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Albuquerque, NM
Abstract
By Stephen T. Holgate and Romain A. Pauwels. Oxford, UK: Health Press, 1999; 64 pp; $24.95
Bronchial asthma tends to be regarded by general medical practitioners as a relatively simple disorder that can be diagnosed and managed in a reasonably uncomplicated and straightforward manner. From the vantage point of the pulmonary consultant, however, asthmatic patients often go unrecognized, and even when asthma is properly diagnosed too often it is undertreated. Who among us has not consulted on an atopic patient who has been referred for chronic cough and wheezing whose initial therapy has been an antibiotic for the treatment of "bronchitis"? Can we truthfully say that only patients with severe persistent asthma requiring our special expertise populate our practices, or do we commonly see patients with milder categories of the disease who have never received prescriptions for controller medication? In fact, support for the superior efficacy of a specialty over primary care for asthma has appeared regularly in the medical literature over the last decade, initially with respect to specialists in allergy and immunology1234 but more recently including pulmonologists as well.56 The reasons for such nonadherence to well-publicized guidelines have been less well-studied but seem to include lack of familiarity with the guidelines and external barriers such as lack of time.7 Sadly, it seems that little can be done concerning such factors as lack of time in the practice setting; however, ignorance can almost always be overcome by education, and the current text, Fast Facts: Asthma, can admirably serve such a purpose.
The Fast Facts series by the UK publisher Health Press Limited concisely summarizes a given medical topic in a format that lends itself to rapid assimilation. The format for each chapter combines text, figures, photographs, and tables covering the standard aspects of the disease in question (ie, pathophysiology, epidemiology, diagnosis, treatment, prevention, and future trends) as they might be covered in a standard medical textbook. However, the text avoids the arcane or controversial material that is usually part of the standard textbook in favor of clear and concise explanations of essential, unambiguous medical knowledge. The photographs, and many of the figures, are in full color and are well-reproduced; the tables tend toward a telegraphic style allowing the reader to grasp important and useful points without fuss and bother. As in other books of the Fast Facts series, a table of contents appears on the front cover, with color-keyed tabs allowing the reader to easily steer to a desired chapter.
The text adheres to the standard classification scheme of intermittent, mild persistent, moderate persistent, and severe persistent asthma, and subsequently links these categories to specific management approaches in the outstanding chapter on drug treatment. Management algorithms are covered in the text and also in two well-organized figures that separately deal with adults/older children and infants/younger children. This chapter also incorporates clear, illustrated instructions on the proper use of various types of delivery devices for inhaled medication and the use of spacers for enhanced drug delivery. I particularly liked the specific examples of asthma management plans (including two types of handouts) that are reproduced toward the end of the chapter.
Inaccuracies or gaps in information are few and far between. The discussion of asthma in the elderly on page 27 lists bronchitis, emphysema, bronchiectasis, and even interstitial pulmonary fibrosis as conditions that might confuse the practitioner, but does not mention the important and frequent comorbidity of congestive heart failure. A one-page list of "Key References" is appended just before the index, but references for the material in each individual chapter might be more useful to the reader seeking additional information on a specific point.
The diagnosis and management of many asthmatic patients is not difficult, requiring a specific body of knowledge (particularly of well-publicized guidelines), an organized mind, and perhaps (and in shortest supply) the time to spend with the patient. Fast Facts: Asthma provides the first ingredient in a palatable and efficacious vehicle, and should be a useful reference for the medical student, house officer, and general practitioner; it may also serve, when necessary, to jog the memory of the specialist in pulmonary medicine or allergies.
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