Wikipedia:Featured article candidates/Asthma/archive1

Asthma
Partial self-nomination. This is the second article we've worked on at the fledgling Medicine Collaboration of the Week, and the topic certainly merits a featured-standard article. We've been working hard on this article for a couple weeks and feel it has improved significantly. It was listed on Peer review (see project page) on August 11th and we have done our best to incorporate the helpful suggestions given. I don't have any experience with WP:FAC, and I don't believe the other participants do either, so we would appreciate any suggestions from the reviewers for how we can further improve the article. &mdash; Knowledge Seeker &#2470; 07:19, August 24, 2005 (UTC) I got some of the updates in. Mr.Bip and Encephalon are putting some great work in finding and listing references. I'll work on incorporating some of them into the article to help fulfill your suggestions, Taxman, but it will take me a couple days because I am on call at the hospital tomorrow (which means I won't come home until the day after). Hope you don't mind giving us a few more days to fix up these sections. &mdash; Knowledge Seeker &#2470; 04:03, August 27, 2005 (UTC)
 * Support. Very good. Could do with better reference system and a description of the staggered approach (e.g. first &beta;2 agonists, then steroids, then long-acting bronchodilators etc etc) as used by the BTS and elsewhere. I miss "alternative medicine" and a consideration whether it contributes to COPD later in life, and smoking should be mentioned as detrimental. Finally, did we mention active avoidance of allergens and removing them (although this is old-fashioned and poorly supported by evidence). JFW | T@lk  07:42, 24 August 2005 (UTC)
 * Support. Simply fantastic improvements. Comments. Hmm I didn't reallize you planned to bring this to FAC so soon, as there are still a few issues. But since most of the article is very good, I think we can get any issues fixed up well. I'll try to be detailed here not because the article is bad but to help it be great. Besides the pathophisiology section the rest seems to lack the depth of research one might expect for a medical related article. 1) For example the treatment guidelines seem to conflict a bit. The top treatment paragraph mentiond leukotriene inhibitors can be used instead, while in the preventer section it is mentioned preventers can be layered. Which ones can be layered? I thought leuk. and corticosteroids could be, but I could be wrong. Do you have a reference for what the standard first line treatment recommendations are? For ex from the American pediatrics community vs European or other. Do they differ? 2) Some mention of the side effects of the primary drugs would be good too. 3) I also agree coverage of alternative medicine should be included. 4) What is the relation to exercise recommendations? Does it help asthma symptoms in the long run or no? Swimming is often recommended as good exercise that doesn't trigger asthma as much, but I don't know if that is a current recommendation. 5) As in peer review I think a mention should be made of athletes with asthma, even some olympic runners have it. If you really feel it is not important enough for inclusion then I'm ok with that. 6) I really think the reliever and preventer phrasing is innapropriate for the headings. That may be the words used with children, but most children with asthma aren't going to be reading this article. 7) Lung modification, I saw the addition that there was none, but a pediatrician friend told me I should stay with a long acting preventive treatment in order to avoid the modification that occurs from attacks.  That may be based on newer information or research than the article so a citation for that would be good. So for any potentially contentious facts or for very important points citation to the most reliable source available would help meet the criteria. I've been meaning to dig up what I could, so I'll try to move along a little faster to find the material. - Taxman Talk 14:38, August 24, 2005 (UTC)
 * Support (Partial self-nomination)
 * Yes, some work yet to do on article (both simplifying some of pathophysiology and increasing breadth of the article).  I hope to continue contributing to this article, but my free-time is short,so I'll try on & off over the next couple weeks.
 * re "Relievers" / "Preventers" these are terms we (doctors and Asthma-UK patient organisation) use in UK (see Management PDF). The terms apply not only for children, but especially with adults to help explain that steroids must be used all the time and not just when symptomatic and that by so doing, they will help lessen need for the short acting dilators (salbutamol). Dilator use does not prevent asthmatic deaths, failure to grow in children with severe asthma nor time lost from school/work, but steroids are shown to do this (excess of course can affect growth).
 * It is perhaps the hardest part of helping asthmatics to manage their condition to persuade people to use something (a steroid) that gives no immediate effect unlike the very obvious response bronchodilators. No "normal" patient knows what bronchodilator or beta2-adrenoceptor agonist means, and the term "steroid" frightens may from using.
 * I, from the UK perspective, would strongly urge that these terms help the non-medic understand the role of different types of drugs used for asthma. Wikipedia is not a medical textbook, but is meant for the 'general public', patients and friend/family of patients. David Ruben 17:46, 24 August 2005 (UTC)
 * Ok, but I wasn't saying remove the terms, just put the section headings back to a less colloquial form like preventative treatments and relief treatments or something to that effect. Then include a mention of the other terms if they are common. I also noticed that glucocorticoid is mentioned first and then corticosteroid is used later without any explanation of whether they are the same or different. Also, isn't theophylline sometimes still used as an ongoing treatment, and not just in an emergency situation? - Taxman Talk 21:43, August 24, 2005 (UTC)
 * Thanks for the feedback. Taxman, I'm sorry if I nominated this earlier than you intended. I am excited by the improvement in the article and may have gotten carried away, but I am confident that the article can be improved enough to merit being selected as a featured article, if it does not already (regardless, we will of course continue to improve the article). Dr. deWolff, are there specific parts you would like footnotes for or what are you suggesting? I've seen previous FACs get criticized for overuse of inline footnotes, so we left the references at the bottom for the most part. Maybe some of the statistics? I'll work on putting more detail into the treatment. I'll do some research too on smoking/COPD correlation. I don't have any information on alternative medicine but I'll bring it up on the talk page and see if anyone else does. Yes, allergen avoidance is mentioned under Asthma. I didn't put side effects in because I didn't want to clutter the article, but if you feel they are appropriate, I'll put them in. I'll also expand the section about exercise, but I am not sure about athletes with asthma. I agree that the "reliever" and "preventer" sound too childish for headings. Incidentally, Dr. Ruben, I know you mentioned that no "normal" patient knows what bronchodilator means, and that may be true in the UK, but in the U.S. that is the term our patients know the medications by (not &beta;2-adrenoreceptor agonist though). I don't want to use country-specific terminolgy and both can be included, but I do feel that those terms are too informal to use for article headings. I don't believe that there is any evidence that asthma progresses or, given that, that steroids reduce progression, but I will look to see if I can find a study specifically addressing that. Thanks again! &mdash; Knowledge Seeker &#2470; 05:27, August 26, 2005 (UTC)

