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Emergency Asthma
BOOK REVIEWS
book. An ophthalmologist is unlikely to buy this book for the one chapter covering complications of ophthalmologic office procedures. However, a primary or family physician might have found it useful to have better chapters on ophthalmologic emergencies or postoperative complications with which patients might mistakenly show up in his or her office. Treatment and greater discussion of those entities requiring emergency subspecialty follow-up or immediate ED referral would have been more valuable. One of the difficulties of trying to write about acute emergencies is that people seldom read the chapter until the emergency is actually happening. With this in mind, a few pages in each chapter with a large bulleted chart stating the most critical issues requiring attention would have probably been more useful than the primarily paragraph format used in this textbook. Despite some of its limitations, this textbook would be a useful addition to the office bookshelf of clinicians in primary specialties provided they spend time reading it before the emergency.
Robin R. Hemphill, MD Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN
Emergency Asthma Brenner BE Marcel Dekker, 1999 594 pages, $165 ISBN 0-8247-1945-X There are 14 to 17 million asthmatic subjects in the United States, and 1% of these seek treatment in an emergency department annually, accounting for up to 10% of ED visits in some hospitals. It seems only appropriate that a concise, focused, yet comprehensive text on this subject was written for the emergency physician. It was with great pleasure that I read the book Emergency Asthma, which is the 13th textbook in a series on clinical allergy and immunology. The list of contributing authors reads like a Who's Who list of emergency medicine asthma researchers, with the names of Camargo, Culdulka, Emerman, Nowak, Panacek, Pollack, and Skobeloff being a fewofthe many. Awell-
JANUARY 2000
351
written foreword by Peter Rosen, MD, sets the tone for the reader. The book is organized into 7 sections: introduction, pathophysiology, epidemiology, provocative factors for ED visits, clinical manifestations, management, and disposition from the ED. For the most part, the chapters are uniformly written and edited, and all are current and well referenced. I especially enjoyed the chapter on the history of asthma because the author reviewed historical writings back to those of the ancient Egyptians in which the signs, symptoms, or treatment of asthma were mentioned. A very useful chapter on ED management guidelines was written by Dr. Richard Nowak in which he contrasts and compares 6 different national and international guidelines for the management of adult asthma exacerbation. The book offers information that appeals to both clinicians and asthma researchers. For example, the chapter on pulmonary function testing provides a simplified but thorough review of how to perform and interpret bedside spirometry in the ED. Additionally, there are individual chapters discussing the current research and recommendations for the use of steroids, aminophylline, epinephrine, anticholinergic agents, and magnesium. There are chapters on the management of acute asthma for adult patients, children, pregnant women, and out-of-hospital settings. The recommendations for treatmentappearto be current and followthe guidelines outlined in previous chapters. There is a chapter on sinusitis that is an excellent current review on the prevalence, pathophysiology, diagnosis, and treatment of sinusitis, which has long been recognized to be associated with asthma. There were very few shortfalls in this textbook. An expanded discussion of the cost-effectiveness of various therapies would have been helpful. For example, in the chapter on anticholinergics, the author concludes that, "As there are no significant adverse effects associated with combination therapy IP2-agonist+antichol inergicsl. patients presenting to the ED with acute asthma may safely be treated with combination therapy .... In contrast to adults, pediatric patients appear to obtain significant benefit from combination therapy ...... However, the pediatric studies that were referenced involved children who presented
ANNALS OF EMERGENCY MEDICINE
with severe asthma exacerbations. The studies involving combination therapy for adult patients with asthma showed only a small statistically significant increase in pulmonary function tests. A discussion of the actual costs of combination therapy compared with P2-agonist treatment alone would be beneficial, especially if all patients (regardless of severity of asthma) were to be treated with combination therapy. Another area of controversy that needs expanded discussion, especially in this era of cost containment in health care, is the issue of subcutaneous injection of p-agonists (epinephrine and terbutaline).ln several areas ofthis book they are Iisted as secondary therapy when aerosol treatments have failed to provide relief of acute asthma. It was even emphasized how safe and efficacious these agents are, even in selected patients over the age of 40 years. So why haven't these agents returned to their previous status of first-line therapy, especially since their costs are only a fraction of that for inhalation therapy in most hospital settings? A couple of additions to any future editions of this textbook would be beneficial: (1) a chart listing the predicted peak flow and FEV 1 rates for adults (a pediatric peak expiratory flow rate table was present), and (2) an appendix listing all ofthe pharmaceutical agents and their dosages that are used for the treatment of asthma. In conclusion, this textbook is a must for academic ED libraries and forthose emergency clinicians and researchers who have a special interest in asthma.
