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)

Mr.Bip and I briefly discussed the best way to do references a little while ago. I am not entirely certain what FA prefers; my feeling is to keep it this way and if the reviewers would like us to do it differently we can change it. Same for the red links—I don't think it will hurt us but we can always write stubs at least. The images should be fine—they all look properly tagged to me. Mr.Bip, a "history" section would be good, I agree. I'll see if I can scare one up, although I am not sure what I will be able to find. — Knowledge Seeker দ 06:27, August 24, 2005 (UTC)

I threw a "History" section together, but it could use some work. One of the sources I used was the abstract from PMID 6757243, but it would be nice to get the complete article, and PMID 14160430 looks to be a good source for history as well. If anyone has access to these articles, that'd be great; otherwise, I'll see if I can hunt them down at the hospital. I think we're ready to submit this FAC; what do you think? — Knowledge Seeker দ 07:08, August 24, 2005 (UTC)

Helped needed for FAC

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

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

1. the effects of smoking in adults with asthma,
2. the effects in children inhaling 2nd hand smoke,
3. relationship btwn maternal smoking during pregnancy and asthma in children, and
4. the effects of smoking on the efficacy of glucocorticoids used for treatment.

Incredibly, and I didn't know this until I looked, Cochrane doesn't have a single MA or protocol on any of the above. Cochrane Central lists 31 RCTs to do with various smoking-asthma issues. Cochrane does have some 125 SR/MAs related to asthma, per se. I can help with writing up the smoking bit, although I can't promise a time frame at the moment. Incidentally, that was an excellent catch by Dr. deWollf - I completely missed the fact that we'd forgotten smoking. However, you're supposed to be telling us these things before we go to FAC, JFW! LOL. :) —Encephalon | ^ζ  05:58:16, 2005-08-26 (UTC)

KS and others - I have found information on each of these topics, here are some links. I'm going to go through them and modify the article. To be honest, I'm not really sure where to fit some of this stuff in, but here goes.

• Asthma and Smoking: Cleveland Clinic - Asthma and Smoking

• PMID 15643345 (The influence of smoking on the treatment response in patients with asthma, Curr Opin Allergy Clin Immunol., 2005)
• PMID 12403881 (Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and woodsmoke, Thorax, 2002)

• Asthma and COPD: AAAAI - When Asthma and COPD Coexist

• PMID 15853852 (Asthma and COPD: differences and similarities, Int J Clin Prac, 2005)

• Airway remodeling in asthma: PMID 12554904 (Pharmacotherapy and airway remodelling in asthma, Thorax, 2003) Full text
• Asthma and Athletes:

• PMID 9819287 (Prevalence of asthma in 1996 Olympic athletes)
• PMID 10984362 (Allergy and asthma in elite summer sport athletes)

• Alternative medicine:

• Alternative Therapy for Asthma - Cleveland Clinic
• PMID 14749604 (Complementary and alternative medicine for bronchial asthma: is there new evidence?, Curr. Op. Pulm. Med. 2004)
• PMID 12532195 (Herbal remedies for asthma treatment: between myth and reality, Drugs Today (heard of this journal?), 2002)
• PMID 15907677 (The Buteyko breathing technique for asthma: a review, Complemen. Ther. Med., 2005)

All this in 20 minutes :) Clearly, we can bury ourselves in literature about this topic. Let's just go for an accurate overview of the topics (1-2 sentences), and refer to links as necessary. Mr.Bip 06:16, 26 August 2005 (UTC)

• Strong work, gentlemen (apologies for the assumption if you are female, Encephalon). I will try to look these up and put them in the article. It'll take me a couple days because I am on call in the hospital tomorrow. — Knowledge Seeker দ 04:01, August 27, 2005 (UTC)
  • Sorry to have created extra work for obviously busy people, but I think it will lead to a much better article in the end. Incorporating the major results from the above would lead to a significantly better than average article. I have access to some good pediatrics textbooks, but I lack the background to understand a lot of the details very well. - Taxman ^Talk 18:16, August 30, 2005 (UTC)
    • No need to apologize, Taxman—we're not the only busy people here. Besides we share the common goal of wanting to improve Wikipedia. — Knowledge Seeker দ 05:59, August 31, 2005 (UTC)

CAUTION

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

Refs

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

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

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

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

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

As always, kind regards—Encephalon | ^ζ  22:57:18, 2005-08-26 (UTC)

Thanks, Seeker. No need to rush — get your sleep Sunday. Oh, and I don't mean to jinx it or anything, but it just ain't happening, dude. Sleeping on a call night as an intern in any normal hospital on a Saturday is simply a contravention of all known Laws of The Universe ©. You should write it up if it happens. :) —Encephalon | ^ζ  22:10:28, 2005-08-27 (UTC)

Encephalon - I want to get on top of this stuff soon too - I added several of those refs. I'm moving back to school this weekend and starting a job, so I'll be pretty busy too. I'll try to do what I can. Also, I guess I'll have to read up on Biochemistry to prepare. Mr.Bip 01:33, 28 August 2005 (UTC)

Don't worry about it, Mr. Bip. You deserve a barnstar for the work you've already done. Just post your info on this talk page when you have time, as above. If there are still refs unaccounted for after Seeker posts here, I'll manually go through the edit histories and locate them. I'd have gone ahead and done it over the weekend, but since I didn't place many of the refs, I thought it courteous to ask the editors who did to say where they want them. Your point about Biochem is an important one, and something we may need to think about. Because of the Asthma FAC, I have not worked on RA; poor WS has been making improvements all by himself. I'm doing some clean up work today, but there is SO MUCH more that needs to be done on RA. We might have to rethink our timing: perhaps, MCOTW can be skipped during those weeks when there is an active push for FA status of one of our articles?—Encephalon | ^ζ  00:56:18, 2005-08-29 (UTC)

