Talk:Asthma/Archive 2

New treatments for Asthma, Bronchial Thermoplasty
Bronchial Thermoplasty is an experimental treatment for asthma where heat (149 degrees or about the temperature of a cup of coffee) created by radio frequency waves, is applied to small- and medium-sized bronchial tubes, reducing the amount of smooth muscle in that area. So far, the treatment appears promising and well-tolerated by patients. Trials appear to have dramatic benefits for those patients with the most severe asthma.(104)

loaded with references http://www.respology.com/CEUs/AsthmaPastPresentandFuture3.aspx

perhaps add this new treatment? I see patients are having results with it....

207.106.86.85 (talk) —Preceding undated comment was added at 20:16, 11 December 2008 (UTC).

I thought this was an encyclopedia
Anonywiki added a number of extremely dubious, inflammatory, and completely unsupported statements to the Buteyko section of this article, including "The mainstream medical community regards the practice as extremely dangerous and it is frowned upon hugely." I removed these, because unsubstantiated claims like that have no place in an encyclopedia.

Orangemike then reverted my deletion, saying that I should request a citation first! Well, I have seen "citation needed" tags in a number of articles, and some sit there for months without any action. In the meantime, the spurious statement is allowed to stay in the article. What nonsense. Anonywiki, if you cannot provide references to support the statements you added, then I will remove them again. Logicman1966 (talk) 12:19, 22 November 2007 (UTC)


 * re this thread's query, yes it is an encyclopedia and so dangerous claims must not be suggested to the readership without editorial responsibility (as per wikipedia does not give medical advice). So such a propostrous suggestion that an asthmatic in extremis should refuse oxygen, is not a dangerous one ? Hmmm just what is mechanism therefore that asthma may in extreme circumstances cause death ? I rather thought it eventually involves brain death due to a lack of circulating oxygenated blood ? As for sources - if someone were to suggest that underwater juggling is good for asthma and a newspaper reports that claim (ie a reliable source), then there is no need insist that wikipedia includes the claim just because no one in the medical community decides to waste their time giving it any serious consideration or expend the energy to write a rebutal - clearly we know the common (majority) opinion on this (PS uncontrolled asthma is an absolute contraindication for scuba diving, of which there are many published guidelines, yet none of these mention underwater juggling).David Ruben Talk 15:54, 22 November 2007 (UTC)


 * You respond to my complaint about people adding unsourced claims to articles, by providing an unsourced claim of your own (asthmatic in extremis should refuse oxygen)?? You didn't understand my point - dubious, inflammatory, or controversial comments should not be added to an article unless they are already supported by a reputable source. Otherwise, perhaps I should add my own comment to this article : "pharmaceutical companies prey on asthmatics by getting them addicted to over-priced medications that do not effectively treat the condition". Of course, I would add the "citation needed" tag....Logicman1966 (talk) 02:27, 23 November 2007 (UTC)

Gender and asthma
I am new to Wikipedia and want to follow the protocols before making any major edits. I am proposing a new heading possibly called "Gender and asthma or Women and asthma".

There are several disparities that run between adult men and women concerning asthma which have not been addressed in the entry. It states,"being female, for persistence of asthma into adulthood." A statistic from the Asthma and Allergy Foundation of America, states that more adult females will die from asthma by 65% in overall asthma deaths. The Office on Women's Health Asthma Reseacrh recognizes that," Some populations, including women,are particularly affected by asthma." They attribute this to factors including difference in hormones, factors relating to pregnancy, and varient reactions to medications. They also acknowledge as a growing concern the adult onset of asthma in women at the start of menopause. Another study from the NIEHS suggests that, "sex hormones may play a role in asthma". This study found a correlation between girls reaching puberty before the age of 12 with an increase incidence of asthma being diagnosed after puberty at nearly twice the rate than girls who experience later onset of puberty. This study remarks that as the age of girls reaching puberty continues to decline the rate of asthma continues to escalate. I can find and follow through with all the footnotes and citations at another time.

I think this would be an appropriate addition to this article. Thank you, WH701 (talk) 22:39, 20 December 2007 (UTC)WH701


 * I added a section on population disparities to the epidemiology section that tries to elaborate more on populations outside of the US (it was mentioned above that the epi section is very US-centric), talks about differences among various US ethnic populations, and includes what you stated about gender and asthma. Do you have the references?Aklauncher (talk) 06:21, 30 December 2007 (UTC)


 * I think it should be called Female Asthmatics 79.72.136.68 (talk) 14:39, 9 September 2009 (UTC)

Papworth method
When page unprotected, Papworth method (a breathing technique with effectiveness demonstrated in a small clinical study) should be added after the meditation mentions in the alternative therapy section —Preceding unsigned comment added by 68.165.11.209 (talk) 17:08, 22 March 2008 (UTC)

CHI3L1
According to the the New England Journal of Medicine, an allele of the gene CHI3L1 doubles the risk of getting Asthma. However, the section on genetics seems to have a requirement that the effect must be found in six populations or something, I can't figure it out, perhaps somebody misunderstood a QTL study. CHI3L1 has been mentioned in the major news media, so it needs to be added to the article. Phlegm Rooster (talk) 18:00, 11 April 2008 (UTC)

Performs As A Trigger
Cold weather can trigger Asthma, by causing wheezing in the throat, which can cause problems to the lungs.

Philippines, 12%
12% of Filipinos cannot breath: Asthma Insights and Reality in the Asia Pacific Region (AIRIAP) study (on the prevalence of asthma in 12 Asia Pacific countries) reported that, as of May, 2008, 10.7 million Filipinos are suffering from asthma, or 12% of the entire Philippine population. The study revealed that 4% of the patients are not being given preventive medicine, or only 963,000 asthmatics are using inhaled corticosteroids (ICS) preventive medicine, while only 23% of asthma patients are familiar with ICS.gmanews.tv/story, 10.7M Filipinos suffering from asthma - study --Florentino floro (talk) 11:58, 5 May 2008 (UTC)

Some view points and a few problems
I am not an expert in asthma or allergy myself but have several members of my family who suffer from allergy one of whom has asthma (likely allergy induced asthma, pollen and dust mite). I have a basic understanding of the literature on asthma and a fairly good understanding on certain aspects of allergy literature and treatment, having researched allergy for my own allergies and from consulting with immunologists for my own allergies. I have three problems with the article. (1) My first problem is that the article is filled up with "citation needed" throughout it with about 20 "citation needed's". Why does a featured article have 20 or more "citation's needed" throughout it? (2) Another problem is the article correctly mentions that ozone can worsen asthma but then later in the article it lists ozone producing air filters as a treatment, without mentioning that these air filtration units fill rooms with ozone which can worsen asthma! I don't think that the text about ozone producing units should be deleted as it is relevant because so many people use ozone producing filtration units. It needs a sentence beside it saying something like "However, ozone has been found to worsen asthma and such ozone filtration devices have demonstrated no clinical benefit to asthma sufferers." (3) Also there is a part where it mentions negative ion producing devices without mentioning that devices which produce negative ions all produce ozone since ozone is a by product in negative ion production by such devices. I don't mean any offense to the editors here, I am pointing out a few imperfections as I see them. Overall I think the article is a very good article and the editors have done a good job. I do think the citations needed need to be resolved. I think a featured article should not have so many "citations needed". I also think the other points that I raised are important and I would welcome comments. I will add this article talk page to my watch list.-- Literature geek |  T@1k?  13:12, 14 May 2008 (UTC)

Alternative to Meds
The person above who dismisses Buteyko to be included in the asthma page has obviously not read the Russian, British and Australian research. My ex-girlfriend was on Advair and other meds, until I sent her to a Buteyko class. Afterwards, under doctor's supervision, she stopped the Advair and cut her other meds by 50%, and improved her sports performance. If she were not so lazy about her breathing exercises I think that she could cut them more. I was not asthmatic, but Buteyko has improved my sports performance and free diving time. Although many physicians in school have heard of the Bohr effect of overbreathing (more CO2= more O2 released by hemoglobin to tissues; less CO2= less O2 being released by hemoglobin to tissues), which results in asthma and other hypoxia symptoms, most medical schools in the US have been slow to accept Buteyko Breathing Therapy, which has been helping people for 50 years, reportedly because most research was done in Russia and Australia (also by an asthmatic Glaxo ex-employee) and the pharmacology companies that fund US medical schools do not seem to acknowledge it for some reason... This is why slowed yoga breathing (as real yogis do) seems to reduce asthma problems, while huffing and puffing yoga and pilates routines aggravate asthma symptoms. Perhaps my comments will not be appreciated because the person who disclosed the problems on another wiki page with meds had his comments removed. 68.106.184.122 (talk) 06:45, 6 June 2008 (UTC)
 * First, if you make further insinuations about the editors of this article, you will be blocked. Second, wikipedia articles require verification by reliable sources.  We also do not give undue weight to fringe therapies.  Just because your girlfriend improved in health, a random occurrence, it does not indicate anything except maybe your girlfriend improved in health.   Orange Marlin  Talk• Contributions 07:57, 6 June 2008 (UTC)

1. I'm sorry that you threatened to block me from discussion- I don't believe my words are an attack on anyone. An asthmatic ex-marketing manager at GlaxoSmithKline made such comments after his condition improved using Buteyko enough to discontinue his years of medication. Wasn't acupuncture considered "fringe" therapy until recently? but now it is covered by health insurance although there is less theoretical physiologic basis for it than for Buteyko. I am skeptical of new ideas myself, but have noticed consistent results with only beneficial side-effects.

2. Buteyko Therapy is based of the Bohr effect, which is measurable. Research has now shown that Buteyko significantly reduces medication needs in 85% of patients (probably the ones who are diligent.) Anyone familiar with medical literature will recognize some of the following sources, which I hope you consider reliable:

  www.ncbi.nlm.nih.gov which published several studies, such as the 2000 paper "A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video" (yes, just a home video) stating "Our results demonstrated a significant improvement in quality of life among those assigned to the BBT compared with placebo (p = 0.043), as well as a significant reduction in inhaled bronchodilator intake (p = 0.008). We conclude that the BBT may be effective in improving the quality of life and reducing the intake of inhaled reliever medication in patients with asthma. These results warrant further investigation."  

  www.unboundmedicine.com/medline Bowler SD, Green A, Mitchell CA Buteyko breathing techniques in asthma: a blinded randomised controlled trial. [Clinical Trial, Journal Article, Randomized Controlled Trial] Med J Aust 1998 Dec 7-21; 169(11-12):575-8.  

  Behavioral Interventions in Asthma- Breathing Training. Thomas Ritz, University of Hamburg, Thomas.ritz@uni-hamburg.de, Walton T. Roth, Stanford University and VA Palo Alto Health Care System  

  American College of Chest Physicians- Hypocapnia and Asthma, A Mechanism for Breathing Retraining? Anne Bruton, PhD and Stephen T. Holgate, DSc. From the University of Southampton, Highfield, Southampton, UK.  

<ul> <li> 2003 BMJ Publishing Group & British Thoracic Society ASTHMA Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. S Cooper, J Oborne, S Newton, V Harrison, J Thompson Coon, S Lewis, A Tattersfield, Division of Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK (Buteyko was found beneficial.) </li> </ul>

<ul> <li> Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Med J Australia 1998; 169: 575-578[Medline]. A medical trial run in 1994 at the Mater Hospital, Brisbane, Australia, clearly showed that asthma patients derive great benefits from learning the Buteyko breathing techniques. For example, usage of reliever medication in the Buteyko group was reduced by an average of 90% after six weeks, and usage of steroid preventer medication was reduced by an average of 49% after three months (with no significant changes in medication usage in the control group). </li> </ul>

<ul> <li> Even the Quackwatch link had: "In conclusion, we found that those practising BBT reduced hyperventilation and their use of beta2-agonists. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without changes in objective measures of airway calibre." (Yes, I'm a skeptic! but the research supports Buteyko.) </li> </ul>

After 20 years on constant meds, and then after a few hours of Buteyko self-therapy, my friend improved the same day. She also notices that whenever she follows the exercises, she improves within hours- quite a coincidence if random. I know that the exercises have helped my free diving and other athletic performance significantly, and helped my friends avoid post-event, (exercise-induced) asthma. Should we not explore alternatives that are being researched by Stanford and in other countries to help asthma symptoms and reduce medications? So that I do not offend you, I will not speculate why such research is not on the front page of newspapers. I'm sorry that I am not wiki-fluent; I rarely write here, but I am dismayed that such current research is not publicized for such an important and popular "disease". 68.106.184.122 (talk) 00:04, 10 June 2008 (UTC) Psnack (talk) 00:46, 10 June 2008 (UTC)


 * OrangeMarlin - please don't threaten people with administrative action for making what amounts (at worst) to snide insinuations. it's unnecessary and overreactive. a simple 'please don't say stuff like that' would be enough.


 * that being said, I am disturbed by the number of times I have seen (on various pages) wp:fringe used to silence comments concerning alternative medicine, so I'm going to butt in and start looking around. if anyone knows an example of this, please leave me a link to the page and appropriate diffs, here: User:Ludwigs2/AltMed.  -- Ludwigs 2  00:32, 10 June 2008 (UTC)


 * P.s. spread the word around... ;-) -- Ludwigs 2 00:47, 10 June 2008 (UTC)

2c here -- ethical teachers of the Buteyko method will teach you that this is not intended to be used as an alternative to medication but an adjunct only -- even the research on Buteyko shows that while symptom control gets better (and rescue medication is certainly used less frequently) lung function does not improve -- the only therapy known to improve lung function in asthmatics are medications, therefore it's irresponsible to suggest that asthmatics discontinue taking preventative medications in favor of the buteyko method.

As an aside, Buteyko postulated the Bohr effect was responsible for the improvements shown in the Buteyko method, however, this theory was never tested. In asthmatics, even eucapneic hyperventilation (fast breathing without a resultant drop in CO2) will induce bronchospasm -- so it's more likely that CO2 is not the real culprit but the cold dry air. Wrin (talk) 09:44, 27 January 2010 (UTC)

New BTS Guideline recommends Buteyko
Personal views/experiences aside, Buteyko should probably get a mention in this article since the British Thoracic Society (who make the British Guideline on the Management of Asthma and are mentioned several times in this article) have now recommended Buteyko in the Guideline.

This actually gives permission for GPs and doctors in Britain to recommend it to their patients.

Here's some recent news coverage from the Prince's Foundation for Integrated Health: http://www.fih.org.uk/news/buteyko_technique.html

And here's a quote from the above article:

"Up until now conventional medicine took the stance that that there was insufficient evidence to recommend Buteyko Technique. However in May 2008 the updated British Guidelines for the Management of Asthma endorsed Buteyko Technique so that GPs and asthma nurses can now recommend it.  The new guidelines grade the research on Buteyko as a 'B' classification - indicating that there are high quality clinical trials supporting the efficacy of the therapy in reducing both asthma symptoms and bronchiodilator usage.  No other complementary therapy has been endorsed by this body for the treatment of asthma."

Yes, I noticed that they spelled 'bronchodilator' wrong so this might need to be taken with a pinch of salt. However, quite a glowing report from a well-respected organisation.

Here's a link to the latest BTS guidelines: http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/asthma_final2008.pdf

The bit on Buteyko is on page 35, section 3.5.3. They quote 5 clinical trials I think.

I plan on updating the Buteyko Method page with some of this information and would appreciate any help tidying it up as I am more a reader of wikipedia than an editor! Spathi (talk) 15:26, 10 July 2008 (UTC)

Peer review
Hi all, For those of you who don't know this article has been peer reviewed recently. You can check it Wikipedia:Peer_review/Asthma/archive2.

Anyways, one suggestion was to explain what is meant by replication, in the causes section. e.g As with other complex diseases, many environmental and genetic factors have been suggested as causes of asthma, but not all of them have been replicated.

However, even among this list of highly replicated genes associated with asthma, the results have not been consistent among all of the populations that have been tested ...

However, this is beyond my scope of knowledge so I would appreaciate it if someone else could help.

Thanks!

Ziphon (ALLears) 11:51, 15 July 2008 (UTC)

No mention of No
To my surprise, exhaled nitric oxide isn't mentioned in our featured article, in fact it is completely absent from Wikipedia! Ouch... --Steven Fruitsmaak (Reply) 18:14, 21 July 2008 (UTC)
 * Started the article few days ago. --Steven Fruitsmaak (Reply) 08:24, 26 July 2008 (UTC)

Asthma Cure
I have recently found, browsing on the web, that Cuban doctors have found an effective vaccine against Asthma, that works by suppresing reactions caused by stimuli. Which only allows the brain to exercise control, any response that is carried by a trigger is suppressed by neurological modification. Which make the airways inmobile unless the normal breathing instinct acts. This has proven to be successful in more than 75% of cases, the other percent require a second vaccination. I, however, think this may become an answer to Asthma. The vaccine, named Valergem, is manufactured in Cuba and investigations are being carried out for a children's version. Eventually, only internal control exercised by the brain original functions are allowed lung function control. I cannot search it because of short time but I would want someone to seek it on the web. 200.75.250.59 (talk) 01:52, 26 July 2008 (UTC)
 * There are several sources online based on a newswire article, but none with sufficient information to judge the vaccine and certainly no scientific articles have been published in the international literature. This prevents inclusion in the article for now. --Steven Fruitsmaak (Reply) 08:24, 26 July 2008 (UTC)

I have also heard that some traditional doctors in Hyderabad, India, use some medicine where they have you swallow a complete fish, any Idea about that Swapnils2106  T  12:29, 25 May 2009 (UTC)

Afferent vs Efferent mixup?
"Whenever these afferent nerve endings are stimulated (for example, by dust, cold air or fumes) impulses travel to the brain-stem vagal center, then down the vagal afferent pathway to again reach the bronchus. Acetylcholine is released from the afferent nerve endings. This acetylcholine results in the excessive formation of cyclic Guanine Mono phosphate (GMP)."

