Childhood Asthma and Other Wheezing Disorders
Authors: Aziz Sheikh
Journal: Journal of the Royal Society of Medicine (2003)

Asthma has now reached epidemic proportions in many parts of the world. In the International Study of Allergies and Asthma in Childhood survey of almost half-a-million adolescents Britain ranked number one, with over one in four young people reporting that they had experienced at least one episode of wheezing in the preceding 12 months. National studies indicate that a similar proportion of British children have, at some point in their lives, been diagnosed with asthma. Whilst such population data are crucial for unravelling the aetiology of asthma and informing health services planning, they say nothing about the impact of asthma on individuals and their families. Interference with sport and leisure activities, disturbed sleep (both for children and their parents) and anxieties regarding the possible adverse effects of inhaled treatments are just some of the concerns that many healthcare professionals hear about daily when caring for young people with asthma.

Childhood Asthma and Other Wheezing Disorders aims to provide a ‘comprehensive account of the biological basis and clinical management of asthma and childhood asthma and other wheezing disorders’, bringing together in one volume ‘all the aspects necessary for full understanding by the trainee or practising respiratory physician, paediatrician or specialist nurse or therapist’. Several of the introductory chapters are dedicated to summarizing recent developments in the anatomy and physiology of the lung together with related advances in genetics and immunobiology.

As would be expected, the work provides a detailed critique of current thinking on the aetiology and pathogenesis of asthma and examines all aspects of treatment. The reader learns of the strength of evidence underpinning individual drug treatments and is offered guidelines for their use; but there is much more to high-quality asthma care than drugs, and the text also encourages professionals to consider the broader impact on individuals and society through chapters exploring the psychological, familial and public health aspects.

A strength of this book is that it successfully draws on the experiences of 49 contributors representing a broad range of clinical disciplines. Also they are geographically diverse, and an international dimension is provided by chapters on asthma in sub-Saharan Africa, south Asia, Latin America, Japan, Hong Kong and the Caribbean. Although the work follows the fashion by labelling itself evidence-based, there are signs that the editor and several of the contributors struggled with some basic principles of this art. They do not always recognize the importance of systematic searches or apply the hierarchy-of-evidence model. For example, a dominant theme in the chapter on asthma in primary care is the effectiveness of specialist asthma-trained nurses in delivering asthma care, yet there is no discussion of how various studies were selected for consideration, and no clear distinction is drawn between evidence from randomized controlled studies and evidence from audits.

This book is unlikely to appeal to those fanatical in their adherence to the evidence-based cult (for whom the current BMJ Books series, ‘Evidence Based...’ is probably more appropriate). However, for clinicians who gain aesthetic satisfaction from a high-quality well-edited publication, this comprehensive, accessible and clinically useful reference text will serve its purpose well.