Medicine And Books

Asthma and Rhinitis

BMJ 1995; 310 doi: (Published 08 April 1995) Cite this as: BMJ 1995;310:949
  1. John Rees

    Ed William W Busse, Stephen T Holgate Blackwell Science, pounds sterling150, pp 1488 ISBN 0 86542246 X

    Bacon classified books as those to be tasted or swallowed and a few to be chewed and digested. Asthma and Rhinitis makes a substantial meal. Its 1400 pages from 170 contributors should be tasted, and particular delicacies should be selected for chewing and digesting. The book is a substantial effort and has brought together an impressive range of authors, most of whom write clearly and authoritatively about their subject.

    On controversial topics the editors have not been afraid to range different sides against each other. The section on exercise induced asthma has a chapter from Sandra Anderson and Alkis Togias on the osmotic effects on the airway followed by I Gilbert and E R McFadden's chapter explaining exercise induced asthma in terms of vascular mechanisms. Anne Tattersfield's introductory chapter in the same section invites readers to assess the evidence in both chapters and form their own opinions.

    The book provides an excellent overview of most aspects, particularly the basics of pathology, cellular involvement, and mediators. There are separate sections on each of the cellular contributors: mast cells, eosinophils, neutrophils, lymphocytes, macrophages, platelets, fibroblasts, and epithelial cells. Chapters such as Peter Jeffery's on the normal human airway wall and those on eosinophil function include elegant scanning and transmission electron micrographs.

    Practical aspects of management are covered in much less detail. There is a chapter on specific immunotherapy, though the conclusions differ from the dismissive paragraph in the chapter on treatment. Little space is given to alternative treatments, education, practical effects on the life of the patient, drug delivery, or compliance with treatment. Most of these accounts are in no more depth than other, shorter texts. This book is the place to go for a review of subtypes of muscarinic receptors, the function of pulmonary fibroblasts, or basic physiology of airway smooth muscle, not for help with a clinical problem.

    The difficulties of books of this size are in balance, consistency, and the changes that occur in a rapidly evolving topic. A text dealing with cellular and molecular mechanisms will date quickly, and though this provides a vast reference source—over 13000 references, 10 for each page of text—references from 1993 are few and from 1994 very rare. This is not a criticism of the editors or the publishers; it is an inevitable problem with a large, multiauthor book in a heavily researched, changing topic.

    The editors set out to provide an extensive review of airway responses in asthma and rhinitis. They have produced a feast of information—it is the most comprehensive and authoritative text available and will satisfy the most ravenous appetite.—JOHN REES, senior lecturer in medicine, UMDS, Guy's Hospital, London

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