I think it should read: ...then down the vagal EFFERENT pathway to again reach the bronchus. Acetylcholine is released from the EFFERENT nerve endings. Horus (talk) 01:12, 26 October 2008 (UTC)

Early Asthma Treatments And Their Long Term Consequences
Is there a scientificly proven link between the the use of    asthma drugs predominantly used in the 1950,s 1960,s and 1970,s (before Ventolin was available on the market) and mental issues for example OCD ,Schizophrenia & memory loss.Is there any statistical research done on early asthma sufferers and their mental conditions when they are now in ther forties and fifties. —Preceding unsigned comment added by 115.166.1.117 (talk) 08:58, 1 November 2008 (UTC)


 * Please take that to the reference desk. This is the first time I have ever heard of such a suggestion. JFW | T@lk  08:31, 2 November 2008 (UTC)


 * Firstly which medications were you thinking of ?
 * For search of PubMed for "asthma schizophrenia" some issues can be considered (but needs a secondary source to rely upon and not just be WP:SYNTHESIS) - In principle difficult as what might be the cause of any observation? Certainly those with chronic mental illness may be less well reviewed or managed in their non-psychiatric illness (see "Physical health care of patients with schizophrenia in primary care: a comparative study")
 * If even begin to understand the simplification of the abstract of "Quasi-linkage: a confounding factor in linkage analysis of complex diseases?" (where "A number of individual markers showing linkage to schizophrenia, asthma, multiple sclerosis, inflammatory bowel disease and type-1 diabetes were tested for") then some genetic predispositions for asthma and schizophrenia might sit near each other on the same chromosomes, and so tend to be co-inherited even though no direct link between the genes or the diseases.
 * Whilst searching PubMed one can find suggestion of a direct common pathway for asthma and affect disorders eg "Substance P and Substance P receptor antagonists in the pathogenesis and treatment of affective disorders." which notes suggestion that "SP has been proposed to play a role in the aetiopathology of asthma, inflammatory bowel disease, emesis, psoriasis, as well as neuropsychiatric disorders including pain syndromes (e.g. migraine and fibromyalgia) and affective disorders, anxiety disorders, schizophrenia and Alzheimer's disease." - unfortunately full review not available online to find out their conclusions on this.
 * Of course if asthma/schizophrenia coexisted as "Concordance of atopic and affective disorders" implies, then if not just coincidence then nature/nuture would need be looked at - i.e. if they do not form by direct genetic/metabolic common pathway, then might asthma by being a miserable chronic disease, make people more depressed or mentally ill ? ( "Prevalence of DSM IV anxiety and affective disorders in a pediatric population of asthmatic children and adolescents" and also   are small studies - but at least show people have looked).
 * Finally to consider historical question of effect prior to modern treatment - but was this researched as well as current studies in in the same manner to allow a metanalysis ? Were criteria for asthma or schizophrenia the same then as now, after the introduction of modern treatments ? Asthma implies asthma previously thought to be partly psychosomatic (or look at 's PDF link for 1986 psychoanalytical idea that asthma a response to smells and in part a learnt behaviour,  suggests not learnt)
 * Search of "salbutamol schizophrenia" gives one hit of "Exacerbation of psychosis associated with inhaled albuterol" but that really does not answer your question
 * So again comes back to which previous treatments were you thinking of ? David Ruben Talk 20:46, 3 November 2008 (UTC)

reply to David Ruben 3rd.Nov.2008 on " Early asthma treatments and their long term consequences" I am researching our state library archives for medications that were prevalent during the period 1950 to 1980 as i will present names of drugs long forgotten.However for a start here are some ALUPENT (common) TEDRAL (common) THEODUR (theophyline i think) suppositories (aminophyline)there was a yellow tablet which was put under the tongue ( researching )and preventative (supposedly long acting)series of injections ( researching).I am really interested in feedback from sufferers from what i call the "experimental era" before the inhalers and corticosteriod preparations were made available.Ifthere is some common thread i think it would be an advantage for the wikipedia asthma article to be extended regarding the psychological and psychiatric consequences of these powerful drugs acting intensely on the human nervous system many of which were in there infancy of drug research.Breatheasy (talk) 08:48, 9 November 2008 (UTC)


 * Just to help with above (and thanks for signing up as a registered user) - INNs of above brands are:
 * Alupent = Orciprenaline
 * Theodur = theophylline is still in the British National Formulary (also see aminophylline which being more water soluble is/was used iv in status asthmaticus, see, as well as a slow release tablet Phyllocontin Continus used in routine control of asthma and COPD)
 * Tedral = combination of Theophylline/Ephedrine/Phenobarbital (see ).
 * Theophylline and Phenobarbital articles mention CNS side effects (confusion being most important). As for psychiatric side effects - see (abstract fails mention which antiepileptic considered) and  in talking about newer anti-epileptics points out problem of cause/effect/co-incidence in neurological/psychiatric areas.  indicates that phenobarbitone was used in the psychiatric treatment of elderly, so quite what psychiatric effects phenobarbitone might have on a mentally-well asthmatic has to be wondered at (I quite agree dangerous to assume nothing as clearly a psychoactive medication).  title looks interesting, but no online abstract.
 * Final point to bear in mind is that these older medications proved less effective for the control of asthma (and to some extent had problems of narrow therapeutic index of safety) and chronic disease states, in themselves, reduce the mental (as well as physical) well being of patients, so difficult to assess a potential problem of an older drug from the poorer asthmatic control (especially as severe asthma would not be treated with just one drug, but rather usually several drugs co-administered) - anyway I await outcome of your further historical research into this :-) David Ruben Talk 03:00, 17 November 2008 (UTC)

Metabolic Acidosis
is an older paper that addresses a question that's puzzled me for some time: why do some asthmatics have a lactic acidosis? Unsure if we need to touch on this, and we'd need a better source, but the concept exists. Alternatively, I understand that some bronchodilators can cause lactic acidosis in high doses. JFW | T@lk  08:31, 2 November 2008 (UTC)


 * Agree many hits for PubMed search of "asthma acidosis" 247hits and more selective "asthma lactic acidoisis" 40 hits. But I'm not sure how great the issue is in terms of notability (ie how rare) and appropriate weight.
 * From this summer: (with full link) "Metabolic acidosis secondary to lactic acidosis may occur in acute, severe asthma and its presence suggests that respiratory muscle fatigue and tissue hypoxia play a major part in the pathogenesis. Non-anion gap metabolic acidosis (NAG acidosis) has also been reported in acute asthma but its impact on the clinical outcome has not been evaluated."
 * Case report from April 2008 (with full link) "Acidosis promptly reversed on discontinuation of inhaled beta-agonists.", and abstract-only of further Feb 2007 reports  and a discussion from Nov'07
 * Abstract without direct access to full article of 'An under-recognized complication of treatment of acute severe asthma' "This patient had lactic acidosis as a direct effect of administration of salbutamol."
 * So seems researchers in part suggest salbutamol and in part from the respiratory distress of the attack itself - would need be careful summarising the research without risk of WP:SYN.
 * BNF only warns of hypokalaemia for high use of salbutamol particularly in conjunction with theophylines, corticosteroids, diuretics and hypoxia. David Ruben Talk 14:55, 3 November 2008 (UTC)


 * Metabolic acidosis in asthmatics can have many etiologies: In the article Metabolic acidosis in severe asthma: Is it the disease or is it the doctor? in Pediatric Critical Care Medicine - Volume 8, Issue 6 (November 2007), it's pointed out that 1) respiratory muscle fatigue, 2) high dose beta agonists (for example as tocolysis) 3) other therapies such as steroids, epinephrine, and other drugs used in status asthmaticus have the effect of causing hyperglycemia and an increase in pyruvate > lactate formation, and 4) tissue hypoxia will all produce lactic acidosis, though the method of action in each case is different. It's suggested that the aggressiveness of initial treatment, especially in children, may correlate to the degree of metabolic acidosis. A metabolic acidosis will of course contribute to feelings of shortness of breath, and will actually increase breathlessness in a person in exacerbation. 216.174.136.2 (talk) 03:05, 10 March 2009 (UTC)

Azma.com
Over the past month, three named accounts and three IPs have repeatedly inserted links to http://www.azma.com. The method of insertion has varied from simple addition as an external link to the insertion of three paragraphs of 'content' describing that site's services. These additions have been reverted thirteen times. Discussions have ensued here and here. The promoters of the link (clearly most, if not all, are employees of that company, if not all the same person as well) argue that the site provides valuable 'asthma trend statistics'. I feel this amounts to air quality (pollution and pollen) forecasting that is available from any weather forecasting service. Concerns about copyright issues and COI (company contracts with pharmaceutical and homeopathic product manufacturers) were brought up as well. Further opinions requested. Maralia (talk) 16:13, 26 November 2008 (UTC)
 * Like others, I have deleted this link, and some text from the same source, a couple of times over the last week or so. I did so because it seemed a clear case of spam. Reading the discussions you refer to above (which I had not previously seen), I am quite convinced that I was right to delete on sight. It seems clear that the anon editor is concerned mainly to promote his/her company and its service. No doubt it is a fine company. No doubt it does a good job. But Wikipedia is not an advertising site. <b style="color:darkblue;">SNALWIBMA</b> ( <b style="color:#2F4F4F;">talk</b> - <b style="color:#2F4F4F;">contribs</b> ) 16:36, 26 November 2008 (UTC)
 * I also agree that this link should not be included. I've requested that it be added to User:XLinkBot's list.  This would give us automatic reversals from IP spammers, which should significantly reduce the load on this article's editors.  WhatamIdoing (talk) 18:03, 26 November 2008 (UTC)

I think azma.com will help Asthma patients deal with this chronic condition, I hope we can get mentioned someday on wikipedia Asthma Page

We make a unique US daily map and have a database of trends by zip code there is no other site doing this for just Asthma related air quality. azma.com is very unique and the only site of its kind, we get constant good feedback from users. SDI Health is affiliated with the Asthma and Allergy Foundation of America and listed on their front page. I had hoped listing azma.com on Asthma Wikipedia page would be helpful, sorry if too self serving for this Article. http://www.sdihealth.com/ http://www.azma.com/ 207.106.86.85 (talk) 19:20, 26 November 2008 (UTC)


 * Thanks for your understanding note. A link to azma.com does not appear to be in compliance with our guidelines for external links.  Additionally, since you're part of the company, then you shouldn't add your own links to anything, because it's a conflict of interest.  If it seems relevant to a particular article, then you could leave a note on the talk page to explain why you think it's a good idea.  WhatamIdoing (talk) 19:25, 26 November 2008 (UTC)

Asthma,Not One Disease
This article starts from the premise that asthma is a single disease. In contrast, argues that asthma is several diseases that share a cluster of signs and symptoms, and hence that effective treatment depends on distinguishing which underlying disease is responsible. Is there enough evidence for this view to merit rewriting this article? I expect such a rewrite to involve a lot of reorganization, but rather little new content otherwise. --Una Smith (talk) 04:19, 6 December 2008 (UTC)

Perhaps you are confusing asthma with COPD. Asthma is not a disease but a medical contition, as is the condition of not being an asthmatic. The use of the word ASTHMA before the condition was discovered about five decades ago was for a symptom of what i think you would now call COPD or pneumoconiosis —Preceding unsigned comment added by 87.80.103.44 (talk) 18:52, 7 May 2009 (UTC)

What Happened To The "Cough Variant Asthma" page
I have found general articles on Asthma to be useless to me. After 14-ish years of a chronic, re-occurring cough, I was finally diagnosed as having Cough Variant Asthma. Immediately after the diagnosis, upon my return home I _THOUGHT_ that I had wiki-ed 'Cough Variant Asthma', and read a very useful article. It's now gone. Is my memory wrong? If not, and it's been merged into the main Asthma article, then I CONSIDER THIS TO BE NOTHING LESS THAN VANDALISM. Please restore the 'Cough Variant Asthma' article, or correct my memory. LP-mn (talk) 16:37, 14 December 2008 (UTC)


 * The cough-variant asthma article existed for 30 minutes somewhere in October before someone redirected it. As it clearly deserves its own article, I restored it as a stub; feel free to improve this stub! --Steven Fruitsmaak (Reply) 17:18, 14 December 2008 (UTC)

Hmmmm... Maybe I was wrong. I clearly remember a MUCH longer article. Huh. I'd be willing to swear that I looked at Wikipedia first. 67.220.13.180 (talk) 21:15, 14 December 2008 (UTC)

Well. just noticed this and I am currently having an asthma attack, so I will work on this section in the next few days. —Preceding unsigned comment added by Sbcaes (talk • contribs) 11:18, 4 October 2009 (UTC)

Cough-Variant asthma is not really an official diagnosis, since it stems from the outdated belief that asthmatics wheeze. In fact, coughing is mentioned specifically by most rapid asthma assessments as a sign of poor control -- it's an unofficial descriptor but not a separate disease with its own separate ICD-10 code. Wrin (talk) 09:48, 27 January 2010 (UTC)

Adding information about new device to "asthma" topic
Hello, I am from Russia, and I was trying to edit the article about asthma by adding there information to the "non-medical treatments" subsection; the information was about Frolov's device, which is about another respiratory training technique, like Buteyko method, which also originates from Russia and is already mentioned. After a few minutes the information was deleted as possibly promotional. Please help me post the information because I believe that it is no more promotional than the information about Buteyko. A lot of people in Russia do get better after using the device, it sells in almost every Russian chemist shop, and I am sure that in Russia more people know Frolovs than Buteyko (if you need evidences on this, please let me know which, and I will work towards submiting them). This is why I believe that it deserves being mentioned.

Folki (talk) 05:25, 15 December 2008 (UTC)


 * Hi,


 * After searching PubMed and Google Scholar, I found no reputable international scientific journals reviewing this method (contrary to the Buteyko method). Therefore, I don't think we should include it in the article. See WP:MEDRS for more information.


 * --Steven Fruitsmaak (Reply) 19:09, 15 December 2008 (UTC)

Cut short medical subsection
The details of Long acting Beta agonists is long.It may be cut short.

Nishanthb (talk) 07:22, 15 February 2009 (UTC)

Pregnancy
Is this sentence really necessary? "Some women also experience a worsening of their asthma during pregnancy whereas others find no significant changes, and in other women their asthma improves during their pregnancy." Some women are affected, some aren't, and some are affected the other way. Surely this doesn't need spelling out. Merpin (talk) 22:19, 4 March 2009 (UTC)


 * I'd actually vote to keep it in the article. Some asthmatics can go from being in the intensive care unit with status asthmaticus every three months to completely symptom free while pregnant. On the other hand, some asthamtics haven't had symptoms since they were kids and suddenly need ICU stays while pregnant. The dizzying change the disease can undergo while one is pregnant deserves mentioning; sometimes it gets worse, sometimes it gets better, and sometimes it stays the same. This may seem self-explanitory but in reality it can mean some serious asthmatics can go off of some of their medications while pregnant whereas some mild asthmatics may have to re-start medications they haven't used in years. I think it's worth mentioning that previously stable asthma can change drastically in the face of pregnancy. IIRC the statistics are about 1/3:1/3:1/3 (worsen:stay the same:improve) Wrin (talk) 03:11, 10 March 2009 (UTC)

Does this article merit a rewrite?
I find this article to be lacking in several ways. First, it does not have a clear 'flow', with several subheadings devoting time to tangentially explaining things which are covered in other subheadings. These subheadings should be reorganized to reflect their titles so that the article has a clear and understandable train of thought.

Second, I find this article to be very vague at differentiating between asthma in a steady-state (which is after all a chronic disease unto itself even in the absence of acute exacerbations) and asthma in the acute state. Symptoms are different for each state, with even acute exacerbations being classifiable into mild/moderate/severe/near death categories. I feel there's too much confusion between 'mild' asthma and a 'mild' exacerbation or 'severe' asthma and a 'severe' exacerbation.

I've already made some edits to the page. I removed a couple of mentions of stridor as a symptom of asthma, since asthma is an obstruction of the lower respiratory tract (lungs) and stridor is a sign of an upper respiratory tract infection. Additionally, some diseases such as vocal cord dysfunction sometimes present with stridor but are easily confused with asthma in those inexperienced at differentiating the polyphonic noise of a wheeze and the very monophonic noise of inspiratory stridor. I also removed reference to the 'blue bloater' as this is a phrase that's colloquially used to describe polycythemic COPD patients, not asthmatics.

