Talk:Asthma

Listing oxygen as a treatment

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

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

Revert

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

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

Links with dermatitis

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

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

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

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

Link Between Allergies and Asthma

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

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

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

Lungs OnLine - should it be referenced or not?

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

Asthma mortality

Should we mention asthma is still potentially fatal?

• It would be quite appropriate. Please add what you think would best convey the history and present status of asthma as a cause of mortality. Courtland 07:06, 2005 Feb 12 (UTC)

Theories of asthma pathogenesis

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

Butekyo claptrap

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

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

vegetarianism and exercise

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

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

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

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

Ideas

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

Things that need to be improved (an incomplete list):

• The epidemiology section
• Writing quality of the introduction
• Pathology and Treatment sections should be written as real paragraphs, not big lists

I'll tackle this one. Mr.Bip

• Also, I think it would be nice to have a historical perpsective on asthma - even mild asthma used to be a debilitating condition before the advent of inhalers

On that note, I think a list of famous asthma sufferers would be interesting. I know lots of famous athletes have had asthma, in addition to intellectuals like Marcel Proust

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

Rewrite

I sat down this afternoon and rewrote a lot of this article, as you can see in the history. Mostly, I rewrote and rearranged the introduction, played with the formatting, moved the image down to the "Pathology" section, and completely rewrote the Pathology section. Let me know what you think.

P.S. I did spend a considerable amount of time researching and writing the Pathology section, so if you have any issues with it, I would appreciate a note about edits you make. Mr.Bip 03:02, 7 August 2005 (UTC)

Wrong tone for wikipedia

• This is technically very good with a detailed description of the immunological processes involved. However, as a mere GP, I struggled to understand it, got bored and started skipping; I do not think that, as an encyclopedic article, it is currently useful to a non-medical newly-diagnosed asthmatic who would be trying to learn the basics about asthma. Unlike the comment above ('Theories of asthma pathogenesis' suggesting taking an axe to the article) I do not suggest removing the technical stuff, but it urgently needs to be in a separate section at the end of the article. I would leave in their current place the general discussion bits on the theory of pathogenesis/pathology.
  • The structure of the article needs be 3-levels: the general introduction, a lay guide to cause/symptoms/diagnosis/treatment and then a technical discussion.
• Asthma diagnosis is not via pulmonary function (spirometry) testing for the majority:
  • Children can't do the tests, diagnosis is by history taking and confirmed by response to treatment
  • In adults, diurnal-variation or reversibility to bronchodilators using Peak Flow Rate Meters is the norm (at least in the UK)
  • Spirometry was rarely performed (in UK), being largely a hospital test, although becoming a little more common in General Practice now. Spirometry is usually used if the diagnosis is in doubt or chronic obstructive airways disease is instead suspected.
• A greater emphasis needs be made to distinguish treatments for symptom control (relievers) verses disease modification (preventers). The current passage is too alarmist, very few asthmatics are so severe as to need nebulisers. There is a ladder of treatment depending upon severity (UK NICE/SIGN) that needs adding.

I shall await comments (being Collaboration article of the week), before editing the overall structure... -David Ruben 21:45, 7 August 2005 (UTC)

David - I appreciate your comments. I welcome the effort to translate what I've written into more comprehensible language (and if you think that is bad you should read what was there before I edited the article). Working in a lab talking about science all day, one loses track of what a layperson can and cannot understand easily. Also, I agree that the article makes asthma seem like a death sentence. There are, of course, many different degrees of asthma, including the kind I suffer from, excercise induced asthma. I was hoping the physicians in the crowd could flesh out more of the clinical aspects of the disease. The "Signs and Symptoms" and "Diagnosis" sections are pretty fragmented - please modify it as you see fit. I think a GP's perspective is exactly what we need for those sections. Mr.Bip 22:29, 7 August 2005 (UTC)

P.S. I just looked over the changes you did make, and they make good sense. It would be great to have a US physician look over it and modify it for any practices that differ in America. Mr.Bip 22:34, 7 August 2005 (UTC)

David - actually, after second thought, I think the structure of the article should stay. Look at this template on the Clinical medicine Wikiproject. I think it makes sense, and I would like to impose a regular structure on disease articles. Mr.Bip 04:20, 9 August 2005 (UTC)

Ok, I agree, but can we have at least a non-professional introductory paragraph to the Mechanisms/Pathophysiology -David Ruben 07:54, 9 August 2005 (UTC)

Formatting issues

Can someone help me out with the formatting at the top of the article, with the image and the infobox? I can't get it to look right on IE and Safari. It's really bugging me. Mr.Bip 00:44, 10 August 2005 (UTC)

On my IE, The ICD box (floating right) sits embedded in the lead paragraph, with the text wrapped around. The image of the kiddo doesn't appear. On Firefox, the photo appears where it should in the lead section, the ICD box sits just below the photo, and the TOC sits where it should on the left. The robust conclusion that we can make from this of course is that IE is stupid.

