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A term with no agreed meaning is as valueless as an experiment with no prior hypothesis. The former is non-communication, the latter is non-science, and the results of both are confusion. The two often coincide in the field of paediatric respiratory medicine, where it is now becoming accepted that the term ‘asthma’, without any qualification or definition, has begun to hinder rather than facilitate progress both in research into the management of wheezy children and in the epidemiological search for the causes of the increasing amount of lower respiratory illness in childhood.1-3
What’s wrong with ‘asthma’?
Firstly, the term is used in several different ways; eithergenerally (or generically) to describe any reversible airway obstruction or specifically to imply symptomatic atopic airway inflammation. Surreptitiously, the two have become confused. Also, it can be used to describe a particular episode of airway obstruction (‘an attack of asthma’) or to mean a tendency to develop recurrent episodes, with the associated prognostic implications. In longstanding asthma, there is often an irreversible component, although strictly, this may fall outside any current definition of the disease.
Secondly, variable airway obstruction in children results from a number of different pathophysiological processes, each of which may have several different causes, and may operate over a variety of timescales. All of these can be labelled ‘asthma’. Two clinical examples illustrate the extremes.
(A) A teenage girl, keen on horses, with multiple atopic features, has troublesome exercise induced asthma, variable airway obstruction which never completely resolves, and daily symptoms. She is relatively resistant to high doses of inhaled corticosteroids, has eosinophilia in sputum samples, and is probably destined for a lifetime of disability.
(B) A 14 month old boy, the third child of a non-atopic smoking mother with no history of wheezing, has had three admissions to the local paediatric intensive care …
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