I tried to rewrite the introduction to flow a little better, but then found repetition lower down in the page. As the peer review indicated, repetition is a problem on this page. Perhaps the introduction should be limited to a definition of asthma, cited from literature, and the rest of the text should be allowed to stand on its own to explain what is only briefly glossed over in the present incarnation of the introduction. Wrin (talk) 23:46, 10 March 2009 (UTC)

Freud and ashtma
About the freudian "explanation" for ashtma, the article is too short.Agre22 (talk) 17:33, 12 March 2009 (UTC)agre22

Why can I not print this article after page 16?
My sister in law was just taken to the hospital with an asthma attack and I'm trying to learn about this condition. I wished to print out the full Wikipedia article on "Asthma" (except for the ending source listing).

However, there are some pages that will not print. I can't print pages 14, 17 and 18! Page 13 ends with the title "Treatment" and Page 16 ends with the title "Non-medical treatments". I am unable to print the one, and two, respectively, following pages. If I was into conspiracies, I would suspect some vague "medical establishment coverup"!!!

Even "print preview" shows up blank for these three pages. Is there somewhere other than this discussion page where I should bring this up? It is odd, to say the least. —Preceding unsigned comment added by FTWillie (talk • contribs) 17:13, 16 March 2009 (UTC)
 * I don't have this problem in Firefox, but I am able to reproduce it in Internet Explorer. Looking into it now. Maralia (talk) 17:27, 16 March 2009 (UTC)
 * I copied the Treatments subsection into another page and tested print preview in IE again. It repeats the behavior—some blank pages—but at entirely different points in the text, which tends to point to IE as the problem, rather than some anomaly in the article formatting. Short of changing browsers, a workaround would be to go to the article and click the 'PDF version' link (in the left sidebar, under the heading 'toolbox') to create a downloadable PDF version of the article. The PDF should print properly, and will probably look much better to boot. Maralia (talk) 17:40, 16 March 2009 (UTC)

Thank you -  PDF worked great and I should have thought of that! FTWillie (talk) 17:48, 16 March 2009 (UTC)FT Willie

The use of the word ASTHMA
I think i have found a couple of instances in the text of the article of the word being used to mean ASTHMA ATTACK. There is already much confusion about the use of the word ASTHMA and dropping the word ATTACK from the term ASTHMA ATTACK can only add to it. The word ATTACK should be replaced wherever it is missing. —Preceding unsigned comment added by 87.80.103.44 (talk) 19:09, 7 May 2009 (UTC)

Hyperventilation is found in 100% of tested asthmatics
Several clinical studies found 100% prevalence of hyperventilation in asthmatics (all asthmatics breathe heavy or more than the medical norm) and breathe even more during asthma attacks. These facts and references should be included in the Causes section. Breathing can be controlled by humans, using direct and indirect means, 24/7. (Artour2006 (talk) 12:31, 12 August 2009 (UTC))

Are you surgesting that asthmatics can cause asthma morbidity to rise just by breathing??? 87.80.103.44 (talk) 15:46, 31 August 2009 (UTC)


 * There is indeed a prevalence of over-breathing amongst people with asthma, this has been confirmed many times. And yes, a person with asthma can directly affect their symptoms by the way they breathe. This is a key principle of the Buteyko technique, and has a physiological explanation - by hyperventilating too much CO2 is blown out, which upsets the natural balance within the lungs. Logicman1966 (talk) 23:53, 4 October 2009 (UTC)

Secondary Symptoms
Although I know the secondary symtoms should not be listed in the article, I think there should be in its own section a list of links to articles where the secondary symtoms of asthma and asthma attacks are listed as primary symtoms of what the articles are about. (87.80.103.44 (talk) 15:59, 31 August 2009 (UTC))

Brittle asthma merge?
Brittle asthma has been recently found wanting, including for quality of references and evidence of notibility as a separate article. I've added some reliable sources for the view that it is a distinct phenotype, and for the division into 2 types. It clearly needs further work. Whether it is best left as a separate article or merged into main asthma I am unsure (certainly 'asthma' does not seem to mention 'brittle asthma').

Discussion at Talk:Brittle asthma. David Ruben Talk 02:44, 18 January 2010 (UTC)

The disease and its dietary concern...Repost...
--124.78.212.48 (talk) 07:37, 19 January 2010 (UTC)
 * http://scholar.google.com/scholar?hl=en&q=allintitle%3A+asthma+diet&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--124.78.212.48 (talk) 07:38, 19 January 2010 (UTC)
 * http://scholar.google.com/scholar?hl=en&q=allintitle%3A+asthma+dietary&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

Disclaimer If the contents in the above links are involved in Glycemic index, Glycemic load and Insulin index, please ignore them as the measures have been questioned --222.64.218.235 (talk) 09:41, 20 January 2010 (UTC)

Does identifying the sound as "Stridor" rule out the asthma attack.
A sound made upon breathing from inside a person during breathing dificulties might be called wheasing or it might be a different sound called stridor. If that sound is found to be stridor rather than wheasing, Does it rule out the posibility of an episode of asthma being a factor in the breathing dificulties? Does it rule out any or all other posibilities? These are not mutually exculsive, It is concivable that an asthma attack and a dissease that has infected a part of the lungs may have a combined effect. I am inclined to think that identifing the nature of the sound cannot rule out an asthma attack being a factor but I am not at all sure about this and I can't work out exactly what the mention of stridor in the article means in relation to this, and I think the acticle could do with some clarification in regards to what it calls "stridor". (87.82.64.107 (talk) 16:20, 11 February 2010 (UTC))
 * I am not an expert but as I understand it stridor and asthma are entirely unrelated. Whereas the wheezing asociated with asthma is a lower respiratory tract expiratory effect stridor is primarily an upper respiratory tract inspiratory effect. The two are not mutually exclusive and indeed entirely independant of one another. --LiamE (talk) 01:27, 14 February 2010 (UTC)

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

The association between the topic and pet.....
--58.38.47.48 (talk) 09:34, 27 March 2010 (UTC)
 * http://scholar.google.com.hk/scholar?hl=en&q=allintitle%3A+asthma+pet&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--58.38.47.48 (talk) 09:36, 27 March 2010 (UTC)
 * http://scholar.google.com.hk/scholar?hl=en&q=allintitle%3A+pet+allergic+asthma&btnG=Search&as_sdt=2000&as_ylo=&as_vis=0

--58.38.47.48 (talk) 09:46, 27 March 2010 (UTC)
 * http://scholar.google.com.hk/scholar?as_q=rhinitis+cat&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

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


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


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

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

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


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


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

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

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

Splitting off a section
Wondering if we should split off Acute asthma exacerbation? We have subsections discussing it in many sections and lot of references deal with it seperately. We could than summarize that page and add it as a subsection to the classification section. Doc James (talk · contribs · email) 18:20, 20 May 2010 (UTC)
 * I'm not convinced that the amount of information in this article about asthma exacerbation is enough to justify a subarticle. Axl  ¤  [Talk]  07:37, 21 May 2010 (UTC)

Confusion
Overall this article is confused, and the absence of an actual understanding of the mechanism behind the disease is not clearly enough set out. Whilst this may be an accurate reflection of the medical/science community's state of mind in respect of asthma, it unhelpful to the general reader. Would an expert please clearly state that the disease is not properly understood in the same way as say, influenza is, as this would considerably reduce the pain caused to the reader by the article.--Muinchille1 (talk) 13:45, 30 June 2010 (UTC)

Fact and Citation Check
(Part of the WikiProject Medicine effort)

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


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


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

Background section
First paragraph:
 * This would be a good area to introduce the three reports mentioned in the General Suggestions.
 * Okay, I have referenced those reports in the first couple of paragraphs. Axl  ¤  [Talk]  09:48, 20 May 2010 (UTC)

Second paragraph:
 * The medicines used to treat asthma can be cited by the Merck Medical Manual | found here as well as the NHLBI 2007 report mentioned in the General Suggestions.
 * I have referenced the individual medications. Axl  ¤  [Talk]  10:03, 20 May 2010 (UTC)


 * The statement about monoclonal antibodies is referenced in the NHLBI 2007 report, but this report does not mention mepolizumab by name.
 * I removed mepolizumab. It shouldn't be mentioned in the lead. Axl  ¤  [Talk]  10:03, 20 May 2010 (UTC)

Third paragraph:
 * The percentage of the US population affected is based on a dated report. Page 1 of the NHLBI 2007 report states that 22 million Americans suffer from asthma.
 * I do not have a citation to offer for the number of British people with asthma.
 * I added a reference. Axl  ¤  [Talk]  15:40, 4 July 2010 (UTC)


 * The number of worldwide cases is found in the GINA report listed in the General Suggestions and on the WHO website |here. These reports will be more accessible than the primary literature reference that is currently being used.
 * The CDC says the number of deaths in the US is actually at 3,613.

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

Classification section
Table:
 * The last column should say FEV1 variability (not FEV variability1).
 * Fixed. Axl  ¤  [Talk]  17:38, 20 May 2010 (UTC)


 * Intermittent nighttime symptoms should be less than ‘’or equal to’’.
 * Fixed. Axl  ¤  [Talk]  17:41, 20 May 2010 (UTC)


 * Intermittent and Mild Persistent %FEV1 of predicted should both be greater than ‘’or equal to’’.
 * Fixed. Axl  ¤  [Talk]  17:44, 20 May 2010 (UTC)

First paragraph:
 * FEV1 should be defined here (Forced expiratory volume in 1 second).
 * Done. Axl  ¤  [Talk]  17:46, 20 May 2010 (UTC)

Brittle asthma
Second paragraph:
 * The Ogorodova et al. citation is in Russian and should be removed. The other citation is sufficient for this paragraph.
 * Done. Axl  ¤  [Talk]  18:04, 20 May 2010 (UTC)

Signs and symptoms
Table:
 * A peer reviewed or more well-established source would be better for a chart of this importance.
 * Table changed. Axl  ¤  [Talk]  09:16, 9 June 2010 (UTC)

Asthma attack
First paragraph:
 * The statement on inaudible wheezing comes from the same source as the table in Signs and Symptoms and should be updated. The textbooks ‘’Murray & Nadel's Textbook of Respiratory Medicine’’ and ‘’Oxford Textbook of Medicine’’, both previously used in this article, would be fine to use here, and both would sufficiently cover this entire section.
 * I changed the reference. Axl  ¤  [Talk]  09:20, 9 June 2010 (UTC)

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

First paragraph:
 * The citation for environmental smoke is okay, but might be difficult for some people to access. The NHLBI and the CDC website would be better sources
 * I changed it to GINA. Axl  ¤  [Talk]  07:10, 11 June 2010 (UTC)


 * The GINA report also mentions ozone as a cause of asthma.
 * I added the reference. Axl  ¤  [Talk]  07:15, 11 June 2010 (UTC)

Caesarean section paragraph:
 * This citation is also a primary source. The British Thoracic Society study mentioned above covers this association and is easier to access (page 72).  Because it ties in to the hygiene hyptothesis, I suggest moving this paragraph down below the antibiotics paragraph.
 * Done. Axl  ¤  [Talk]  10:57, 16 June 2010 (UTC)

Hygiene hypothesis:
 * This hypothesis is explained on page 17 of the ‘’Harvard Medical school guide to taking control of asthma’’.
 * I put a better reference in. Axl  ¤  [Talk]  17:30, 22 June 2010 (UTC)


 * There is no source listed for the link between asthma and cleaning products.
 * It looks like someone has removed that info from the text. Axl  ¤  [Talk]  16:39, 21 June 2010 (UTC)


 * This hypothesis is also mentioned in more detail below. Perhaps that section could be mentioned here.
 * I added a link. Axl  ¤  [Talk]  10:16, 24 June 2010 (UTC)

Viruses and Asthma:
 * There was no mention of these specific viruses in any of these sources. If this sentence is to remain, a source needs to be found.
 * I have corrected this. I removed the statement about those unreferenced viruses. Axl  ¤  [Talk]  10:22, 30 June 2010 (UTC)

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

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

Exacerbation
First paragraph
 * The citation takes you to the wrong section of this website. |This would be better.

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

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

First paragraph:
 * The increased incidence of hay fever and asthma was not verified by the cited source.

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

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

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

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

Socioeconomic factors
General:
 * Page 366 of the NHLBI 2007 report covers this topic and could be cited in this section.

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

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

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

Pathophysiology
Figure: This figure may need a citation.

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

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

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

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

Differential diagnosis
Second paragraph:
 * The citation used here (Hargreave, FE; Parameswaran K (August 2006)) does not include aging or family history. A better citation should be used.

Third paragraph:
 * A medical text book would be a good reference.

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

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

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

Leukotriene and Mast cell stabilizers:
 * These sections are directly from the Merck Manual. They need to be rephrased.
 * The NHLBI 2007 report covers these drugs on page 213.

Antimuscarinics/anticholinergics:
 * Smokers lung/emphysema are covered in the NHLBI 2007 report on page 248.

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

Allergy desensitization: Omalizumab:
 * This is discussed in a CDC study on Environmental triggers of asthma - http://www.atsdr.cdc.gov/csem/asthma/docs/asthma.pdf page 35
 * No information was found on regular injections. This drug is discussed on page 32 of the GINA report and page 213 of the NHLBI report.

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

GERD:
 * Discussed on page 49 of the NHLBI and in the Merck Manual

Chronic sinus disease:
 * Discussed on page 63 of the GINA report.

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

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

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

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

Second paragraph:
 * According to the |CDC, the term fast-acting should be quick relief.

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

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

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

First paragraph:
 * The citation used here does not cover loss of consciousness. The Merck Manual does include this symptom.

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

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

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

Epidemiology
Chart:
 * I could not find this chart using the citation.

Second paragraph:
 * The increased prevalence in westernized countries is also covered on page 21 of the NHLBI 2007 report.

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

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

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


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

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

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

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

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

which can be accessed on:

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

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

All contentious suggestions should be discussed here by active editors until a consensus is reached and an editor agrees to make the proposed changes. I will not be making direct edits before this review is posted and discussed unless:
 * there are missing, inaccurate, or unreliable sources in the reference list or
 * there is ‘medical’ information that could be harmful or misleading to the public at large.

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

Useful references & links

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

BSW-RMH (talk)

General comments
There are four priority issues for this article:
 * Improve the introductory material
 * Fix broken citation links and add references for missing citations
 * Expand the History section subtantially
 * Expand most other sections to be comprehensive

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

BSW-RMH (talk)

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

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

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

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

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

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

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

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

Classification
This section should be expanded to explain that while Asthma is classified based on severity, at the moment there is no clear method for classifying different subgroups of asthma beyond this system, though it is clear there that different subgroups exist. Finding ways to identify these groups is a current critical goal of Asthma research:
 * “Taken together these studies emphasize that there is a heterogeneous group of patients with severe asthma, not all of whom can be controlled with the current medication arsenal that is endorsed by the guidelines.”
 * ”In the fall of 2009, the new NHLBI-sponsored multicenter asthma clinical trials network AsthmaNet began designing novel protocols to . . . identify novel composite asthma phenotypes that will impact clinical asthma care in the future. Understanding asthma heterogeneity is crucial to allow development of responder profiles or to identify patients at risk for individual medications in the future. After all, the challenge is to find the right medication for your severe asthma patient in the future.”
 * Moore WC, Pascual RM. Update in asthma 2009. Am J Respir Crit Care Med. 2010 Jun 1;181(11):1181-7. Review. No abstract available.

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

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

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

“Presently, no precise physiologic, immunologic, or histologic characteristics can be used to definitively make a diagnosis of asthma, and therefore the diagnosis is often made on a clinical basis related to symptom patterns (airways obstruction and hyperresponsiveness) and responses to therapy (partial or complete reversibility) over time.”- This quote gives a clear overview of the diagnostic approaches for Asthma.
 * Lemanske RF Jr, Busse WW. Asthma: clinical expression and molecular mechanisms. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S95-102. Review.

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

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

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

KEY INDICATORS FOR CONSIDERING A DIAGNOSIS OF ASTHMA: Consider a diagnosis of asthma and performing spirometry if any of these indicators is present. These indicators are not diagnostic by themselves, but the presence of multiple key indicators increases the probability of a diagnosis of asthma. Spirometry is needed to establish a diagnosis of asthma.
 * Wheezing—high-pitched whistling sounds when breathing out—especially in children. (Lackof wheezing and a normal chest examination do not exclude asthma.)
 * istory of any of the following:
 * Cough, worse particularly at night
 * Recurrent wheeze
 * Recurrent difficulty in breathing
 * Recurrent chest tightness
 * Symptoms occur or worsen in the presence of:
 * Exercise
 * Viral infection
 * Animals with fur or hair
 * House-dust mites (in mattresses, pillows, upholstered furniture, carpets)
 * Mold
 * Smoke (tobacco, wood)
 * Pollen
 * Changes in weather
 * Strong emotional expression (laughing or crying hard)
 * Airborne chemicals or dusts
 * Menstrual cycles
 * Symptoms occur or worsen at night, awakening the patient.