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

In Treatment: "For those in which exercise can trigger an asthma attack, the episode usually occurs after the exertion, not during it. Higher levels of ventilation, colder air, and drier air all tend to make the episodes worse. For instance, activities in which one breathes large amounts of cold air, such as cross-country skiing, tend to be more worse for asthmatics, whereas swimming in an indoor, heated pool, with warm, humid air is less likely to provke a response." is from Harrison's. — Knowledge Seeker দ 17:28, August 30, 2005 (UTC)

Really? I find the first sentence hard to believe. I mean what about prolonged exercise? If the sentence were true, then for the most part asthmatics could delay symptoms simply by continuing to exercise. Myself as an example I get symptoms during prolonged exercise, even as short as 5-10min into it if I think about the last time I had symptoms. I think the author was implying short duration exercise, but never said. What do you think? The rest of that quote is golden though, and covers exactly what I had found and was thinking of adding. - Taxman ^Talk 18:35, August 30, 2005 (UTC)

I took it out, pending further confirmation. Feel free to reword the other sentences. I have a propensity to write long sentences, and the second sentence in particular ended up rather complex. — Knowledge Seeker দ 05:14, August 31, 2005 (UTC)

In Treatment: "These include an increased severity of symptoms, more rapid decline of lung function, and decreased response to preventitive medications. Asthmatics who smoke typically require additional medications to help control their disease. PMID 15643345. Furthermore, exposure to secondhand smoke is detrimental as well, resulting in more severe asthma, more emergency room visits, more hospital admissions related to asthma. PMID 12403881. Smoking cessation and avoidance of those who smoke is strongly encouraged in asthmatics." "...most studies show that early treatment with glucocorticoids prevents or ameliorates decline in lung function as measured by several parameters.PMID 12554904" following sentence is from Harrison's. Thanks Mr.Bip for finding all these journal articles. — Knowledge Seeker দ 06:02, August 31, 2005 (UTC)

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

Basic science references

The very detailed paragraph about the bronchial immune response is very sparsely referenced. What was the main reference for this work? JFW | T@lk 21:04, 30 August 2005 (UTC)

JFW - I mostly wrote that. My refs were (3) and (5) in the article, plus this article - Lilly CM, Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics. J Allergy Clin Immunol 2005, S526-31. PMID 15806035. Hope this helps. Mr.Bip 20:43, 31 August 2005 (UTC)

Copy of original refs for article

• Template:Anb Diagnosing Childhood Asthma in Primary Care, Patient UK PatientPlus article written for doctors
• Template:Anb British guideline on the management of asthma - Scottish Intercollegiate Guidelines Network (SIGN) Online Full PDF Summary PDF
• Template:Anb Alberts, W. Michael. "Irritant-Induced Asthma: Diagnosis And Management". Medscape General Medicine. http://www.medscape.com/viewarticle/408732. Accessed on August 24, 2005.
• Template:Anb Asthma Prevention Program of the National Center for Environmental Health Center for Disease Control and Prevention. Asthma At-A-Glance. 1999.
• Template:Anb Finotto S, Glimcher L. T cell directives for transcriptional regulation in asthma. Springer Semin. Immunopathology 2004, 25(3-4):281-94. PMID 15007632.
• Template:Anb Fraser Health: Asthma: Facts. http://www.fraserhealth.ca/HealthInfo/PublicHealth/Asthma/facts.htm. Accessed on August 24, 2005.
• Template:Anb Inwald D, Roland M, Kuitert L, et al. Oxygen treatment for acute severe asthma. BMJ 2001;323:98-100. PMID 11451788.
• Template:Anb Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328:434. PMID 14976098.
• Template:Anb Lilly CM, Diversity of asthma: Evolving concepts of pathophysiology and lessons from genetics. J Allergy Clin Immunol 2005, S526-31. PMID 15806035.
• Template:Anb Maddox L, Schwartz DA. The Pathophysiology of Asthma. Annu. Rev. Med. 2002, 53:477-98. PMID 11818486.
• Template:Anb Marketos SG, Ballas CN. Bronchial asthma in the medical literature of Greek antiquity. J Asthma. 1982;19(4):263-9. PMID 6757243.
• Template:Anb McFadden ER, Jr. Asthma. In Kasper DL, Fauci AS, Longo DL, et al (Eds.), Harrison's Principles of Internal Medicine (16th Edition), pp. 1508-1516. New York: McGraw-Hill;2004.
• Template:Anb Mujica VR, Rao SS. Recognizing atypical manifestations of GERD; asthma, chest pain, and otolaryngologic disorders may be due to reflux. Postgrad Med J 1999;105:53-55. PMID 9924493.
• Template:Anb National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health pub no 97-4051. Bethesda, MD, 1997.
• Template:Anb World Health Organization. Bronchial asthma: scope of the problem. http://www.who.int/entity/respiratory/asthma/scope/en/index.html. Accessed on 23 Aug 2005.
• Template:Anb Blanc PD, Trupin L, Earnest G, et al. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. Chest. 2001;120(5):1461-7. PMID 11713120
• Template:Anb Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. J Paediatr Child Health. 2002;38(3):252-7. PMID 12047692

The view after a step back

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