Oh. and I'd like to SUPPORT please!— Encephalon |  &zeta;   18:57:31, 2005-09-01 (UTC)
 * Support. Honestly this is an extremely well-written, thorough article. I'm not a clinician, so this is outside my specialty, however I read through it late last night and was very impressed. I made a few minor changes in the first three sections, but those are simply stylistic and it's difficult to say whose version is better. I'd like some more wikification of topics... but I tend to be very "wiki happy" with my articles, and I'm not sure where my preferences stand in relation to standard wiki etiquette. I'll read through this article more closely tonight to add some more in depth analysis and criticism. All-around however, every topic that I thought should be included was. Semiconscious  ( talk  · home) 19:52, 30 August 2005 (UTC)
 * Alternative treatment, more treatment details, and athletes with asthma are in, at least in basic format; I'll work on expanding them. We're redoing the reference system. I'll get to smoking/COPD and permanent lung damage later. There are conflicting reports regarding irreversible lung changes, although it appears that there is more evidence that early glucocorticoid use can prevent long-term lung changes. What is less clear, though, is if this has any correlation with progression of asthma: some lung parameters might decline, but it looks like there is no evidence that someone would progress from mild to moderate or moderate to severe asthma. &mdash; Knowledge Seeker &#2470; 20:56, August 30, 2005 (UTC)
 * I apologize for moving slowly on addressing concerns. I know we are all busy, but residency has left me with less free time than I have ever had before. I hope this will not hurt our chances for achieving featured status even if it takes me some time to make all the appopriate improvements. &mdash; Knowledge Seeker &#2470; 21:05, August 30, 2005 (UTC)
 * Well all the recent efforts look great, the article has really improved in my book. The references look great, I'm not picky as to what style is used specifically. Addressing the major points in the journal articles on the talk page would solve almost everything left that I can think of, and you seem to have it outlined well above. The one article on lung changes is a review of the current literature and states that thee is some conflicting reports so noting that they do occur, but also where the conflicts are would cover that just fine. I agree that the article notes lung parameters decline, but that no link is made to a progression to more severe catagories of asthma. Our article should do the same basically. Finish what you have planned for these points and I anticipate adding my full support. This has already been here for a while, if Raul654 wants to let it stay for longer it's up to him, but that's my preference as long as you can get the above fixed in a couple days. - Taxman Talk 21:27, August 30, 2005 (UTC)
 * Thanks for all your advice, Taxman. I think we have now incorporated all the areas you suggested. Is there anything that I've missed or are there any other comments or suggestions anyone else has? &mdash; Knowledge Seeker &#2470; 06:04, August 31, 2005 (UTC)
 * More than welcome. Being an asthmatic with a strong science interesst I can spot the things needed, but not always understand them enough to fix them. I'm glad that helped. I've switched to support, because overall it is really good now, but still two things would improve it more. The alternative medicine section still needs expansion to say what treatments are used, and you should probably link to Complementary and alternative medicine. That would be enough there in my opinion. Then the addition of general side effects to the preventative treatment section really helped I think. How can the article be comprehensive if it only notes the treatments are good, but not the (small %) bad effects? So that should be extended to the other treatments, with perhaps the emergency section only getting a blanket statement that higher doses and emergency treatments do carry higher risks, but that is balanced against the urgency of the problem. That sounds valid to me, but I'll let you be the judge. Also shouldn't theophyline also go in the preventive treatment section, as I thought it still was used as a last resort preventive treatment, not just in emergency situations. Again, I'll let you be the judge. And finally, every medical definition of asthma I've seen refers to reversibility, as does the diagnosis section of the article, so shouldn't the lead? - Taxman Talk 16:13, September 1, 2005 (UTC)