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

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

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

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

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

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

Management
This sections requires expansions to be comprehensive. An overview of disease management before jumping into details of medications would be useful here. patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained
 * Assessment and monitoring, obtained by objective tests, physical examination,
 * Education of patient about the condition
 * Control of environmental factors that affect asthma
 * Pharmacologic therapy

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

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

History
This reference has an extensive section on the history of Asthma:
 * National Asthma Education and Prevention Program (NAEPP). Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute; 2007.http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

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

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

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


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

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

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

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

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

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

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


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


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


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

Associated Comorbidities
Do you think the associated comorbidities deserves its own section or should be merged with prognosis or management (I could see it possible going in management but I think it would needlessly clutter that section). I put a skeleton there based off of the Gibson Lancet review article (which I've used pretty extensively for the COPD section as well) because I think those complications are directly relevant to asthma. If you think its worth it I (or whomever) can extend those sections. Kallimachus (talk) 12:26, 19 September 2010 (UTC)
 * I would say that it deserves it's own section, there are enough sources to make it a valid effort. Ronk01   talk  18:59, 22 September 2010 (UTC)
 * I have very WP:BOLDly moved some information pertaining to steroid use to the Management section. Increased risk of cataracts and osteoporosis/loss of bone mineral density are not comorbidities per se, but adverse effects of long-term corticosteroid treatment. The other two mini-sections (on GERD and sleep disorders) can probably be fleshed out from other sources. Fvasconcellos (t·c) 00:22, 10 October 2010 (UTC)
 * I think there ought to be a distiction between things that have a co-morbidity with asthma attacks (i.e. things that occur at around the same time in the same individuals) and things that have a co-morbidity with the people that have had asthma attacks and survived. Remember asthma attacks can be fatal.82.44.45.118 (talk) 14:20, 9 October 2010 (UTC))

This goes against other text
Since an increase in an inhaled corticosteroid (ICS) can cause a high chance of adverse drug reactions, it is found beneficial to add a LABA to an ICS regimen for long term control when symptoms increase, instead of increasing the dose of the ICS. ref Self, Timothy. Chrisman,Cary. Finch, Christopher. "Applied Therapeutics: The Clinical Use of Drugs, 9th Edition" Philadelphia: Lippincott Williams & Wilkins, 2009. Chapter 22 (Asthma)

Does anyone have a link / access to this book? ICS do not cause a high chance of adverse drug reactions. Thus removed. Doc James (talk · contribs · email) 01:16, 28 October 2010 (UTC)


 * Hmm, depends how you define "high chance of adverse drug reactions". In this context, I suppose that it refers to "side-effects". In any case, the statement is misleading and best removed. Axl  ¤  [Talk]  10:58, 3 November 2010 (UTC)

Environmental causes?
GINA is given as a reference for saying passive smoking is a cause of asthma. I've done a search there and can't find it. Editor/author, more explicit reference? —Preceding unsigned comment added by RayJohnstone (talk • contribs) 15:32, 29 November 2010 (UTC)
 * You are right. In any case, this maternal smoking isn't "passive smoking" in the conventional sense. I have changed the sentence to fit with the GINA reference. Axl  ¤  [Talk]  10:55, 30 November 2010 (UTC)

Asthma is one of The Bodies Protective Mechanisms
I'm not sure if this idea of "Asthma is one of The Bodies Protective Mechanisms" can go onto the main article at this time may be in the future when there is more reseach, but I do feel it has a place on the discussion page. This idea is from the work of Doctor Buteyko, here is the link to one of his translated Buteyko Breathing Charts he used in teaching the Buteyko method: The Bodies Protective Mechanisms —Preceding Alexspence (talk • contribs) 15:46, 5 December 2010 (UTC)

Buteyko method
The Buteyko method should be considered for further investigation for its importance on this page. It only has one board's opinion which, for an unrelated reason, makes it not considered an important factor in treatment of asthma. The Buteyko method has been reported to have a greater than 90% rate for curing asthma completely and yet this has not been posted on this page. The bohr effect should also be referred to on this page. — Preceding unsigned comment added by Tim-J.Swan (talk • contribs) 13:57, 23 June 2011 (UTC)


 * The Buteyko method is not supported by clinical evidence ( suggests some symptomatic control but no change on bronchial dynamics, is negative). In acute severe asthma, relying on Buteyko-based techniques carries a theoretical risk of severe harm.
 * Before mentioning any non-recommended alternative treatment one would need to demonstrate that it is used widely. attempts to do this, but it is much too small scale to use as a reliable source.
 * Perhaps you could identify a secondary source that mentions alternative approaches to asthma. This would probably be suitable. JFW &#124; T@lk  14:38, 23 June 2011 (UTC)


 * 10.1503/cmaj.090089 (CMAJ 2010) has the following:
 * Many patients with severe asthma also turn to alternative medicine. The approaches range from chiropractic to breathing exercises. There is a paucity of studies of these treatments, but to date the evidence indicates that none are efficacious (Table 1).
 * Table 1 does not mention Buteyko by name, despite referencing . JFW &#124; T@lk  14:42, 23 June 2011 (UTC)

New treatments
Radio reports in June 2011 mentioned a new treatment for asthma. ACEOREVIVED (talk) 20:59, 8 June 2011 (UTC)


 * Do you recall what it was? JFW &#124; T@lk  23:42, 9 June 2011 (UTC)


 * I think it's likely to have been bronchial thermoplasty http://www.bbc.co.uk/news/uk-13690102 --Truthflux | talk 09:32, 10 June 2011 (UTC)


 * Thanks.
 * So someone is doing a clinical trial, and it's made the news. It seems obvious that this is not yet used in routine practice, and the news writers have hyped it up again, as usual: "Tens of thousands of patients across the UK with the most severe forms of asthma stand to benefit most from the treatment." That is, if it works and doesn't cause horrendous complications like delayed tracheal stenosis. JFW &#124; T@lk  09:58, 10 June 2011 (UTC)


 * I work for the company that developed the Alair system that delivers Bronchial thermoplasty treatment so I have a conflict of interest, but I do believe more information on Bronchial thermoplasty(BT) including more information on role of smooth muscle and asthma is warranted. Bronchial thermoplasty is approved by FDA (2010) for severe persistent asthma. BT was studied in 4 clinical trials 3 of which were randomized and one was double blind. BT is being performed in well over 65 centers in the US, Europe, and Canada, with more being added all the time. I guess it is not "routine" but it is widespread in its use. Bronchial thermoplasty has been performed on over 400 patients including the clinical trials. There is 5 years of safety data and persistence of effect out to 2 years published in major journals. The complications are generally minor and transient in nature. No stenosis has ever been seen, especially tracheal stenosis as mentioned above, treatment in not performed in trachea, it is performed in all airways 3mm and larger distal to mainstream. please let me know if you have any questions. Yes there is also another clinical trial called PAS2 PAS2 as a Condition of Approval of the PMA for the Alair System, the FDA requires Asthmatx to generate data to assess the durability of the BT treatment effect as well as safety data in the intended use population in the United States.Webste29 (talk) 22:52, 1 August 2011 (UTC)
 * This is still a therapy in the early stages of clinical use. One or two sentences at most is all the coverage it should get here. Doc James  (talk · contribs · email) 23:05, 1 August 2011 (UTC)


 * It sounds like the exact place of this treatment is not yet clear. We could mention it (I have noticed that it's FDA approved), but perhaps in a "research directions" section. What we cannot suggest is that everyone with severe uncontrolled asthma is offered bronchial thermoplasty, because that is simply not the case.
 * As an encyclopedia, Wikipedia should not be predicting what might happen but describe what is currently happening. If secondary sources suggest that BT is a promising technique, then this is suitable for inclusion in the right context.
 * Webste29, can I commend you on disclosing your COI? JFW &#124; T@lk  08:51, 2 August 2011 (UTC)
 * I don't necessarily deserve to be commended, I am a new and naive user to the encyclopedia and Doc James has helped me understand the importance of COI, I had to learn the hard way when I began editing this entry. I just want BT to be mentioned clearly and fairly so there is no mis-information. The severe persistent asthmatic does not have alot of options and this is a new technique to help them that shows promise that is often misunderstood because it is so different. I will be happy to answer questions or provide links to literature or other information you may have. JFW I can even point you to the physicians that did some of our research in UK and Netherlands since i see you are in UK and from Netherlands Webste29 (talk) 15:54, 2 August 2011 (UTC)

Continuous Epinephrine
Research facilities are studying and implementing Continuous Epinephrine treatments given by Respiratory Therapists over 2 hour durations for emergency room patients experiencing severe asthma attacks along with IV magnesium. I am having difficulty finding sources for this, so any help would be appreciated .Je.rrt (talk) 02:02, 20 August 2011 (UTC)


 * This sounds like an experimental treatment that does not merit discussion in an encyclopedia article (see WP:NOTNEWS and WP:CRYSTAL). I would be very reluctant to let a respiratory therapist use a drug like epinephrine without at least a degree of input from a respiratory physician or critical care specialist! JFW &#124; T@lk  09:14, 21 August 2011 (UTC)
 * I couldn't find any references for this. Axl  ¤  [Talk]  22:54, 21 August 2011 (UTC)

I have ashma and I'm extremily overweaght. I came to North Dakota to visit my daughter. I'm breathing much better up here. I have aqlswo lost about 25 pds in a month and a half. I'm eating fresh grown vegtables up here. But my breathing is so good. I believe my good breathing is much the reson I'm losing weight. Could this bebthe reason. I normally live in FL. — Preceding unsigned comment added by 74.207.186.202 (talk) 19:49, 9 September 2011 (UTC)


 * We are not permitted to give medical advice to individuals, sorry. Axl  ¤  [Talk]  22:25, 9 September 2011 (UTC)

sometimes fatal
Anthony Shadid died sudenly at age 43 of an acute asthma attack according to New york times so perhaps this can be used to cite asthma is sometimes fatal? EdwardLane (talk) 17:55, 20 February 2012 (UTC)


 * I would not want to use the New York Times as a source for asthma deaths. There is sufficient WP:MEDRS-compatible literature. JFW &#124; T@lk  18:31, 20 February 2012 (UTC)


 * That's fair enough, but I never stumbled across those, and basically was a bit surprised to find no mention of anyone actually dying of asthma in the article. If you have some sources in the med journals and can reference those then it should probably get into the article EdwardLane (talk) 11:14, 21 February 2012 (UTC)


 * 10.1111/j.1398-9995.2004.00526.x is a bit dated, but covers this on an international level. JFW &#124; T@lk  22:18, 21 February 2012 (UTC)

History section
The "History" section could be significantly lengthened (improved) by using this source: http://www.nejm.org/doi/full/10.1056/NEJMra1102783 -- John Broughton  (♫♫) 14:53, 30 March 2012 (UTC)
 * Nice find. Will take a look at this eventually unless someone beats me to it.-- Doc James (talk · contribs · email) 17:35, 30 March 2012 (UTC)

Coagulation
These Dutch people review the influence of the coagulation system on asthma. It's from Blood so probably quite relevant, but I wonder why they didn't choose a respiratory journal! 10.1182/blood-2011-11-391532 JFW &#124; T@lk  17:46, 5 April 2012 (UTC)

A 2012 review
-- Doc James (talk · contribs · email) 23:52, 11 April 2012 (UTC)

OBVIOUS MISTAKE ALERT: There are Two "Hygiene hypothesis" Sections
1. Directly following the "Tobacco" section, not linked in the TOC.

2. Directly following the "Exacerbation" section, linked in the TOC. — Preceding unsigned comment added by 216.58.103.104 (talk) 05:33, 27 April 2012 (UTC)

My review of this article
I am a (health student) at (consumer reports). I am reviewing this article according to the instructions at WP:HealthReview.

I suggest changing the article in the following ways: I would add advice about not diagnosing and manageing asthma without spirometry.

I think that this article could be improved by adding this statement: Clinicians often rely solely upon symptoms when diagnosing and managing asthma, but these symptoms may be misleading and be from alternate causes. Therefore spirometry is essential to confirm the diagnosis in those patients who can perform this procedure. Recent guidelines highlight spirometry’s value in stratifying disease severity and monitoring control. History and physical exam alone may over- or under-estimate asthma control. Beyond the increased costs of care, repercussions of misdiagnosing asthma include delaying a correct diagnosis and treatment. These references support the above statement:

and ABIM Foundation logos, Thank you for your attention. Juna.keehn (talk) 14:59, 3 July 2012 (UTC)
 * National Asthma Education and Prevention Expert Panel Report Guidelines for the diagnosis and Management of Asthma. NIH Publication Number   Teor 2007.
 * J, Bernstein IL et al. Attaining asthma control. A practice parameter. J Allergy Clin Immunol. 2005;115:S3-11.
 * Global strategy for asthma management and prevention: GINA executive summary Eur Respir J 2008 31:143-178.
 * Fuhlbrigge A, Kitch B, Paltielet D et. al. FEV1 is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol. 2001;107:61-6.
 * Magadle R The Risk of Hospitalization and Near-Fatal and Fatal Asthma in Relation to the Perception of Dyspnea Chest. 2002;121:329-333.
 * Which of these references support which part of this text? Doc James  (talk · contribs · email) (please reply on my talk page) 13:46, 8 July 2012 (UTC)

causes
causes should have a new section to include the cause of Pot-room-asthma which is well known to develop in metal foundry workers particularly in aluminium foundries. It is caused by breathing in Hydrofluoric acid, as this is a known component of air-pollution it should also be listed as a contributing factor, if not significant cause, in its own right. Hydrofluoric acid as a gas will cause lung damage but it also causes air-way hyper responsiveness the hall-mark of asthma. — Preceding unsigned comment added by 220.101.92.239 (talk) 16:44, 10 July 2012 (UTC)

Intermittent Fasting
I added this section. It has been criticised, presumably for being from a "primary source". There is a considerable body of material about Intermittent fasting which includes secondary material, but I don't have time to find it now. Rather than submit to deletionist bias, I'd like to keep this text here. When we have a sufficient citation, it can go back in the article.

Intermittent fasting (eating very little on every second day) improved asthma-related indicators, peak expiration flow and other health indicators within 2 weeks of starting the routine.

Rixs (talk) 17:30, 20 August 2012 (UTC)
 * Sure once a review article is available per WP:MEDRS we can consider re adding it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:31, 20 August 2012 (UTC)
 * This is the paper. It is a case series of ten patients. They put ten overweight asthmatic patients on a diet and found that their asthma symptoms improved. This paper is totally unsuitable as a reference for Wikipedia. (The journal itself, "Free Radical Biology & Medicine", isn't the most inspiring either.) Axl  ¤  [Talk]  21:47, 20 August 2012 (UTC)
 * With a literature search, I didn't find any relevant material suitable for Wikipedia. Axl  ¤  [Talk]  22:00, 20 August 2012 (UTC)
 * Incidentally, research in the field of Intermittent fasting is an emerging area. I found out about it from a BBC documentary TV programme. The people that do this are mainly interested in aging but are discovering other benefits so this small study was an aside. -- Rixs (talk) 12:29, 21 August 2012 (UTC)

Is Asthma Treatment As Effective As Advertised?
I would like to comment on the statement in the introduction "Despite this, with proper control of asthma with step down therapy, prognosis is generally good.[13]"

First, the reference cited applies only to children. Second, a recent population-based survey from five European countries found that over half of asthma in adults remained not well controlled, even after treatment (see Demoly P, Gueron B, Annunziata K, Adamek L, Walters RD. Update on asthma control in five European countries: results of a 2008 survey. Eur Respir Rev 2010; 19:150-157).

Another relevant observation regarding asthma treatment effectiveness is that clinical trials used to support current guideline recommendations routinely exclude NINETY-FIVE PERCENT of all asthma patients (see Travers J, Marsh S, Williams M, Weatherall M, Caldwell B, Shirtcliffe P, Aldington S, Beasley R. External validity of randomised controlled trials in asthma: to whom do the results of the trials apply? Thorax 2007; 62:219-223 AND Herland K, Akselsen J-P, Skjønsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger "real life" population of patients with obstructive lung disease? Respir Med 2005; 99:11-19). One of the routine EXCLUSIONS is asthmatics who either currently smoke or who have consumed more than 10 pack-years of cigarettes in the past. Non-PHARMA studies fail to show any patient-important benefits in asthmatic smokers (by patient-important I mean fewer symptoms, better quality of life or decreased health care utilization) given inhaled corticosteroids (the mainstay of current asthma treatment). For supporting evidence, see: Hahn DL. Importance of evidence grading for guideline implementation: The example of asthma. Ann Fam Med 2009; 7:364-369.

Therefore, I suggest that the authors take a too sanguine view of the ability of current guideline treatments to control asthma.