Seriously though, I don't know why it's happening. I went through the histories, and note that when you view the older revisions in IE, the picture turns up fine. In fact, even when you view the revision I just made [1],[2] the image is there. It's only when you return to the actual page (Asthma) does the image disappear. —Encephalon | ζ | Σ 06:02:25, 2005-08-10 (UTC)

It's the cache. Clear your cache, Bip. Firefox retrieves pages differently from IE, which seems to depend a lot more on the cache at the standard settings. It looks OK on IE now.—Encephalon | ζ | Σ 06:04:50, 2005-08-10 (UTC)

Screenshot to your right. Was there anything else about the image and the box that bothered you, Bip? Regards—Encephalon | ζ | Σ 06:18:17, 2005-08-10 (UTC)

(Removed ss)—Encephalon | ^ζ  07:50:19, 2005-08-18 (UTC)

"Layperson's Review" of Asthma article

Hi Folks,

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

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

So here goes....

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

General stylistic notes

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

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

Technical style, jargon, etc

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

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

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

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

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

Miscellaneous

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

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

---

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

I add my thanks as well. I will work on modifying the article. — Knowledge Seeker দ 06:42, August 15, 2005 (UTC)

Technical errors

The recent edits may have improved the readability but have introduced/highlighted several errors:

1. Peak flow meters measure the restriction of airflow through the bronchi, not 'lung capacity'; a term that has a very specific meaning in lung function measurement.
2. I would dispute the term 'Many' for those asthmatics with allergy. It is generally a tiny minority of the total. Yes a few people get asthma-like bronchoconstriction in the presence of cats or dogs and a greater number find they get symptoms along with their hayfever. But for the majority of asthmatics, direct allergy is not relevent to their disease and antihistamines have NO effect. (the use of serology tests of dubious significance does not prove an allergy, merely the presence of some antibodies)
3. The terms used (at least in UK) for bronchodilators and steroid inhallers is very specifically 'Relievers' & 'Preventers'.

David Ruben^talk 00:53, 22 August 2005 (UTC)

DR - I corrected the first two errors you found, which are my fault. I'm not a doctor (yet), so thanks for catching those things. I actually feel like there might be several more technical inaccuracies in the language in this article, but we need doctors to look at it to be sure. I think that the UK and US terms you mention in your last comment are both used in the article. If you see a problem, feel free to change it. Mr.Bip 01:06, 22 August 2005 (UTC)

Sorry Mr.Bip, my internet link went paralytically slow, freezing my computer as I tried to implement the above changes myself - no intension meant to over-ride your own edits on these :-)

The article on peak flow meter makes the same error and I will correct too. David Ruben^talk 01:45, 22 August 2005 (UTC)

Thanks, Dr. Ruben. Regarding the terms relievers and preventers, perhaps it is a UK thing then? I, of course, can deduce their meaning, but an average patient in the United States would not recognize the terms. I don't really care about a U.S. vs. U.K. thing, but the terms reliever and preventer sound a bit too informal to me to be section titles (perhaps I just prefer overly formal speech?). I'm going to reword them slightly; please feel free to edit it further if you think appropriate. — Knowledge Seeker দ 20:18, August 22, 2005 (UTC)

Nominate for FAC?

I think this article has improved, and benefitted from the suggestions on peer review. I'd like to nominate it for featured article status—any comments/objections? I hope it's up to par, but even if not, it will give us direction on how to improve this (and future) articles. — Knowledge Seeker দ 01:46, August 24, 2005 (UTC)

Good idea, KS. I am wondering about a couple of things though:

1. References. The first two use the footnote template system, but the first doesn't work (I think the ref number in the article was removed). The second jumps to [1]. A larger issue I think we need to discuss at our MCOW or Lounge pages is what form of references should we use for our medical articles? If I recall correctly, the MoS is vague on this point. For us the matter will essentially boil down to Harvard vs. Vancouver, I should think. The footnote template on WP is essentially of the Vancouver form, and biomedical journals generally do follow that form; however, the problem with this is on WP that if any edit is made to a footnote in the article, I believe the "jumps" get screwed. More experienced users pls correct me if I'm wrong.
2. Red links. Is it considered unwise to submit for FA with red links in the article? Should we start stubs on some important terms, eg. wheezing? I think I'll go ahead and get one or two started by tomorrow.
3. Images. These need to be all cleared — it's the first thing they seem to look at on FAC.—Encephalon | ^ζ  02:12:16, 2005-08-24 (UTC)

I've had my eyes on getting this article to FA status for a while. I think it's probably close to ready, thanks to the last push by Encephalon, KS, and DR. I've just done a another combing through the article, added a few links and corrected a few typos. To address Encephalon's concerns: I think that WP articles are quite mixed when it comes to footnotes. I think that little recent research is discussed in this article, so I feel fine about using the general reference section at the end of the article without in-line citations. I don't think the red links are a problem in themselves either, but starting stubs is never a bad idea. And lastly - the images. Since I picked all of them myself, I can promise that they are all from government or public domain sources - I made super-sure that they would be OK. Double check them please. Let's nominate this article :) Mr.Bip 05:10, 24 August 2005 (UTC)

PS - On second thought, I feel like this article needs a "History" section before it would really be FAC quality. I can't find any good online resources on the history of asthma, and I don't have access to a library at the moment. If someone can add a section soon, that would be great. Otherwise, I would like to nominate this to FAC to see how close we are to the featured standard. Mr.Bip 06:05, 24 August 2005 (UTC)