Bronchial asthma

Bronchial asthma, 2nd ed. D. Behera (Jaypee Brothers Medical Publishers, New Delhi). 2005. 338 pages. Price: Rs.495.00 ISBN 81-8061-434-4

Bronchial asthma is the most common chronic respiratory disorder among all age groups with a prevalence of 5 to 10 per cent. The disease affects 155 million individuals in the world. Asthma is a difficult disease to define, thus hampering classification and treatment. Currently, there is no cure for asthma, which underscores this disease as a major problem of public health.

In general, the book contains clear flow charts and Figures, which makes the reading more entertaining and easy to understand. In addition, the topics are presented with straight forward clear language. The scope is broad and takes into account statistics and definitions. International research is presented, strengthening the book's appeal as worthwhile reading for international readers also.

The book addresses many timely areas. The Figures are clearly represented and the epidemiology is well detailed. The use of the term bronchial asthma is not well described. Similarly, the definition of allergens, e.g., Blag 2, is not well presented.

Under the heading infection, there is no mention of endotoxin. Endotoxin exposure is a topic of great interest in asthma. For example, the controversy of whether endotoxin (lipopolysaccharide) increases or decreases asthma is not described.

The terms of T helper (Th) Th1 and Th2 are mentioned initially, but are not fully described until a later chapter. The section related to food allergen and breast-feeding is well described. Under occupational asthma there is no mention of endotoxin exposure for grain workers. The description of the leukotriene pathway is interesting but appears out of order in relationship to the discussion of aspirin sensitive asthmatics.

The chapters on therapeutics on asthma management provide information that is currently state of the art. A potential weakness for this section, as for any textbook, is that guidelines may rapidly change. In addition, the multiple chapters with different guidelines with subsets of multiple asthma patients tend to be slightly confusing. Additional considerations are that the description of alternative treatments presents standard therapies, e.g., methotrexate and gold, but does not include a description of more recent therapies, e.g., anti-IgE and soluble interleukin-4 (IL-4) receptor therapy. These topics are not described in the text, only presented in a table. The chapters on severe asthma and asthma in children are well researched and will likely be a help in asthma management.

Overall, the book contains an extensive and profound report of most of the literature produced regarding asthma in the last decades. The book presents 21 chapters (most of them carefully written and appropriate for the topic) including concepts regarding the aetiology and understanding of pathophysiology of the asthma. Every chapter is supported by a vast review of the literature. A strength of the book is that the author presents his point of view, and yet leaves open possibilities for alternative interpretations.

The author ends on the intriguing comment that asthma incidence is less in India compared to some Western countries. This observation generates great interest and suggests a follow up topic for a subsequent book.

Monica Campo & Patricia W. Finn

Respiratory and Critical Care Division

Department of Medicine

Brigham and Women's Hospital

Harvard Medical School

Boston, Massachusetts

MA 02115, USA

e-mail: pwfinn@rics.bwh.harvard.edu

Copyright Indian Council of Medical Research Aug 2005
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