Exacerbations of Asthma

Edited by S.L. Johnston and P.M. OByrne

Published by Informa Healthcare

Pages: 354. Price: £95.00. ISBN: 1-84214-318-2

Exacerbations of Asthma
This book deals specifically with a clinically important feature of asthma, i.e. exacerbations. It is subdivided into six main sections, each dealing with several aspects of asthma exacerbations. The sections deal with relevant topics, including: epidemiology; pathophysiology; in vitro and in vivo experimental models; treatment; prevention; and delivery of care. Each section has several chapters. This set-up provides a nice overview of the current knowledge on asthma exacerbations in both children and adults reviewed from different angles.

The topics are discussed in an informative and adequate manner and instructive tables and figures are provided. Many established experts from the field have contributed and, hence, this book may serve as a “standard work” for both clinicians (GPs, paediatricians, pulmonologists) and respiratory researchers.

However, I have a few criticisms. In some chapters, important references are far from up to date; for example those on current guidelines, Global Initiative for Asthma (GINA) 2002, and the socioeconomic burden of asthma exacerbations, in which references are cited from 1996. Following the registration of novel, more effective anti-asthma medications (combinations), such as inhaled corticosteroids (ICS)/long-acting β₂-agonists (LABA; approx. 1998) and leukotriene receptor antagonists (approx. 1996), figures may appear different from those prior to 1996.

In the section on experimental models of asthma exacerbations, there is a well-balanced chapter that quite nicely covers the murine models, which consists of separate paragraphs on bronchoprovocation tests with virus and allergen stimuli and the combination of both. In contrast, the chapter on human exacerbation models is far too concise and strongly focused on the combination of viruses and allergens. Although this is an important and hot topic, it does not represent the most applicable or validated model of asthma (exacerbations). Despite the available literature on various human models of asthma, especially the allergen bronchoprovocation test (which is still a very useful model) and other experimental challenges, such as ozone and sulphur dioxide, only a very limited number of references have been listed in this chapter.

In the Treatment and Prevention section, there is the omission of quite essential information (most references are cited up to 2004), including the discussions from recent years, e.g. the SMART study (Chest 2006) which questions the safety of LABAs in the treatment of asthma, and data from the IMPACT trial (BMJ 2003), showing equal efficacy for both the combination ICS/LABA and ICS/ leukotriene receptor antagonists in reducing asthma exacerbations in 1,490 asthma patients over 1-yr. Adding these references/ topics would have made this section more balanced. In addition, a chapter relating to novel targeted therapies, especially the recently registered anti-immunoglobulin E for patients with severe allergic asthma would have been appropriate, not in the least since this therapy has now been added to the asthma management according to the revised GINA guidelines (2006).

I have one further minor comment: some schematic figures, especially those depicting the complexity of cellular mechanisms and interactions, would have been better presented in (partial) colour.

In conclusion, this book covers a highly relevant topic, is wellstructured and is written by various experts in the field, and hence suitable for both clinicians and (clinical) researchers in the field of asthma. However, a major let down is that most of the references date back to 2004.