 * Taxman, you're an awesome critic, and I hope you'll continue to offer your thoughts on all the articles that we work on for the MCOTW. I'd like you to consider joining us as a regular participant: the "intelligent layperson" perspective is very valuable. Regarding the above, a new section on alternative medicine for asthma has been completed. I'd have posted it earlier, but my computer did a bad thing and ate it all up, and I had to rewrite. I referenced it quite heavily, as that is often the most contentious area in any given treatment of medical topics. Your suggestion on linking to the main article is good, I'll look into it. Re: theophylline, it's actually not that commonly used either way. In emergencies, adding it to B2 agonists does not give significant benefit, but increases risk of tachyarrhythmias/tremor/nausea/etc. It's used as a last ditch (ie. pt failing everything else). For long term management it's a possible candidate if i.steroid + addon does not = good control. So yeah, it could be added as a possible option. Re: the emerg caveat, I'm not sure it's necessary; if the others want to add it I wont object. Re the lead, I think it's written as a simple overview of some of the major aspects of asthma; reversibility mentioned later on is fine. Cheers— Encephalon |  &zeta;   18:56:31, 2005-09-01 (UTC)
 * Oh, well thanks. It's nice to be wanted, though for most medical topics I'm probably better at the peer review stage to help iron out the final issues and give the overview advice. So if you'd like to nominate all your articles there once they've finished the collaboration focus stage, and give me a nudge if I forget to notice them, that's where I could probably help the most. It works the best if there are people willing to impliment good suggestions, as happened very well in this case. So if you guys want to keep that up, I'll keep reviewing. Also I just happened to have a little more knowledge about asthma. As for the article, I was aware theophylline was last ditch, so the way it is now is fine. For the caveat part I was only suggesting that as an easier alternative than discussing side effects of each type of medicine. But I do feel side effects for each ype of treatment are pretty important in order to be complete, so whatever you think is best to cover that. - Taxman Talk 20:03, September 1, 2005 (UTC)
 * Looks like Encephalon pretty much took care of that stuff. Anything else that can be done? Incidentally, I'm on call again tomorrow, which means I won't come home until the following day (and I'll probably sleep all day after that), so if there are any new suggestions I might not get to them for a couple days. &mdash; Knowledge Seeker &#2470; 22:52, September 1, 2005 (UTC)

Needs editing; then I'll probably support. Tony 07:12, 31 August 2005 (UTC)
 * Thanks for your suggestion, Tony, and for going through the article and fixing it up. I'd hoped it was in good shape by this point; is there a specific paragraph or section that could use improvement in your opinion, or do you feel it overall needs to be cleaned up? &mdash; Knowledge Seeker &#2470; 07:24, August 31, 2005 (UTC)
 * I went through and made a few small changes, as did Mr.Bip. I think it's pretty good now; of course, I'll continue to read over it and fix awkward phrasing and such when I see it. If there is a particularly problematic section, please let me know. Thanks! &mdash; Knowledge Seeker &#2470; 06:22, September 1, 2005 (UTC)


 * Support—I've gone through it and made numerous small edits. It's a good article, worthy of FA status. Tony 06:29, 2 September 2005 (UTC)

Some links to some well thoughtout feedback: Peer review/Asthma, and Talk:Asthma (Avocado's layperson-review). (courtesy of Mr.Bip) David Ruben 18:06, 24 August 2005 (UTC)
 * Object; no mention of ventolin.  Erwin 
 * Ventolin is a trade name, the drug is mentioned under its generic name, Salbutamol. --WS 11:27, 2 September 2005 (UTC)