CrescentRidge (talk) 21:19, 27 August 2012 (UTC)
 * Proper asthma treatment would include stopping smoking. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 21:53, 27 August 2012 (UTC)


 * CrescentRidge, you are right to point out that the reference is specific to children. The prognosis is children is better than the prognosis in adults. I have deleted the sentence.
 * The issue of whether adult patients have a good prognosis after "proper control" is arguably self-evident, depending on your definition of "proper control". If they have ongoing symptoms despite treatment, they don't have "proper control". Axl  ¤  [Talk]  23:13, 27 August 2012 (UTC)

Research section
The "research" section contained a single sentence on doxycycline, and has now started to attract primary research. I have temporarily removed it until one of us finds the time to start a section that can be said to faithfully represent current major research trends in asthma research. JFW &#124; T@lk  22:02, 2 October 2012 (UTC)

Refs
Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:56, 26 November 2012 (UTC)
 * GINA Guidelines updated to 2011 http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf
 * GINA Guidelines updated to 2011 http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf

Comments
James asked me to read the article and offer comments.
 * Intro: it would be helpful to inform the reader in a few words what atopic syndrome is (because a distinction is introduced). I would add systemic steroids and possibly phosphodiesterase inhibitors to the acute treatments, perhaps with the caveat that they are used in more severe acute asthma.
 * Added definition of atopy. The use of theophylline is controversial (which I have added). I do not think it is of great enough significance for the lead. Will add iv steroids and magnesium which has better evidence. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:47, 20 January 2013 (UTC)


 * Signs and symptoms: it might be better to expand this section a little. Normal asthma-related sputum is clear or yellow (and bursting with eosinophils), but the presence of green sputum is taken (in the BTS/SIGN guidelines) as evidence of bacterial bronchitis as a trigger. Perhaps the statement on comorbid psychological disorders could be expanded, in the sense that we don't know whether this is "chicken or egg" and which disorders in particular stand out.
 * There is evidence that sputum color says little about infection type. I am unable to find "green sputum" in the SIGN guideline. While add that it is typically mucous like. Added further details about psychological problems. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:08, 20 January 2013 (UTC)


 * Causes: the word "epigenetic" may benefit from a short explanation. In the "genetic" section, I believe the gene names may need to be italicised. I would rephrase the statement about Churg-Strauss, because to the best of my knowledge asthma is not associated with other forms of vasculitis.
 * Done Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:53, 20 January 2013 (UTC)


 * Pathophysiology: this section is awfully brief, and there is quite a lot more to be said about interactions between cell types and the various cytokines. It can be hard to present this stuff in a readable fashion for the layperson.
 * Agree, hate writing this section and would love some help :-) Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:53, 20 January 2013 (UTC)


 * Diagnosis: in the "classification" section the GINA definition should perhaps be moved to the introduction. In "exercise-induced asthma" it is unclear whether the 3% of bobsled racers have exercised-induced asthma or bronchoconstriction.
 * Agree and fixed the first one. They have changed the name of "exercise induced asthma" to "exercise induced brochoconstruction". Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:00, 20 January 2013 (UTC)


 * Prevention: no comments
 * Management: the opening paragraphs do not seem to distinguish between mild symptoms controlled with bronchodilators or acute exacerbations. While one can certainly be the heralding of the other, most sources treat these phenomena as distinct. I recall that LTAs are more useful in those with exercise-induced symptoms - is this reflected in the sources? I would be very cautious with bronchial thermoplasty - from what I've heard the initial response is worsening of asthma symptoms, and limited long-term data is available.
 * Have toned down the thermoplasty comments. And added more details regarding LTAs. They are still not first line in exercise induced symptoms and have not seen any sold evidence which supports a special use in this group. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:14, 20 January 2013 (UTC)


 * Prognosis: no comments
 * Epidemiology: the text contradicts the image, with African countries having a higher rate of asthma than many other countries. Is there an explanation why South Africa is so severely affected?
 * For most of Africa there is simply no data on frequency rates. South Africa of course is a semi first world country and thus one would expect rates similar to other semi first world countries. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:30, 20 January 2013 (UTC)


 * History: no comments, except for the fact that it leaves off in the 1950s and could still include some more modern developments
 * Hate writing history sections too :-) Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:30, 20 January 2013 (UTC)

Hope this helps. JFW &#124; T@lk  00:30, 2 January 2013 (UTC)

More comments
From the lead section, paragraph 2: "Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic) where atopy refers to a predisposition toward developing certain hypersensitivity reactions." Shouldn't this be type 1 hypersensitivity? I do not believe that the American Heritage Dictionary of the English Language is a suitable source for the definition of "atopy". Axl ¤  [Talk]  13:12, 20 January 2013 (UTC)
 * It appears that Dorlands has locked itself down and no longer gives e access. Do we have a better source to clarify this? Doc James  (talk ·contribs · email) (if I write on your page reply on mine) 13:16, 20 January 2013 (UTC)
 * I shall look for some sources later. Leave it with me. Axl  ¤  [Talk]  13:25, 20 January 2013 (UTC)
 * From Black's Medical Dictionary, 41st edition (2005):-


 * Atopy, meaning out of place, is a form of hyper-sensitivity characterised&mdash;amongst other features&mdash;by a familial tendency. It is due to the propensity of the affected individual to produce large amounts of reagin antibodies which stick to mast cells in the mucosa, so that when the antigen is inhaled, histamine is released from the mast cell. Atopy is the condition responsible for asthma and hay fever (see also allergy). It is estimated that 10 per cent of the human race is subject to atopy. (See also dermatitis.)


 * From Stedman's Medical Dictionary (2000):-


 * Atopy: A genetically determined state of hypersensitivity to environmental allergens. Type I allergic reaction is associated with the IgE antibody and a group of diseases, principally asthma, hay fever, and atopic dermatitis.


 * "ABC of Asthma" and "ABC of Allergy" both include IgE in their definitions of atopy. Axl  ¤  [Talk]  22:22, 21 January 2013 (UTC)
 * I have adjusted the text and changed the reference. Axl  ¤  [Talk]  23:08, 23 January 2013 (UTC)

In the lead section, paragraph 3, why no mention of LABAs? Axl ¤  [Talk]  13:15, 20 January 2013 (UTC)
 * They are second line and controversial. Thus left the discussion for the body of the text. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:17, 20 January 2013 (UTC)
 * "Controversial"? I have to disabuse you of that concept. Of course they should be used only in conjunction with an inhaled corticosteroid. However I am sure that you are aware of the benefits of this synergistic use, and the widespread use of Seretide (Advair) and Symbicort. In the "Medications" subsection, the current text is rather alarmist in its presentation of LABAs. Axl  ¤  [Talk]  13:23, 20 January 2013 (UTC)
 * Looking at the evidence and we have this 2012 Cochrane review which found increased adverse effects even when used in combination with steroids.
 * These meds are very strongly promoted with many drug reps doing the rounds. They have even come and visited me in the ER. Of course they are widely used as advertising works (remember Vioxx). Yes I may be a little cynical but... Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:38, 20 January 2013 (UTC)
 * Okay added a bunch of stuff. The picture seen is still not very rosy but I do not think this is my fault. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:54, 20 January 2013 (UTC)
 * Fair enough, there does seem to be a small increase in the risk of serious adverse events with formoterol: Cochrane quotes a number needed to harm of 149. In comparison to the increased control that most patients receive, especially when used in a combination device? The benefits far outweigh this small risk. Axl  ¤  [Talk]  20:26, 20 January 2013 (UTC)
 * Do we have a ref that states that the benefits far outweight the risks? We have this ref quantifies the risk at 3/1000 per 3 months. And than we have this study  which states that increased ICS is the same as adding LABA. While they do increase PEF  how meaningful of an end point is this?  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:58, 21 January 2013 (UTC)
 * And than the risk of industry involvement.  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 07:02, 21 January 2013 (UTC)


 * Those studies are looking at children, which admittedly isn't my area of expertise. The BTS guideline states (on page 41): "Children: Administration of inhaled steroids at or above 400 micrograms BDP a day or equivalent may be associated with systemic side effects. These may include growth failure and adrenal suppression." 400 micrograms is a moderate dose for children. I believe that mild-moderate growth failure can't really be pinpointed in individual patients, but only in treated cohorts. Thus I do not think that it would be reported as a serious adverse event.


 * On page 42 of the guideline: "No exact dose of inhaled steroid can be deemed the correct dose at which to add another therapy. The addition of other treatment options to inhaled steroids has been investigated at doses from 200-1,000 micrograms BDP in adults and up to 400 micrograms BDP in children. Many patients will	benefit	more from add-on therapy than from increasing inhaled steroids above doses as low as 200 micrograms BDP/day. At doses of inhaled steroid above 800 micrograms BDP/day side effects become more frequent. An absolute threshold for introduction of add-on therapy in all patients cannot be defined."


 * Page 43 continues: "The first choice as add-on therapy to inhaled steroids in adults and children (5-12 years) is an inhaled long-acting β2 agonist, which should be considered before going above a dose of 400 micrograms BDP or equivalent per day and certainly before going above 800 micrograms BDP."


 * Later on page 43: "Safety of long-acting β2 agonists: Following a review in 2007 of LABA in the treatment of adults, adolescents, and children with asthma, the Medicines and Healthcare products Regulatory Agency (MHRA) further reviewed the use of LABA, specifically in children younger than age 12 years and concluded that the benefits of these medicines used in conjunction with inhaled corticosteroids in the control of asthma symptoms outweigh any apparent risks."


 * The clinical bottom line: give the inhalers that will get the patient's asthma under control, because poorly-treated asthma is worse than any potential side-effects. Axl  ¤  [Talk]  12:56, 21 January 2013 (UTC)


 * I just had a look at the 2007 NHLBI guideline (which we don't use in the UK). They recommend that increasing the dose of moderate-dose glucocorticoid should be given equal weight with addition of LABA. Axl  ¤  [Talk]  13:32, 21 January 2013 (UTC)
 * I guess I could add that "The British Thoracic Society in 2007 deemed the benefits to outweigh the risks." But it is a little old. What do you suggest?  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:06, 21 January 2013 (UTC)
 * The BTS guideline is from May 2008, revised in January 2012. The BTS guideline from "2007" is "a little old" while the NHLBI guideline from 2007 is fine? Axl  ¤  [Talk]  14:39, 21 January 2013 (UTC)
 * If they are not contradicted by more recent sources I would not have concerns. What do you think we should say? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:17, 21 January 2013 (UTC)
 * I don't think that side-effects or safety concerns should be mentioned in the lead section at all. This is a general article about asthma, not a journal article about LABAs. Similarly in the "Medications" subsection, we should remember that this is a general article about asthma, not guidance for doctors on the management of asthma. Extended discussion about side-effects should be avoided. My recommendation:-


 * "Long-acting beta-adrenoceptor agonists (LABA) such as salmeterol and formoterol can improve symptoms when given in combination with inhaled glucocorticoids. This often achieves better asthma control, although there is a slightly increased risk of serious adverse events."


 * Axl ¤  [Talk]  15:58, 21 January 2013 (UTC)

Okay have adjusted to more or less match this excepted added in a bit about the effect being less certain in children. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:58, 22 January 2013 (UTC)
 * I have changed "symptoms" to "side-effects" to avoid confusion with asthma symptoms. I am still not entirely happy, but I think that we have a reasonable compromise. Axl  ¤  [Talk]  22:06, 23 January 2013 (UTC)
 * Okay thanks. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:07, 23 January 2013 (UTC)

LTA
There seems to be some bias against leukotriene antagonists, both in the lead section (paragraph 3) and in the "Medications" subsection. The text seems to imply that LTAs are used instead of inhaled steroids, yet this is very rarely the case. Axl ¤  [Talk]  13:19, 20 January 2013 (UTC)
 * Have not seen much evidence supporting their us. Will look again. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:38, 20 January 2013 (UTC)
 * GINA only mentions them twice and as second line agents  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:59, 20 January 2013 (UTC)
 * Agree with your concerns regarding the lead and adjusted it. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:07, 20 January 2013 (UTC)
 * I am still unhappy with the "Medications" subsection, which describes LTAs as "an alternative to inhaled glucocorticoids", despite the caveat "not preferred". Also, I don't think that "less preferentially" needs to be mentioned in the lead either. By the way, in the under 5 age group, the BTS guideline recommends LTAs as second line treatment ahead of LABAs. Axl  ¤  [Talk]  13:15, 21 January 2013 (UTC)
 * How do you think they should be described? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:21, 21 January 2013 (UTC)
 * I think that the issue is surrounding the NHLBI guideline. Does anyone actually use LTAs instead of inhaled glucocorticoids? In the UK, no-one does. Axl  ¤  [Talk]  13:35, 21 January 2013 (UTC)
 * GINA on pg 32 states they can be used as a non recommended alternative in adults. I have never come across a reason to use them alone :-)  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:00, 21 January 2013 (UTC)
 * How about we say that LTAs are recommended as second/third line treatment? Axl  ¤  [Talk]  14:45, 21 January 2013 (UTC)
 * Would be fine with that and changed. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:17, 21 January 2013 (UTC)
 * Thanks. In the lead section, I don't think that there is any need to include the qualifier "less preferentially". Axl  ¤  [Talk]  16:05, 21 January 2013 (UTC)

Yes as LABA are not recommended LT become the second line agent. Removed the preferential bit and added these details to the treatment section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:09, 22 January 2013 (UTC)
 * I have altered the text about LTAs. I have included montelukast; montelukast was the first available LTA. Also, its once daily dosing makes it preferable to zafirlukast, at least in the UK. I am now happy with the description of LTAs. Axl  ¤  [Talk]  15:10, 22 January 2013 (UTC)
 * Looks good. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:36, 22 January 2013 (UTC)
 * Okay, thanks. Axl  ¤  [Talk]  22:22, 23 January 2013 (UTC)

Steroids, corticosteroids, glucocorticoids
In the lead section and the rest of the article, this class is variously named. While technically correct, perhaps use a single term for consistency and clarity? Axl ¤  [Talk]  14:59, 22 January 2013 (UTC)
 * Okay went with steroids. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:36, 22 January 2013 (UTC)
 * The "Management" section still includes many references to "glucocorticoids". (For what it's worth, I think that "glucocorticoids" is preferable because it is more precise, and less likely to be confused with anabolic steroids, but I don't have a strong opinion on this.) Axl  ¤  [Talk]  18:16, 22 January 2013 (UTC)
 * Yes Wikipedia is just coming up again. Will work on it. Okay think I have it now. Doc James  (talk · contribs · email) (if I write on your page reply on mine)

Reader feedback
I just had a quick look at the reader feedback for this page, a lot of it seems focused on wanting more diagrams and less complex terminology. I don't know whether it might be worth adding a hatnote to the article suggesting that if the medical terminology is too complex, and you just want to get a quick understanding of the causes, symptoms and treatments then you might want to look at the 'simple english' wikipedia entry simple:asthma? I guess that article ought to be looked at carefully too. In fact I wonder whether that ought to be a template of some sort that applied to all medical articles? EdwardLane (talk) 10:29, 11 February 2013 (UTC)
 * There is discussion to move simple English to the top of the language list for those looking for simple content. I think that is a good and reasonable compromise. THe feedback recommends more pictures. More pictures of what? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:01, 11 February 2013 (UTC)
 * The discussion you mention looks interesting, I'm not opposed to that, and I think I'll probably respond to the thread on wp medicine when I get a moment. It is not exactly clear what the 'simplify the language' feedback wants in terms of diagrams - The article here might perhaps like a diagrams showing general lung function and perhaps a comparison between normal function and an asthmatic episode? EdwardLane (talk) 11:55, 12 February 2013 (UTC)
 * You mean a picture of the out put of a PFT for asthma versus COPD versus normal. We could do that. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:05, 12 February 2013 (UTC)
 * not exactly but looking at the spirometry page there might be something in that idea. I'll describe my suggestion again when I have abit more time EdwardLane (talk) 16:54, 12 February 2013 (UTC)

Edit request on 6 March 2013
should be changed to
 * Methylxanthines (such as theophylline) were once widely used, but do not add significantly to the effects of inhaled beta-agonists. There use in acute exacerbations is controversial.
 * Methylxanthines (such as theophylline) were once widely used, but do not add significantly to the effects of inhaled beta-agonists. Their use in acute exacerbations is controversial.

Alanlcit (talk) 05:01, 6 March 2013 (UTC)
 * Yes check.svg Done BryanG (talk) 05:38, 6 March 2013 (UTC)

Hygeine Hypothesis
"The hygiene hypothesis is a theory which attempts to explain the increased rates of asthma worldwide as a direct and unintended result of reduced exposure, during childhood, to non–infectious bacteria and viruses.[42][43]"

Should this not be 'non-pathogenic bacteria and viruses'? Aren't all bacteria and viruses infectious?

Tomwebber92 (talk) 09:28, 10 April 2013 (UTC)
 * Thanks excellent point. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:20, 11 April 2013 (UTC)

Link to Pathophysiology article
A link should be put on the Asthma page to Pathophysiology of asthma. Specifically, an indent made in the paragraph "pathophysiology". I cannot edit it as the article is locked. 129.180.1.214 (talk) 13:14, 13 April 2013 (UTC)

Asthma
Im 16 with asthma and i smoke weed every day and belive me it really does help take the pain off. — Preceding unsigned comment added by 216.210.45.17 (talk) 16:34, 15 May 2013 (UTC)


 * Asthma is typically painless, so your statement doesn't quite make sense. Smoking anything (particularly cannabis) is extremely unwise, particularly in people with asthma. But this is not medical advice, it just reflects the position of professional societies and public health bodies. JFW &#124; T@lk  16:32, 19 May 2013 (UTC)

Edit request on 12 June 2013
Bold text indicates insertion or rewording. Bold & italic text indicates removal.

