79.28 09:18, 14 December 2006 (UTC)

Exercise Induced Asthma (EIA)
I removed the text below from the main article page. I think it probably needs to be reincluded into the article, but it needed to be better integrated. Consider also a link to Exercise-induced asthma instead. --Mdwyer 17:32, 3 January 2007 (UTC)

This is a condition characterized by coughing, wheezing and chest tightness that occurs 5-8 minutes into strenuous exercise. These symptoms can be exacerbated by cold temperatures or a polluted environment. Treatment usually centers around Beta2 agonist inhalation therapy. Two common ones are the short-acting Albuterol 2 puffs 15 minutes prior to exercise and the long-acting Salmeterol 2 puffs 30 minutes prior to exercise. For persons who find difficulty in using an inhaler, leukotriene inhibitors are beneficial when taken at least 1 hour prior to exercise. DrCarter12 16:48, 3 January 2007 (UTC)

Causes
This text has been moved from the end of the article, as I felt it didn't improve it. — Encephalon 13:39, 10 February 2007 (UTC)

Many studies have linked asthma, bronchitis, and acute respiratory illnesses to air quality experienced by children. One of the largest of these studies is the California Children's Health Study. From the press release"The study showed that children in the high ozone communities who played three or more sports developed asthma at a rate three times higher than those in the low ozone communities. Because participation in some sports can result in a child drawing up to 17 times the “normal” amount of air into the lungs, young athletes are more likely to develop asthma."

That text has been reinserted as your personal opinion is irrelavent and this text has been removed as it is unsourced "Another theory is based on the correlation of air pollution and the incidence of asthma. Although it is well known that substantial exposures to certain industrial chemicals can cause acute asthmatic episodes, it has not been proven that air pollution is responsible for the development of asthma. In Western Europe, most atmospheric pollutants have fallen significantly over the last 40 years, while the prevalence of asthma has risen." DodgeTheBullet 15:42, 10 February 2007 (UTC)

I think some of the world's greatest minds have to be thanked for making articles like these acurate and informative.

I found the hookworm tidbit amazing. I hope within a few years we have a cure!

Household cleaning sprays
A study comes to the following conclusion: "Frequent use of common household cleaning sprays may be an important risk factor for adult asthma." (source: The Use of Household Cleaning Sprays and Adult Asthma: An International Longitudinal Study Cyrus Grisham 12:10, 12 July 2007 (UTC)

Epidemiology
This section seems a little U.S.-centric. Australia's rate of asthma among children is, according to this government website, around 14%. Leon 10:54, 22 February 2007 (UTC)

Asthma diagnosis
I would dispute this statement?
 * "In many cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination."

There are clear guidelines for the diagnosis of asthma which I have inserted into the document. I accept that it is difficult following these guidelines in children who cannot do peak flow. --Gak 08:07, 10 May 2007 (UTC)

Ancient texts
How accurate were the pre-20th Century treatises on asthma compared to the modern understanding? -- Beland 13:55, 31 July 2007 (UTC)

NHLBI asthma guidelines
New guidelines out. Definitely need mention. JFW | T@lk  06:39, 3 October 2007 (UTC)