This third edition of Gershwin and Halpern's classic text, Bronchial Asthma, has been completely rewritten and expanded to include, from a variety of disciplines, the latest techniques and developments in the clinical diagnosis and treatment of asthma. With its new patient-oriented chapters on living with asthma, the book will empower the internist, the family practitioner, and the specialist in their struggle to reverse the current trend of increasing asthma mortality and to improve the quality of life of their patients and their families. The editors have selected authoritative contributors to Bronchial Asthma, organizing it into four comprehensive parts: I. Definitions and Host Responses to Bronchospasm defines asthma by analyzing its epidemiology, pathogenesis, and genetic roots, and illuminates the roles of mast cells and eosinophils. Chapters also cover the use of the pulmonary function laboratory and the differential diagnosis of asthma in children and adults. II. Patient Management introduces the latest thinking and techniques about treatment and management of patients, including allergic evaluation, radiological treatment, the role of immunotherapy, the differential management of status asthmaticus, the management of pregnant asthmatics, and an evaluation of unconventional therapies. III. Special Clinical Problems explores respiratory tract infections, the roles of anti-inflammatory agents, food additives, air pollution, aspergillosis, and occupational asthma. Four new chapters analyze exercise-induced asthma, asthma's relationship with chronic sinus disease, and the cross-cultural treatment of asthma in Europe and Japan. IV. Living with Asthma, an entirely new section, examines asthma in school children, athletes and asthma, legal issues for asthmatics, the psychology of asthma, and the use of prospective disease management.

Although the mechanisms and triggers that stimulate and are responsible for the natural history ofasthma are steadily being more clearly defined, uncertainties still surround both the genetic basis and the etiologyofone of the most common syndromes in the world. In fact, it is ofconsider- able concern and interest that the incidence of asthma today appears to be rising. These statistical increments may only reflect an increasing awareness of the disease, or its earlier and more sophisticated diagnosis. More important, however, asthma mortality appears to be increasing. This increase has occurred despite the continuing expansion of a diag- nostic and management information base, and the developmentofnovel andevermoreeffective therapeutic modalities. Severalexplanations have been offered for this increase in mortality, including that it may result from a statistical artifact [based on a change in the coding criteria for asthma from the International ClassificationofDiseases Version 8(ICD- 8) to ICD-9], worsened pollution, delays in seeking medical help, behav- ioral changes, deficits in the asthma education of both patients and primary careproviders, toxicity ofbeta-agonists, and noncompliance with instructions for the proper use of medications. It should also be empha- sized that the increases in both incidence and mortality may be a reflec- tion of accumulating body burdens of environmental toxicants and of increased oxidativedamage. There has clearly beenadegradation ofenvi- ronmental quality. And although considerableattention has been focused on this possibility in both the scientific and lay press, more research in this area is definitely needed.