Asthma

A number of other health conditions occur more frequently in those with asthma, including: gastro-esophageal reflux disease (GERD), rhinosinusitis, and obstructive sleep apnea.[21] Psychological disorders are also more common[22] with anxiety disorders occurring in between 16–52% and mood disorders in 14–41%.[23] However, it is not known if asthma causes psychological problems or if psychological problems lead to asthma.[24]

Asthma

Many environmental factors have been associated with asthma's development and exacerbation, including: allergens, air pollution, and other environmental chemicals.[28] Smoking during pregnancy and after delivery is associated with a greater risk of asthma-like symptoms.[29] Low air quality, such as from traffic pollution or high ozone levels,[30] has been associated with both asthma development and increased asthma severity.[31] Exposure to indoor volatile organic compounds may be a trigger for asthma; formaldehyde exposure, for example, has a positive association.[32] Also, phthalates in PVC are associated with asthma in children and adults,[33][34] as are high levels of endotoxin exposure.[35]

Asthma is associated with exposure to indoor allergens.[36] Common indoor allergens include: dust mites, cockroaches, animal dander, and mold.[37][38] Efforts to decrease dust mites have been found to be ineffective.[39] Certain viral respiratory infections, such as respiratory syncytial virus and rhinovirus,[41] may increase the risk of developing asthma when acquired as young children.[40] such as:[40] respiratory syncytial virus and rhinovirus.[41] Certain other infections, however,  may decrease the risk.[41]

Asthma

Paragraph 1, sentence 3: ...or more separate populations including: GSTM1, IL10, CTLA-4,...

More grammar errors, especially errors concerning absence of commas and misuse of colons, likely exist, but I'm too tired to find them all, and I have better things to do. Thanks for your concern.

PS: After re-reading the guidelines regulating the edit requests, I thought I should mention that the way I wrote this describes the new version rather than the original. All requested changes regard grammar, so a reason should not be necessary as it should be common knowledge.

JMtB03 (talk) 23:06, 12 June 2013 (UTC)
 * I have implemented most of your requests as they are all minor. If I missed any punctuation please let me know. Thank you for helping to improve Wikipedia. &mdash; KuyaBriBri Talk 17:30, 13 June 2013 (UTC)

Pronunciation?
I think it would be very helpful to non-native English speakers to include the IPA for the pronunciation of the word "asthma". I won't do it because I don't know IPA well enough.

I understand it can be pronounced as ASS-ma (British) or AZ-ma (US). If anybody could include that in the article, that would be great.

--Cotoco (talk) 22:30, 13 August 2013 (UTC)

Spirometer image explains asthma?
How can you justify the reversion of my last edit, putting the spirometer as the header image? It doesn't even go part-way in explaining anything to do with the disease, just diagnostics. CFCF (talk) 16:52, 12 November 2013 (UTC)
 * This is an iconic image of asthma management. The image of pathophysiology is not nearly as clear and needs a lot of text to go with it. Thus it fits better in the section on pathophysiology. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:53, 12 November 2013 (UTC)

Edit Request on 26/11/2013
The article says "Also, phthalates in PVC are associated with asthma in children and adults[33][34] as are high levels of endotoxin exposure.[35]"

I read Liu article's abstract (citation 35) and it says "Asthmatics are particularly sensitive to inhaled endotoxin, and inhalation induces both immediate and sustained airflow obstruction. The paradox of endotoxin exposure is that higher levels of exposure in early life might mitigate the development of allergy and persistent asthma. With endotoxin exposure being significantly higher in homes with animals and in farming households, where allergy and asthma are less likely to develop, endotoxin and other microbial exposures in early life may keep allergen sensitisation and asthma from developing by promoting Th1-type immune development" which seems to imply that exposure to LPS from people who are already asthmatic causes exacerbation of symptoms, while exposure during early childhood and childhood has a protective effect. I didn't read the whole article as I don't have a paid subscription to Elsevier Journal, but if someone has it can I ask him to read it and edit/don't edit according to what the article says?

If the full article says there is this protective effect you could change "Also, phthalates in PVC are associated with asthma in children and adults[33][34] as are high levels of endotoxin exposure" to "Also, phthalates in PVC are associated with asthma in children and adults[33][34], while high levels of endotoxin exposure exacerbate the symptoms in the asthmatic, but are thought to have a protective effect during infancy"

Dreubian (talk) 10:12, 26 November 2013 (UTC)Dreubian


 * Liu's paper is a little old now (2004). The role of endotoxin in asthma remains unclear, perhaps even controversial. This 2011 paper describes the current understanding, which hasn't changed much. I have deleted the statement about endotoxin (and the reference to Liu) from the "Environmental" subsection. I have added a new sentence to the "Hygiene hypothesis" subsection. Axl  ¤  [Talk]  14:44, 26 November 2013 (UTC)

Acetaminophen
Have added that "The majority of the evidence does not; however, support a causal role." for acetaminophen based on "The weight of evidence of the collected studies in our review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol. "  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 14:32, 18 May 2014 (UTC)

Pronunciation? (re-added)
[I had previously added this on 2013-08-13, but it was moved to the archive before anyone responded or added what was requested to the page.]

I think it would be very helpful to non-native English speakers to include the IPA for the pronunciation of the word "asthma". I won't do it because I don't know IPA well enough.

I understand it can be pronounced as ASS-ma (British) or AZ-ma (US). If anybody could include that in the article, that would be great.

Cotoco (talk) 20:37, 17 June 2014 (UTC)
 * Do not understand IPA either. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 21:13, 17 June 2014 (UTC)

potential mistake
There is section Medications and there is named reference <tt>NHLBI07p213</tt>, which is defined elsewhere in the article and points to page 213. However in this section the reference is redefined with page 560, but this does not work, and reference to page 213 is used instead. So I suspect that this is a typo and put a note here to review for more competent editors. Paweł Ziemian (talk) 20:17, 12 August 2014 (UTC)
 * Are you are referring to reference number 9: page 213 of the NHLBI document? Exactly which statement in the article are you referring to? The document itself has 440 pages, of which 417 are numbered. Axl  ¤  [Talk]  23:35, 12 August 2014 (UTC)
 * There is a sentence in wikicode <tt> Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation. </tt>. The mistake here is mainly a redefinition of the reference, which technically does not work. If the referenced document has 440 pages, the 560 here is definitely wrong. So I suspect that the template <tt>harvnb</tt> is just rubbish here. Paweł Ziemian (talk) 20:25, 16 August 2014 (UTC)
 * I am not sure what the harvnb template does. Anyway, it was not necessary so I have deleted it. Axl  ¤  [Talk]  22:49, 16 August 2014 (UTC)

Semi-protected edit request on 19 September 2014
In the article for Asthma: Please add "Coughing often occurs during nighttime or in the morning." to the end of the first paragraph, to give a reader an idea of when asthma could occur most, and not just that someone has it all the time. Please add "It can also be caused by specific medications, including aspirin, ibuprofen, and naproxen." after the first sentence in the second paragraph, to warn readers that these medications are capable of causing asthma.

Mtlovelace (talk) 05:22, 19 September 2014 (UTC)


 * The lead section (in this case the first three paragraphs) is intended to be an overview of the whole article. It is not intended to include an exhaustive list of all features. As such, the lead section includes a basic list of the commonest symptoms. I do not think that the lead section should elaborate further. The section "Signs and symptoms" includes the statement "Symptoms are usually worse at night and in the early morning".


 * Drugs are an infrequent cause of asthma. They are mentioned in "Causes", subsection "Medical conditions". Again, I don't think that they need to be mentioned in the lead section. Axl  ¤  [Talk]  09:46, 19 September 2014 (UTC)

Untitled
ATTENTION JD WOLF, Too much fanfare? Bull_Sh!!!!!!!!!! http://brainimmune.com/andor-szentivanyi-and-the-beta-adrenergic-theory-of-allergy-and-asthma/ — Preceding unsigned comment added by Belgrade Glendenning (talk • contribs) 15:08, 22 September 2014 (UTC)


 * Hello, please calm down. Look through the article. Do you see any other key theories about asthma linked prominently to the person who first described them? Well, yes, in the "history" section. That's what I mean. JFW &#124; T@lk  20:58, 22 September 2014 (UTC)
 * Agree with Jfd Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:04, 23 September 2014 (UTC)


 * Actually,, I think we need a very good secondary source (not just someone's personal website) to support your assertions even for the "History" section. Citation index results alone are not ideal sources for an encyclopedia. Papers from the 1990s seem to dispute some of the tenets of this &beta;2-adrenergic theory. On the other hand, seems supportive.  JFW &#124;  T@lk  19:36, 23 September 2014 (UTC)

I did NOT give you a personal website. I gave you a webpage with a review written by a world renowned immunologist. I gave you SCHOLARLY references to show the link between BA2 and The Beta Adrenergic Theory of Asthma. I am concerned that an editor of Wikipedia knows absolutely nothing about what he is editing. Nobody is asking your opinion about The Beta Adrenergic Theory but instead I am pointing out there is no other theory of asthma that can be identified with a specific individual {aside from crackpots}. — Preceding unsigned comment added by Belgrade Glendenning (talk • contribs) 22:18, 23 September 2014 (UTC)


 * A webpage is not a peer-reviewed source (brainimmune.com). Have a look at WP:MEDRS. Your tone is unpleasant and abusive, and I am wondering why you think that is necessary. JFW &#124; T@lk  23:03, 23 September 2014 (UTC)

BTS
... have updated their guideline https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2014/ JFW &#124; T@lk  16:05, 19 October 2014 (UTC)

Asthma & platelets.
In the Wikipedia Platelet article, asthma is included in the list of conditions that can lead to platelet disorders. However, platelets aren't mentioned in this article. It seems like a valuable bit of information:

Platelet disorders Altered platelet function ....Acquired ........Disorders of adhesion ............Asthma[53]

The inclusion of asthma in the list references this review article:

53. Review: "The role of platelets in the pathophysiology of asthma" 2007, Vol. 18, No. 5, Pages 319-328 (doi:10.1080/09537100701230436); K. N. Kornerup, and C. P. Page http://informahealthcare.com/doi/abs/10.1080/09537100701230436

Thank you, Wordreader (talk) 05:45, 5 December 2014 (UTC)
 * The above may be a more better ref, assuming a domain expert is happy with it (Review & Open access) RDBrown (talk) 10:39, 5 December 2014 (UTC)
 * It could go under pathophysiology maybe. Doc James  (talk · contribs · email) 13:08, 5 December 2014 (UTC)
 * It could go under pathophysiology maybe. Doc James  (talk · contribs · email) 13:08, 5 December 2014 (UTC)


 * I don't want to appear to be ungrateful of your efforts, RDBrown and Doc James, because I'm not, but the bald addition to the Pathophysiology section of the concept of procoagulation, linked to: https://en.wikipedia.org/wiki/Coagulation#Procoagulants, leaves me, as an RN with extra anatomy & physiology education, scratching my head. Consider how disoriented the casual reader would be! The reader is forced into following the link to a section of the Coagulation article, Pharmacology: Procoagulants section. This speaks of "hemostaic agents", "thrombin", "fibrin", "gun-shot wounds", and cabbages and kings. There is no mention of asthma in that section, nor even in the whole article. How is that poor reader supposed to see how this apparently arcane tidbit applies to their readings on asthma and their wheezing child without the authors taking them in hand and helping them to do so? [For that matter, there's not even an explanation of the meaning of "pathophysiology" without following yet another out-of-article link.]


 * This addition of "procoagulation" without explanation is, to me, a poster-child for the biggest problem that Wikipedia has in its science/ technological/ medical articles: that of unnecessary jargon and an impenetrable thicket of concepts. Is it any wonder that casual readers are forced to either pinball all over WP in a vain attempt to figure out what one article they are interested in is trying to say or give up in frustration or both?


 * As a medical professional, my goal was always to help lay persons understand new and complex concepts. When I taught human biology at a school for estheticians, these were mostly young woman who just wanted to get on with learning how to do facials on each other. But when I felt it was applicable, I taught far more than their dopey textbook had included. When we discussed skin and skin tones, I brought in pastels for everyone and had them match their own skin color and those of the other students to see how we are all based on shades of orange with pink and blue overtones. With a discussion on pH, I brought in pH paper and we tested everything we could get our hands on. When I discussed emulsification, I brought in ingredients and a blender so we could make mayonnaise. They learned more than was expected of them in the curriculum, retained it, and took tests I wrote that were far more demanding than the textbook's suggested ones. The point is that you can include technical information yet still explain it in such a way that readers learn and increase their understanding instead of their bafflement.


 * Suggestions:
 * Keep in mind that WP is about multi-dimensional communication. The communication doesn't need to be at the level of a medical student, but should be presented in such a way that the vast, vast majority of readers can access it and from which they can learn.
 * Imagine that you are trying to explain asthma to a distraught mother. How would you word it and what drawings would you sketch out to help her understand?
 * Place a simpler, plain English, version of the article in the beginning with increased complexity afterwords for those who want to plow ahead.
 * Provide an explanation of all technical terms as soon as they occur, parenthetically if need be, so that readers don't have to leave the article at every turn and fall off the edge of WP. I have absolutely no objection with also linking technical terms to their respective articles, in fact they should be linked.
 * Alternately, the explanation of a term could make up the parent text with the linked technical term in the parenthesis or set off by commas.
 * If you object to defining terms as they pop up in the text, perhaps a glossary could be added to this and other technical articles with an explanation of terms contained within. I would find this a less useful solution, though.


 * I am climbing back down from my soapbox now. Thank you for your time, Wordreader (talk) 21:59, 7 December 2014 (UTC)
 * Yes too complicated. Moved to subpage Pathophysiology_of_asthma Doc James  (talk · contribs · email) 22:06, 7 December 2014 (UTC)

Content
"or 5-lipoxygenase inhibitors (e.g., zileuton and St John's wort)" Ref does not mentioned St John's wort? Per ref "zileuton is available only in the United States." Thus not suitable for the lead IMO. Doc James (talk · contribs · email) 05:01, 12 December 2014 (UTC)
 * It's always better to delete an entire MEDRS-quality review-cited sentence than just the uncited parenthetical examples when those examples are all that concerns you. In any event, I'm assuming you're happy with the citation support of the examples now. Probably was a good thing you reverted it, because I didn't notice that the leukotriene antagonist link was going to a page on inhibitors and antagonists.  That's fixed now.  It amuses me how zileuton has noticeable adverse effects, yet those of a ground up plant in a pill are indistinguishable from placebo.  Seppi  333  (Insert 2¢ &#124; Maintained) 09:37, 12 December 2014 (UTC)

Pathophys of asthma
Just wondering, asthma pathophys is usually guided by the triplets- (1) bronchospasm, (2) mucous plugging, (3) airway inflammation. Even in this really indepth page about Pathophysiology of asthma, there seems to only be a mension of goblet cell hyperplasia in one of the pictures only - when this is one of the pathophys thingos behind mucous hypersecretion. Does anyone know why this is? 182.255.99.214 (talk) 12:53, 9 February 2015 (UTC)
 * Pathophysiology is hard to write about in plain English. Please feel free to work on the pathophysiology of asthma article. Doc James  (talk · contribs · email) 13:03, 9 February 2015 (UTC)

Asthma and Cystic Fibrosis carriers
Research suggests that certain carriers of Cystic Fibrosis are more likely to suffer from Asthma. See, for example, the article on the CF gene mutation DeltaF508. Perhaps this should be mentioned in the section on genetic causes. Thanks! --Lbeaumont (talk) 12:28, 7 February 2015 (UTC)
 * Any secondary sources that have found it notable? (see WP:MEDRS) Doc James  (talk · contribs · email) 12:31, 7 February 2015 (UTC)
 * See:
 * That is a primary source. Any secondary sources like review articles? Doc James  (talk · contribs · email) 07:49, 10 February 2015 (UTC)
 * I found another primary source, but no secondary sources. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 14:11, 10 February 2015 (UTC)

Non-"disease" approach to asthma and its management, using aspirin.
Asthma does not imply sickness and therefore, using the word 'disease' seems to be a stretch in terminology. 'Daily asthma' (needing use of steroidal applications) can easily be converted to 'light/occasional' asthma (requiring only occasional use of a 'preventer', such as Serevent) by regular ingestion of aspirin. Aspirin is effective in this way at doses well below the recommended limit of 4000mg daily per adult. Ref. bit ly/salamol "Aspirate well with aspirin.". — Preceding unsigned comment added by Gerrytlloyd (talk • contribs) 12:17, 14 March 2015 (UTC)


 * Any medically-related content must be cited to sources compliant with WP:MEDRS - we don't cite random blogs. AndyTheGrump (talk) 12:32, 14 March 2015 (UTC)


 * The OP's remark is very strange, I have never heard of aspirin being used, particularly in a paeds disease which can sequelae on aspirin with Reye's syndrome (detrimental effects to brain, liver, hypoglycemia). Aspirin is contraindicated in kids unless rheumatic fever and Kawasaki disease. This idea of aplication into asthma is just another example of the dangerousness of "alternative" solutions. Salbutamol at low levels will not result in its side effects (tremor, anxiety, headache, palpitation etc etc) 182.255.99.214 (talk) 22:57, 14 March 2015 (UTC)

Most important DDx
The most important DDx is bronchiolitis - why is it missing?!!!!!!!!!!!!!!! 182.255.99.214 (talk) 10:58, 9 February 2015 (UTC)
 * Sure will add. Doc James  (talk · contribs · email) 11:54, 9 February 2015 (UTC)
 * Coolbeans, it's particularly important in paeds because SOB, cough, wheeze is pathognomonic in asthma... also bronchiolitis, and it's one of those things where if they're <2yo we say its bronchiolitis, and if its >2yo its asthma sorta thing 182.255.99.214 (talk) 12:57, 9 February 2015 (UTC)

I would also really like Reactive airway disease to appear as an important DDx 182.255.99.214 (talk) 09:26, 13 March 2015 (UTC)