Daniel J. Dire, MD Department of Emergency Medicine University of Oklahoma Health Sciences Center Oklahoma City. OK
109
book. An ophthalmologist is unlikely to buy this book for the one chapter covering complications of ophthalmologic office procedures. However, a primary or family physician might have found it useful to have better chapters on ophthalmologic emergencies or postoperative complications with which patients might mistakenly show up in his or her office. Treatment and greater discussion of those entities requiring emergency subspecialty follow-up or immediate ED referral would have been more valuable. One of the difficulties of trying to write about acute emergencies is that people seldom read the chapter until the emergency is actually happening. With this in mind, a few pages in each chapter with a large bulleted chart stating the most critical issues requiring attention would have probably been more useful than the primarily paragraph format used in this textbook. Despite some of its limitations, this textbook would be a useful addition to the office bookshelf of clinicians in primary specialties provided they spend time reading it before the emergency.
Robin R. Hemphill, MD Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN
Emergency Asthma Brenner BE Marcel Dekker, 1999 594 pages, $165 ISBN 0-8247-1945-X There are 14 to 17 million asthmatic subjects in the United States, and 1% of these seek treatment in an emergency department annually, accounting for up to 10% of ED visits in some hospitals. It seems only appropriate that a concise, focused, yet comprehensive text on this subject was written for the emergency physician. It was with great pleasure that I read the book Emergency Asthma, which is the 13th textbook in a series on clinical allergy and immunology. The list of contributing authors reads like a Who's Who list of emergency medicine asthma researchers, with the names of Camargo, Culdulka, Emerman, Nowak, Panacek, Pollack, and Skobeloff being a fewofthe many. Awell-
JANUARY 2000
351
written foreword by Peter Rosen, MD, sets the tone for the reader. The book is organized into 7 sections: introduction, pathophysiology, epidemiology, provocative factors for ED visits, clinical manifestations, management, and disposition from the ED. For the most part, the chapters are uniformly written and edited, and all are current and well referenced. I especially enjoyed the chapter on the history of asthma because the author reviewed historical writings back to those of the ancient Egyptians in which the signs, symptoms, or treatment of asthma were mentioned. A very useful chapter on ED management guidelines was written by Dr. Richard Nowak in which he contrasts and compares 6 different national and international guidelines for the management of adult asthma exacerbation. The book offers information that appeals to both clinicians and asthma researchers. For example, the chapter on pulmonary function testing provides a simplified but thorough review of how to perform and interpret bedside spirometry in the ED. Additionally, there are individual chapters discussing the current research and recommendations for the use of steroids, aminophylline, epinephrine, anticholinergic agents, and magnesium. There are chapters on the management of acute asthma for adult patients, children, pregnant women, and out-of-hospital settings. The recommendations for treatmentappearto be current and followthe guidelines outlined in previous chapters. There is a chapter on sinusitis that is an excellent current review on the prevalence, pathophysiology, diagnosis, and treatment of sinusitis, which has long been recognized to be associated with asthma. There were very few shortfalls in this textbook. An expanded discussion of the cost-effectiveness of various therapies would have been helpful. For example, in the chapter on anticholinergics, the author concludes that, "As there are no significant adverse effects associated with combination therapy IP2-agonist+antichol inergicsl. patients presenting to the ED with acute asthma may safely be treated with combination therapy .... In contrast to adults, pediatric patients appear to obtain significant benefit from combination therapy ...... However, the pediatric studies that were referenced involved children who presented
ANNALS OF EMERGENCY MEDICINE
with severe asthma exacerbations. The studies involving combination therapy for adult patients with asthma showed only a small statistically significant increase in pulmonary function tests. A discussion of the actual costs of combination therapy compared with P2-agonist treatment alone would be beneficial, especially if all patients (regardless of severity of asthma) were to be treated with combination therapy. Another area of controversy that needs expanded discussion, especially in this era of cost containment in health care, is the issue of subcutaneous injection of p-agonists (epinephrine and terbutaline).ln several areas ofthis book they are Iisted as secondary therapy when aerosol treatments have failed to provide relief of acute asthma. It was even emphasized how safe and efficacious these agents are, even in selected patients over the age of 40 years. So why haven't these agents returned to their previous status of first-line therapy, especially since their costs are only a fraction of that for inhalation therapy in most hospital settings? A couple of additions to any future editions of this textbook would be beneficial: (1) a chart listing the predicted peak flow and FEV 1 rates for adults (a pediatric peak expiratory flow rate table was present), and (2) an appendix listing all ofthe pharmaceutical agents and their dosages that are used for the treatment of asthma. In conclusion, this textbook is a must for academic ED libraries and forthose emergency clinicians and researchers who have a special interest in asthma.
Daniel J. Dire, MD Department of Emergency Medicine University of Oklahoma Health Sciences Center Oklahoma City. OK
109