Wheezing Disorders in the Preschool Child
http://www.100md.com
《新英格兰医药杂志》
Wheezing, an extremely common symptom in young children, is a major diagnostic and therapeutic challenge for the pediatrician. The underlying causes are diverse, and knowledge about asthma in older children and adults cannot be extrapolated to young children who wheeze — a fact that is perhaps the main justification for this book. Martinez and Godfrey are both experienced clinicians, well known for their original research on childhood asthma, and both are charismatic teachers. They have produced a compact and readable monograph that is meant for practicing clinicians. The content deals with the epidemiology of wheezing, the role of viral infections, immunologic background, clinical features, lung function, differential diagnosis, and management of wheezing in early childhood, topped off by an unexpected last chapter on "hot issues" for future research.
I am pleased with the book. What makes it special? It is the first book that focuses entirely on wheezing in the preschool child. The authors did not, as they state in their preface, merely "collect and collate as much objective information as possible"; there is also a lot of original Martinez-and-Godfrey creativity to enjoy between the lines. They manage to avoid excessive jargon in discussing epidemiology, immunology, and genetics, and they explain the recent advances in these complex areas in a most attractive and concise way. The book provides a lot of opinion and experience and, as a special feature, has some very useful chapters that integrate clinical and recent experimental data in unifying theories. Although some of these theories may turn out to be wrong, the authors make it much easier for the clinician to get a grip on this complicated matter. Such integrative summaries are provided for the onset of wheezing disorders, interaction among genetic, immunologic, and environmental factors, and treatment.
The treatment algorithms are worth looking at more closely. They take into account the age and background of the child as well as the frequency of attacks and the response to earlier treatment steps. The authors emphasize the use of short courses of systemic corticosteroids, a practice for which the evidence is sparse and controversial, whereas long-term administration of inhaled corticosteroids is delayed and recommended for defined, refractory cases, and rarely for infants. This is an uncommon approach to which some clinicians may be intuitively opposed, but its merit may be that unnecessary long-term treatment with an inhaled steroid, which is also not based on evidence in the case of preschool wheezers, can often be avoided.
Any criticism? I found the small type — one of the ways to reduce the size of the book — to be too small. The quality of the pictures and color schemes of some graphics could have been improved. There are a few other excellent, recent books dealing with childhood asthma, but these do not focus on the preschool child. This new book thus nicely complements textbooks such as the more academic and bulky, multiauthored one on childhood asthma edited by Michael Silverman (Childhood Asthma and Other Wheezing Disorders. London: Arnold, 2002). Wheezing Disorders in the Preschool Child will be much appreciated by general pediatricians, fellows, and students, and also by academic experts who may disagree here and there but will admire the eloquent authority and scientific creativity of two remarkable authors.
J.C. de Jongste, M.D., Ph.D.
Erasmus University
3000 CB Rotterdam, the Netherlands(By Fernando D. Martinez a)
I am pleased with the book. What makes it special? It is the first book that focuses entirely on wheezing in the preschool child. The authors did not, as they state in their preface, merely "collect and collate as much objective information as possible"; there is also a lot of original Martinez-and-Godfrey creativity to enjoy between the lines. They manage to avoid excessive jargon in discussing epidemiology, immunology, and genetics, and they explain the recent advances in these complex areas in a most attractive and concise way. The book provides a lot of opinion and experience and, as a special feature, has some very useful chapters that integrate clinical and recent experimental data in unifying theories. Although some of these theories may turn out to be wrong, the authors make it much easier for the clinician to get a grip on this complicated matter. Such integrative summaries are provided for the onset of wheezing disorders, interaction among genetic, immunologic, and environmental factors, and treatment.
The treatment algorithms are worth looking at more closely. They take into account the age and background of the child as well as the frequency of attacks and the response to earlier treatment steps. The authors emphasize the use of short courses of systemic corticosteroids, a practice for which the evidence is sparse and controversial, whereas long-term administration of inhaled corticosteroids is delayed and recommended for defined, refractory cases, and rarely for infants. This is an uncommon approach to which some clinicians may be intuitively opposed, but its merit may be that unnecessary long-term treatment with an inhaled steroid, which is also not based on evidence in the case of preschool wheezers, can often be avoided.
Any criticism? I found the small type — one of the ways to reduce the size of the book — to be too small. The quality of the pictures and color schemes of some graphics could have been improved. There are a few other excellent, recent books dealing with childhood asthma, but these do not focus on the preschool child. This new book thus nicely complements textbooks such as the more academic and bulky, multiauthored one on childhood asthma edited by Michael Silverman (Childhood Asthma and Other Wheezing Disorders. London: Arnold, 2002). Wheezing Disorders in the Preschool Child will be much appreciated by general pediatricians, fellows, and students, and also by academic experts who may disagree here and there but will admire the eloquent authority and scientific creativity of two remarkable authors.
J.C. de Jongste, M.D., Ph.D.
Erasmus University
3000 CB Rotterdam, the Netherlands(By Fernando D. Martinez a)