 * Working here at Gosford Hospital is an incredible paediatrician (respiratory fellow) Dr Aleisha Nielsen (https://www.facebook.com/aleisha.nielsen), respiratory fellow from Westmead Hospital, who is able to contribute to this article :) 182.255.99.214 (talk)
 * Reactive airway disease is a symptoms of asthma. It is not a disease in and of itself. Asthma is condition which causes reactive airway disease. Doc James  (talk · contribs · email) 23:12, 13 March 2015 (UTC)
 * I'll do a quotation on Reactive airway disease from that Wiki page: Current medical use describes an asthma-like syndrome in infants that may later be confirmed to be asthmatics when they become old enough to participate in diagnostic tests such as the bronchial challenge test. So essentially asthma can't be confirmed until a child is old enough to do a post-bronchodilator test.
 * Meanwhile, they will then be trialled on salbutamol etc and if their respiratory distress (nasal flaring, grunting, subcostal and intercostal recession, etc) improves it is known as reactive airway disease, and if not it is bronchiolitis. Reactive airway disease is a syndrome (I guess you could call it "symptoms"), and is different from asthma. As Mayo Clinic describes, RAD may or may not be caused by asthma. It can also have an allergenic cause.
 * This might be something to confirm with a Pediatric consultant. Do we have any here on Wiki? If you don't mind me asking Doc James, are you a consultant? 182.255.99.214 (talk) 05:02, 14 March 2015 (UTC)
 * I am an attending yes (the Canadian term for consultant). The key with Wikipedia is high quality references. Mayoclinic is not a very good source. I will take a look. Doc James  (talk · contribs · email) 05:37, 14 March 2015 (UTC)
 * Great, it may be one of those things, just to dip into the pediatric ward and ask to speak to a paeds respiratory consultant to confirm. I'm pretty sure that this is the case - but I am accounting for jurisdictional differences too ;) 182.255.99.214 (talk) 22:57, 14 March 2015 (UTC)

This ref refers to RAD broad group of conditions with asthma being one type. I will update the RAD page. Doc James (talk · contribs · email)
 * Great stuff, I'm liking this more. I've done my own edit, and highlighted the second use of the term. So the first one for RAD is the group of conditions involving reversible airway narrowing, and the second one (more specifically to paeds) is as a term for "baby" asthma (I think this is what you were alluding to earlier). But it's not the same thing as asthma. Let me know what you think! 182.255.99.214 (talk) 23:03, 14 March 2015 (UTC)
 * The analogy I'd use is the terms ODD and ID. ID is not diagnosed before 5yo, and ODD doesn't necessarily progress into ID. The difference here is that RAD is a syndrome whereas ODD and ID are both diagnoses 182.255.99.214 (talk) 23:05, 14 March 2015 (UTC)
 * Yup. Do you have a textbook that says it is part of the differential? Doc James  (talk · contribs · email) 01:37, 15 March 2015 (UTC)

Changes
This is not needed "Medical researchers suspect". One can just state the position.

Per "Clinicians usually treat acute symptoms" People with the symptoms usually treat themselves. Thus "Treatment of acute symptoms is usually" is better wording

We do not put Wikitionary links in the lead. They go at the end with the other sister projects. Doc James (talk · contribs · email) 00:56, 14 May 2015 (UTC)

St. John's Wort
I am looking at this text on St John's wort as treatment added in this dif. It is basically:

which does not mention asthma

and

which does not mention asthma

I am confused? We add text that supposedly supports the use of this plant for asthma yet the refs do not discuss the disease? Doc James (talk · contribs · email) 05:59, 20 May 2015 (UTC)


 * I see that you have deleted the "information" about St. John's wort.
 * I only found one paper about asthma & St. John's wort. The paper found no benefit, but significant adverse effects. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 12:52, 20 May 2015 (UTC)
 * That's relevant if it's commonly used and having significant adverse effects. Did either of you find anything to suggest that it's frequently tried by those with asthma in that paper? Otherwise, my search came up the same and I found next to nothing on PubMed. TylerDurden8823 (talk) 14:31, 20 May 2015 (UTC)
 * I am not sure what you mean by "relevant" in this context. It is relevant in the sense that it is a peer-reviewed paper that mentions the effects of use of St. John's wort in asthma. It is also relevant in the sense that I could not find any other journal sources that describe this use. I am not implying that this information should be included in Wikipedia's article. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 17:48, 20 May 2015 (UTC)
 * I meant that it's relevant (as in worth discussing) that St. John's Wort has significant adverse effects and no proven benefit if this is a treatment asthmatics commonly turn to instead of more conventional (and effective) treatments. However, I wrote that before really looking through the search and I also saw there was little to no discussion of its role in asthma treatment so I agree that it's probably not worthy of significant mention. TylerDurden8823 (talk) 18:22, 20 May 2015 (UTC)
 * Okay, that's fine. :-) <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 18:50, 20 May 2015 (UTC)
 * Thanks Axl. Will add this review. Doc James  (talk · contribs · email) 07:31, 21 May 2015 (UTC)

There's no pharmaceutical 5-lipoxygenase inhibitors available except Zileuton, which doesn't have wide availability. Widespread international use, for decades in some countries, has found that SJW has no common or rare adverse effects in humans except photosensitization; moreover, Hyperforin is a much more potent inhibitor of 5-LOX than Zileuton, so simply by rank of their efficacy and our conclusion, I'll revise our article for consistency.

In any event, I agree with the above consensus. Our readers with asthma don't need to know their options in cases where there exists phytochemicals that have significant efficacy at the relevant pharmacodynamic targets of approved drugs; we should just push pharmaceuticals down their throat, right? And, the other readers who might be interested in drug pharmacology don't need to know anything about phytochemical pharmacodynamics either, because that's "alternative" medicine and couldn't possibly be useful in treating any medical condition. Patients should also be informed of the potential for hypersensitivity reactions and other significant adverse effects of these substances, and subsequently advised to avoid consumption of any such treatments; the benefits of ingesting salad or flowering plants just aren't worth the risk of anaphylactic shock.  Seppi  333  (Insert 2¢) 18:48, 21 May 2015 (UTC)
 * Your sarcastic retorts are unhelpful. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 19:07, 21 May 2015 (UTC)
 * My cynicism arises from this review - http://www.ncbi.nlm.nih.gov/pubmed/15330011 - not the above conversation. This author reviewed phytochemicals for use in 3 conditions; instead of indicating that these have any efficacy for any indication, he just states a universal conclusion that all non-pharmaceutical treatments have potential adverse effects like hypersensitivity reactions.  That abstract suggests to me the author has a bias against nonpharmaceutical agents; various compounds may not be approved pharmaceuticals for reasons other than the efficacy-safety profile, first and foremost - far ahead of a drug's treatment profile - is just the monetary cost-benefit analysis of getting a drug approved.   Seppi  333  (Insert 2¢) 19:41, 21 May 2015 (UTC)
 * The issue is that text was added regarding St. John's Wart yet not one of the references supporting said text discussed St. John's Wart in relation to asthma.
 * This is unreferenced "As of 2013, there are no available pharmaceutical 5-LOX inhibitors which possess drug efficacy in excess of available OTC products." This article is about asthma. We need references that mention treatment in relation to this disease. We are not here to attempt to publish our only primary research on the topic. Doc James  (talk · contribs · email) 22:56, 21 May 2015 (UTC)

Prolonged expiratory phase, Expiratory wheezing
Please tell me why this is not present :/ 156.22.3.1 (talk) 12:19, 23 May 2015 (UTC)
 * Yes while wheezing can occur when breathing out. It may also occur when breathing in as well when the disease worsens. I will add something. Doc James  (talk · contribs · email) 00:01, 24 May 2015 (UTC)

Semi-protected edit request on 15 April 2015
Request a minor addition to the first sentence in the third paragraph, which reads as: "Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as salbutamol) and oral corticosteroids.[9]"     I would like to see "albuterol" added since this is the common US usage for salbutamol. The two terms are synonymous, according to my own asthma rescue inhalers info sheets. 209.248.92.90 (talk) 08:54, 11 September 2015 (UTC)

98.16.173.73 (talk) 00:52, 15 April 2015 (UTC)
 * Red information icon with gradient background.svg Not done: As you haven't made a request. If you'd like to make a request, change  to   with your request.  Kharkiv07  Talk  00:58, 15 April 2015 (UTC)

Leukotriene receptor antagonists
... work best when you're not taking inhaled steroids 10.7326/M15-1059. JFW &#124; T@lk  15:00, 24 September 2015 (UTC)

Semi-protected edit request on 22 October 2015
in the section of alternative medicine, I would like to add the contribution of ancient indian medicine in bronchial asthma

Shanthan Jodavula (talk) 16:10, 22 October 2015 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. Cannolis (talk) 16:15, 22 October 2015 (UTC)

Request for Doc James
Hi Doc James, this article is astonishingly bad - no mention of the fungal species associated with asthma development, and with asthma progression. A quick pubmed search comes up with the following useful review:

http://www.ncbi.nlm.nih.gov/pubmed/25159468

The conclusion is:

"Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species."

Please implement. Thank you.
 * We discuss it right here "Home factors that can lead to exacerbation of asthma include dust, animal dander (especially cat and dog hair), cockroach allergens and mold"
 * This summaries the ref you have provided which says "increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium"
 * Have added the ref you mention to that line. Doc James  (talk · contribs · email) 16:04, 8 November 2015 (UTC)
 * Muchas gracias. Another niggle: the new ref mentions not only exacerbation but importantly also onset. — Preceding unsigned comment added by 81.154.23.217 (talk) 17:42, 9 November 2015 (UTC)

Good morning Doc James. Thank you for the asthma intervention. However, reading the article more closely, I am increasingly unhappy as concerns the Prevention aspects. Common-sense medical advice includes having a shower or bath and washing your hair before going to bed every evening but especially after working in the garden, putting mattresses out in the frosty air for a couple of hours in the winter to kill the mites (below zero degrees Celsius), and removing/preventing Alternaria growth on wet bathroom tiles using a simple window wiper. I was hoping to find such everyday advice in the cited references, but instead the NAEPP) (2007) reference in the lead falsely states that Alternaria is (only) an outdoor fungus, and complicated and imperfect washing procedures are recommended for bedclothes (how on earth do you wash a mattress?). I realise that I do not have suitable literature at hand, but I feel unwilling to put in the literature research work as long as the article is blocked and my suggestions may be ignored. Let me know how you advise we/I/you proceed. And no, registration is not an option for me. — Preceding unsigned comment added by 81.154.23.196 (talk) 19:48, 10 November 2015 (UTC)
 * If you have good references, happy to see content / conclusions within them added to this article. Doc James  (talk · contribs · email) 22:07, 10 November 2015 (UTC)

Semi-protected edit request on 7 January 2016
As per https://en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine/Cochrane_update this article uses the outdated reference (last reference under lifestyle modification) to https://www.ncbi.nlm.nih.gov/pubmed/22592674. The updated article https://www.ncbi.nlm.nih.gov/pubmed/24085631 has the same conclusion and should be used instead of the old one.

Snipergang (talk) 15:17, 7 January 2016 (UTC)


 * Thanks, have updated. JFW &#124; T@lk  17:40, 7 January 2016 (UTC)

Semi-protected edit request on 23 January 2016
Request to add the additional information to the subsection "Hygiene Hypothesis", between the 1st & 2nd paragraphs:

According to a study of the National Survey of Children’s Health, while children born outside of the United States have lower odds of developing asthma, this protection dissipates after approximately 10 years of living in the U.S. After this time, their risk for developing allergic diseases dramatically increases with their length of residence in the United States.

Solistide (talk) 23:48, 23 January 2016 (UTC)
 * We typically just use review articles and other high quality secondary sources per WP:MEDRS. We do not typically use popular press. Best Doc James  (talk · contribs · email) 12:14, 24 January 2016 (UTC)

Controllers vs Relievers and Preventers
This article should differentiate between these and probably mention the best for each. --Waqqashanafi (talk) 16:41, 24 January 2016 (UTC)
 * It upsets me to see Spiriva Handihaler being described as an asthma "reliever". I am not convinced that the distinction between "controllers" and "preventers" is valid. As to which is "best", it depends which pharmaceutical company you ask. <b style="color:#808000">Axl</b> ¤ <small style="color:#808000">[Talk] 01:23, 25 January 2016 (UTC)

1
Please change "Low air quality from factors such as traffic pollution or high ozone levels,[36] has been associated with both asthma development and increased asthma severity." to “Low quality air from factors such as traffic pollution, and high ozone levels,[36] hazardous air pollutants, and particulate matter has been associated with both asthma development and increased asthma severity."   At the end of this portion, please add "Exposure to such low quality air has been shown to be more prevalent in urban environments." [37] Source: [37] Corburn, J., Osleeb, J., & Porter, M. (2006). Urban asthma and the neighbourhood environment  in New York City. Health and Place, 12, 167-179.

Graceundis (talk) 20:32, 30 April 2016 (UTC)
 * This is based on http://www.ncbi.nlm.nih.gov/pubmed/16338632 which is a primary source from 2005. Per WP:MEDRS we tend to stick with just secondary sources. Doc James  (talk · contribs · email) 13:03, 1 May 2016 (UTC)

2
Please add: “More than half of pediatric asthma cases occur in areas that don’t meet EPA air quality standards. [38]” to the "Environmental" section of this page.

Graceundis (talk) 20:35, 30 April 2016 (UTC) Grace Undis 4.30.16
 * This source http://www.ncbi.nlm.nih.gov/pubmed/?term=11427385 is from 2001. A little old and appears to apply to just the USA I image. We could add "Over half of cases in children in the United States occur in areas with air quality below EPA standards". Only really makes sense though when we know what percentage of children live in such areas. Doc James  (talk · contribs · email) 13:03, 1 May 2016 (UTC)
 * ✅ Doc James  (talk · contribs · email) 12:01, 10 May 2016 (UTC)

3
Add to "Epidemiology" section: "Asthma in children has negative effects on quality of life for the children and their parents. Children with asthma have higher risk of lower physical, psychological and social function and their parents have higher risk of lower physical function."

Graceundis (talk) 20:40, 30 April 2016 (UTC)
 * That looks good. Under signs and symptom or prognosis though would be best. Doc James (talk · contribs · email) 13:54, 1 May 2016 (UTC)
 * Added some. Doc James  (talk · contribs · email) 12:06, 10 May 2016 (UTC)

4
Please add to Paragraph 2: "Onset before age 12 is more likely due to genetic influence, onset after 12 is more likely due to environmental influence."

Graceundis (talk) 20:43, 30 April 2016 (UTC) ✅ Doc James  (talk · contribs · email) 12:08, 10 May 2016 (UTC)

5
Please add to the "Management" section: "Teaching methods proven to be effective for adolescents are direct monitoring and feedback on medication taking habits as well as self management skills in an interactive group setting in schools."

Graceundis (talk) 20:46, 30 April 2016 (UTC)
 * Ref says "Promising approaches to improving adherence". Not seeing enough there yet. Doc James  (talk · contribs · email) 12:23, 10 May 2016 (UTC)

6
Please add to "environmental" section: "Children born to mothers who experience stress during pregnancy are at a higher risk of asthma onset."

Graceundis (talk) 20:51, 30 April 2016 (UTC)
 * ✅ Doc James  (talk · contribs · email) 12:28, 10 May 2016 (UTC)

7
Please create a new subsection under "Lifestyle Modification" entitled "Community Managements". Beneath the new subsection, please add the following content: "While modifying lifestyle can improve and control asthma attacks, asthma management at a community level can be beneficial. The intensity of persistent asthma severity in children varies by state so providing asthma management workshops for parents may help families with asthmatic children be better prepared in case of asthma attacks. Schools can hold peer education workshops in which older students can deliver training to younger students on how to avoid triggers and better manage their asthma. Communities with high prevalence of members with asthma can also hold community-based interventions that will teach about asthma management and can work with residents to improve living and air qualities in the neighborhood."

Graceundis (talk) 20:52, 30 April 2016 (UTC)
 * Ref does not appear to be the correct one? Doc James  (talk · contribs · email) 12:31, 10 May 2016 (UTC)

8
Please add to the end of the 1st paragraph in the "environmental" section: "Climate change that causes rising temperatures that worsen smog pollution may also be linked to increased asthma development."

Graceundis (talk) 20:54, 30 April 2016 (UTC) Grace Undis 4.30.16
 * Relates to air pollution. All the things that increase air pollution belong on that page rather than here IMO. Doc James  (talk · contribs · email) 12:32, 10 May 2016 (UTC)

9
Please add this new paragraph to the end of the "History" section: "Due to the increase in asthma development, statewide air monitoring programs to monitor air quality were proposed and are currently in use. In 2010, a standard guideline for asthma pollutants sulfur dioxide and nitrogen dioxide was set. States were mandated to meet this guideline. Those that did not were required to adopt plan revision measures that was set by the EPA. Beginning in 2017, Tier 3 standards will be issued for new vehicles. The use of technology to control emissions will be a new imposed standard that can help reduce asthma inducing pollutants."

Graceundis (talk) 20:56, 30 April 2016 (UTC) Grace Undis 4/30/16
 * Not seeing were the ref supports the text you suggest? Doc James  (talk · contribs · email) 12:36, 10 May 2016 (UTC)

10
Request 1: In the 2nd paragraph under "epidemology" section please change "While asthma is twice as common in boys as girls,[21] severe asthma occurs at equal rates.[179]" to "Children aged 0-17 years had higher prevalence (9.5%) than adults aged 18 and over (7.7%) for the period 2008-2010. Females had higher asthma prevalence than males (9.2% compared to 7.0%)"

Request 2: Please add a "demographic prevalence" subsection under "epidemiology with the following content: "Demographic prevalence Multiple race: 14.1% Asian : 5.2% Black: 11.2% American Indian/Alaskan native: 9.4% White: 7.7% Puerto Rican: 16.1% Mexican: 5.4%"
 * The specific country level data belongs here Epidemiology_of_asthma. Feel free to add it if not already covered. Doc James  (talk · contribs · email) 12:46, 10 May 2016 (UTC)

Request 3: Please add a "death rates" subsection under "prognosis" with the following content: "Death rates Asthma death rate per 1,000 persons with asthma was 0.15 for 2007-2009. Asthma death rate per 1,000 persons with asthma were more than 30% higher for females than males, 75% higher for black persons, and almost 7x higher for adults than children. Highest rate for adults was 65 and older (0.58/1000 person with asthma)"

Sources: Graceundis (talk) 21:02, 30 April 2016 (UTC)
 * Which ref supports the mortality bit?
 * This ref is better Added some details from it  Doc James  (talk · contribs · email) 12:49, 10 May 2016 (UTC)

Discussion

 * Will take a look. Will need to clarify that most of these suggestions only apply to the United States. Doc James  (talk · contribs · email) 12:47, 1 May 2016 (UTC)
 * Pictogram voting question.svg Question: Are you still working on this? Can the request be changed to answered or does it still need to be reviewed? -- Cameron11598  (Converse) 03:45, 10 May 2016 (UTC)
 * Thanks for the reminder. Still traveling. Will take care of some of it. But yes still working on it. Doc James  (talk · contribs · email) 11:51, 10 May 2016 (UTC)
 * Thanks! Safe Travels to you! -- Cameron11598  (Converse) 00:42, 11 May 2016 (UTC)
 * I think I have addressed them all Doc James  (talk · contribs · email) 00:37, 13 May 2016 (UTC)

Sulphites
Can someone with detailed knowledge include a mention of the environmental agents such as SO2 (sulphur dioxide), which used to be sprayed on fruit, and E223 (sodium metabisuphite), which is still a very common sterilizing agent and preservative (at least in the UK/Ireland). Both of these are well-known agents, and I have been interviewed by medical researchers after personally identifying the latter as affecting myself. One of the issues that came up during that interview was that certain inhalers made the lungs more sensitive to the agents -- hence once started they were hard to dispense with -- but I cannot find a source reference. TonyP (talk) 12:46, 8 June 2016 (UTC)

Bad asthma: antibodies and thermoplasty
Review 10.1016/S2213-2600(16)30018-2 JFW &#124; T@lk  13:56, 1 July 2016 (UTC)


 * JCI review as well: 10.1172/JCI84144 JFW &#124; T@lk  13:41, 4 July 2016 (UTC)

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Recent NY times article re Barnyard Dust
This is very relevant to the issue. I thought I would FYI the editors here. Barnyard Dust Offers a Clue to Stopping Asthma in Children Rybkovich (talk)
 * We need to wait until proper sources per WP:MEDRS Doc James  (talk · contribs · email) 21:39, 5 August 2016 (UTC)

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

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

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

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

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

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

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

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

Interesting
how half of Wikipedia on almost any medically relevant topic emits 'alternative treatments showed no significant effect'. Interesting x 2 why billion + Chinese still use traditional medicine as much as modern. They must all be crazy, right. The cause-effect way of thinking must have appeared in 19th century with modern medicine, scientific method and Carl Popper, and before then people would just randomly pick plants from the forest and give to ill. I laugh at modern 'skeptic' scientist disparaging anything older than his grandma. 212.200.65.111 (talk) 21:05, 10 October 2016 (UTC)


 * Thanks for your rant, but please read WP:TALK. Traditional medicines that work become mainsteam medicines (e.g. look at the artemisinins for malaria, a traditional Chinese remedy that went mainsteam). Those that have been proven not to work are a waste of money, even if upwards of a billion people buy into them. That's science, sorry. Modern medicine uses some ancient remedies very effectively (colchicine for gout and digitalis for cardiac arrhythmias). JFW &#124; T@lk  22:38, 12 October 2016 (UTC)


 * You are welcome, but not a rant but criticism of bias. Not all traditional stuff has been scrutinized by modern science. Less than 1% of plants from Malaysian rainforest have been scientifically analyzed so far. The fact is that mainstream medicine does not know whether all alternative stuff being used does or does not work. It knows only about some stuff. 212.200.65.113 (talk) 23:01, 13 October 2016 (UTC)


 * Perhaps. But it is not Wikipedia's fault that these studies have not been conducted. JFW &#124; T@lk  22:06, 20 October 2016 (UTC)


 * Alternative medicine: Alternative or fringe medicine is any practice claimed to have the healing effects of medicine and is: proven not to work; has no scientific evidence showing that it works; or that is solely harmful. Out of numerous definitions of CAM Wikipedia chose this one. So yes, it is Wikipedia's fault for pushing this biased view. 93.87.170.63 (talk) 14:11, 22 October 2016 (UTC)

The Word "very" in the Prognosis Section Should be "Vary."
If you have editing authority, please review and make the change. Thank you.

73.53.74.16 (talk) 19:21, 24 December 2016 (UTC)Rich Davis, 12/24/2016


 * Done. Thank you for your attention to detail. GrindtXX (talk) 19:59, 24 December 2016 (UTC)

Semi-protected edit request on 31 March 2017
Add in Environmental Section after sentence ending with increased asthma severity According to the Environmental Protection Agency, for every 10ug/m3 increase in fine particles there is an associated 1-4% increase in respiratory hospital admissions. Morbidity increases with is associated with ozone and particulate matter during warm seasons and carbon dioxide, nitrogen dioxide and particulate matter during cold seasons.

Environmental risk factors such as outdoor and indoor pollution can decrease lung growth and function resulting in the narrowing of the airways and compromising lung function in children. Urban and rural lifestyle may contribute to risk factors within certain socioeconomic levels. Children in rural environments have lower risks for asthma and aeroallergen sensitization. In contrast, children in urban environments exposed to pollution for prolonged duration are at increased risk of reduced lung function and slower lung growth. However, despite the important contribution of traffic pollution in urban air quality, few studies have evaluated that traffic was the major source of air pollutants in urban areas on health. These studies suggest that traffic intensity, specifically trucks, can lead to adverse respiratory health effects in children under 5 years of age. In another study, there was a relationship between Black Smoke, but not nitrogen dioxide (NO2), to respiratory health. Black Smoke is known to be a marker of detection for diesel exhaust, the study suggests that diesel was responsible for the effects of respiratory health.

Add after sentence ending in minority communities. Low-income and minority communities may suffer disproportionately from exposure to pollutants that cause asthma. Hispanic and non-Hispanic black populations have a higher exposure to particulate matter ≤ 2.5 μm in diameter. Individuals in low SES neighborhoods are also more likely to be exposed to fine particulate matter. Minorities and lower SES populations are more likely to be concentrated near industrial zones, which have a greater number of Toxic Release Inventory facilities and major stationary point sources of air pollution. Five year averages of asthma hospitalization are up to 5 times higher in these census blocks, when compared to blocks with lower minority populations and less point sources of air pollution. Health disparities related to asthma are associated with housing cost, low-income and minority individuals, access to healthcare and location of pollutant in relation to housing. , Taylork4 (talk) 02:17, 31 March 2017 (UTC)
 * Content is partly copied and pasted from sources such as
 * Please read WP:MEDRS. Many of yur sources are primary sources such as
 * Also what you write pertains to just the United States and yet it is made to sound like it applies to the world.
 * You need to also summarized more and use easier to understand language. Best Doc James  (talk · contribs · email) 13:11, 31 March 2017 (UTC)

"famous" (well known) people with asthma
Would it be worth to include a list or link towards a list with known people (especially sports people) that have asthma? In the wiki page on sports induced asthma, there is some mentioning of people at top level sports with asthma, but would it not be nice to include a little chapter here on this page as well?

Asthma as a diagnosis is often hard to hear while the majority of people will be able to continue a balanced life style with lots of sport (and even top level sport).

So maybe it would be good to include a little paragraph on "living with asthma" with attention to - importance to use the medication regulary (often chronic situation, taking meds every day, all their life) - important to use medication BEFORE exercising (the bronchodialoters) (esp for those with asthma induced by sports) (often people do not take it because they feel ok and do not expect to feel something - mentioning that asthma is chronic, but not necessary life altering (leaving out the very severe cases of course) - mentioning that asthma is not life altering in most cases, but that some professions/sports might be out of reach (eg diving, changing jobs when it is occupational asthma) - the search to the proper inhaler (often people stick with one that actually is not good, worsens certain symptoms but they think it is just their asthma) + need for yearly check ups and so..

Garnhami (talk) 12:08, 8 May 2017 (UTC)


 * I doubt that knowing about famous people with asthma is going to improve the treatment for in individual. We should only really discuss celebrities whose diagnosis and treatment have had a demonstrable impact on the public perception of the disease in question. JFW &#124; T@lk  13:38, 8 May 2017 (UTC)
 * Agree with User:Jfdwolff. There are reports that some sports figures get a diagnosis of asthma so they can get access to asthma meds to improve their performance as the drugs help those without the disease aswell. Doc James  (talk · contribs · email) 13:53, 8 May 2017 (UTC)


 * of course: some cyclist (if not a lot) do not have asthma and use it to take the drugs in their advantages. However coming back to the question raised about the famous people (or people in top sport), both of you are seriously underestimating the impact. Up to 90% of people (who are active (in sports)) who get a diagnosis with asthma will ask themselves the same, similar questions: can I still have a normal life, can I still be active (play sport) and I wonder if there are people out there with this problem that are still very active. Never underestimate the value of knowing someone is doing something with the same problem. There is a reason why these lists are already out there (and actually being used by lungspecialist! I have seen them in waiting rooms or as pamphlets to read, to convince people it is not over! I actually know doctors that use it to stimulate people, esp. kids. It surprises me to read both of you are doctors but not seem to use or know about this type of encouragement. Tell a kid with asthma to take his inhaler every day and you might succeed, tell a kid to use his inhaler because some "hero" takes it too and he can still become the olympic champion and you are almost 100% sure he will use it every day) Besides: "demonstrable impact" on the public? Hard to measure. I am not advocating to make a big text on this btw, but just a general reminder to people that asthma is not the end of the ride. They should stay active, take the meds regularly, look for the best treatment plan (inhaler) (often overlooked).Garnhami (talk) 20:35, 8 May 2017 (UTC) A small personal experience: telling certain kids that Paula Radcliffe has asthma, pretty much makes them sprint off within a nanosecond, yelling to their parents they are going to become to next one with asthma winning the medal. The same trick also applies when you tell kids they need to wear a helmet because every well known cyclist wear one as well! Never failed me! (at least until they reach a certain age)

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Asthma prevention by avoiding pollution
I just added information to the "prevention" section to raise the idea of preventing asthma by lowering pollution.

I do not know what sources to cite. I picked two review articles. The idea that I felt was missing is that asthma can have its cause based in pollution, and that communities can lower asthma rates by lowering pollution. There might be better ways to phrase this or better sources to cite.  Blue Rasberry  (talk)  16:32, 30 May 2017 (UTC)
 * Refs just cover pesticides. The one ref says "In conclusion, this article suggests that occupational exposure to pesticides is associated with an increased risk of respiratory symptoms, asthma and chronic bronchitis, but the causal relationship is still under debate."
 * I have thus moved it to the section on cause#environmental. I am unable to find where it talks about prevention. Let me look for other sources. Doc James  (talk · contribs · email) 17:15, 30 May 2017 (UTC)
 * How about "The World Health Organization recommends decreasing risk factors such as tobacco smoke, air pollution, and the number of lower respiratory infections." based on the WHO fact sheet? Doc James  (talk · contribs · email) 17:21, 30 May 2017 (UTC)

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NEJM
10.1056/NEJMra1608969 - severe and difficult to treat JFW &#124; T@lk  14:57, 7 September 2017 (UTC)
 * as cite journal for easier copy & paste. The NEJM abstract notes it as as review, but Pubmed only has it as a journal article so far. RDBrown (talk) 07:36, 12 September 2017 (UTC)
 * as cite journal for easier copy & paste. The NEJM abstract notes it as as review, but Pubmed only has it as a journal article so far. RDBrown (talk) 07:36, 12 September 2017 (UTC)

Asthma article
I agree that the September 7 nejm (Israel and Reddel, 377:965-76) article is hard to read, but it does show some of the new ideas and definitions that are important and should be in the Wikipedia article.

First, the consensus definitions of "severe asthma" and "difficult-to-treat asthma.

Second, the the notion that the diagnosis of asthma often needs confirmation as does inhaler techniques, adherence, comorbid conditions and continued exposures.

Third, the idea of asthma phenotypes and phenotype-targeted therapies: immunotherapy, anti-IgE antibody (omalizumab) and anti-IL-5 antibodies (mepolizumab, reslizumab and benralizumab).

Cefisher (talk) 23:38, 11 September 2017 (UTC)
 * Sure added a bit on Omalizumab Doc James  (talk · contribs · email) 15:50, 12 September 2017 (UTC)

Lancet Seminar
10.1016/S0140-6736(17)33311-1 JFW &#124; T@lk  20:47, 24 February 2018 (UTC)

Aspirin Induced Asthma
The information under the Aspirin Induced Asthma section is not accurate. It currently states: "Respiratory reactions MAY occur to all COX-1 inhibiting medications including aspirin, ibuprofen, and naproxen. In addition to asthma, people OFTEN develop nasal polyps..." This is not accurate due to the words MAY and OFTEN. I have tried to edit this several times with cited sources, but my edits are deleted. Here is the problem: reactions to all COX-1 inhibiting NSAIDs and nasal polyps are in fact criteria for diagnosis with AERD. Saying reactions MAY occur is not accurate. Saying nasal polyps OFTEN develop is also not accurate. These are criteria for being diagnosed with the disease. A patient who reacts only to aspirin, for instance, has a drug allergy - not AERD. A patient without nasal polyps also does not have AERD. It is actually possible to have AERD without asthma - but not without nasal polyps and NSAID reactions.

References:

https://www.aaaai.org/conditions-and-treatments/library/asthma-library/aspirin-exacerbated-respiratory-disease

https://www.samterssociety.org/files - there are nearly 100 studies on AERD on this page.

https://www.youtube.com/watch?v=i8PHXeNuioY - here is a lecture on AERD by the internationally recognized expert, Tanya Laidlaw, MD
 * User:Andyleigh12 one of the removals was due to the content being copied and pasted from a source. We must paraphrase.
 * The other ref says "Patients with AERD have evolving sinusitis that starts as mild mucosal inflammation and progresses into a severe persistent disease that often completely fills the sinus cavities with inflammatory tissue and becomes associated with NP"
 * Thus early on nasal polyps may not be present.
 * In fact the AAAAI goes on to say "People with AERD usually have asthma, nasal congestion and recurrent nasal polyps". It than says "The characteristic feature of AERD is that patients develop reactions to aspirin and other NSAIDs" Doc James  (talk · contribs · email) 13:01, 4 August 2018 (UTC)

Editing Request
The National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute (NHLBI) recommends that asthma treatment incorporates various methods, such as asthma monitoring, patient and family education, the removal of environmental triggers, and/or the use of long-term and quick-relief medication.

— Preceding unsigned comment added by KSRE89 (talk • contribs) 16:28, 17 January 2019 (UTC)

Semi-protected edit request on 26 May 2020
Epidemiology section, last sentence.

Change from "Child are more likely see a physician due to asthma symptoms after school starts in September" to "Children are more likely to see a physician due to asthma symptoms after school starts in September". 82.129.70.34 (talk) 21:49, 26 May 2020 (UTC)
 * Yes check.svg Done Eggishorn (talk) (contrib) 22:33, 26 May 2020 (UTC)

Semi-protected edit request on 26 May 2020
Within the management section, adverse effects subsection: The third sentence should read "Rinsing the mouth after the use of inhaled steroids can decrease the risk of thrush". 82.129.70.34 (talk) 22:01, 26 May 2020 (UTC)
 * Yes check.svg Done Eggishorn (talk) (contrib) 22:34, 26 May 2020 (UTC)

GINA 2020 guidelines
The new GINA guidelines for management of asthma recommend use of inhaled steroids + formoterol, instead of salbutamol/SABAs. This is a large departure from history, but is being widely updated. Should we update this page, and possibly other related pages? --cannywizard (talk) 10:40, 23 October 2020 (UTC)

CHM for Taiwanese children
In 2013 it was published an analysys made on the medical records of the National Health Insurance Research Database (NHIRD) from 1997 to 2009, from whiche were acounted the Taiwanese people with diagnosis with asthma and aged 6 to 18. The Chinese herbal medicine (CHM) resulted a medical prescription commonly used to control diseases and the Ma-Xing-Gan-Shi-Tang (MXGST) was the most commonly used herbal formula (source: PMC 3771466, Evidence-Based Complementary and Alternative Medicine).Philosopher81sp (talk) 12:23, 6 November 2020 (UTC)