Pediatric Annals

editorial 

All That Wheezes Isn't Asthma... But Most That Does Is!

Stanford T Shulman, MD

Abstract

Asthma serves as the topic of this issue of Pediatric Annals. This is appropriate as every primary care physician who provides care to children understands its importance. As pointed out in Jackie Pongracic's guest editor column, asthma stands out as the most common indication for childhood hospitalization in the United States. The impact of asthma in terms of morbidity, mortality, financial burden, and disruption of normal activities is enormous.

The good news is that significant improvements have been made in asthma management in recent years, with both new classes of effective medications and new methods of delivery. In addition, the pace of scientific advances that clarify the pathogenetic mechanisms involved in asthma has accelerated in the last few years. These topics and others are discussed in the excellent articles included in this issue. It will be fascinating to follow the fate of the so-called "Hygiene Hypothesis" with respect to whether it becomes more supported by data in the future or fades away as unproved.

Our house staff and students commonly hear me joke (sort of) that "all important illnesses are infectious, when you get down to it." I really doubt that asthma is infectious in etiology, but a very strong case can be made that infections (particularly respiratory syncytial virus and rhinoviruses) have an extremely important impact upon the evolution of asthma, upon acute exacerbations, and perhaps upon determining whether a child develops transient or more longlasting disease.…

Asthma serves as the topic of this issue of Pediatric Annals. This is appropriate as every primary care physician who provides care to children understands its importance. As pointed out in Jackie Pongracic's guest editor column, asthma stands out as the most common indication for childhood hospitalization in the United States. The impact of asthma in terms of morbidity, mortality, financial burden, and disruption of normal activities is enormous.

The good news is that significant improvements have been made in asthma management in recent years, with both new classes of effective medications and new methods of delivery. In addition, the pace of scientific advances that clarify the pathogenetic mechanisms involved in asthma has accelerated in the last few years. These topics and others are discussed in the excellent articles included in this issue. It will be fascinating to follow the fate of the so-called "Hygiene Hypothesis" with respect to whether it becomes more supported by data in the future or fades away as unproved.

Our house staff and students commonly hear me joke (sort of) that "all important illnesses are infectious, when you get down to it." I really doubt that asthma is infectious in etiology, but a very strong case can be made that infections (particularly respiratory syncytial virus and rhinoviruses) have an extremely important impact upon the evolution of asthma, upon acute exacerbations, and perhaps upon determining whether a child develops transient or more longlasting disease.

The stamps portrayed here this month include the green Danish stamp that specifically mentions asthma and allergies, showing a sneezing patient and perhaps ragweed. The black and ochre French stamp honors Elie Metchnikoff, with the building in the background, the Pasteur Institute in Paris, where he carried out his studies that discovered phagocytosis. Metchnikoff received the Nobel Prize in 1 908 for his pioneering immunologic studies. The multicolored stamp from Dominica portrays a physician auscultating the chest of a youngster, perhaps because he is wheezing with an asthma exacerbation. The two Portuguese stamps are companions, one depicting the effects of smoking upon the heart and lungs, and the other without smoking and healthy organs.

The stamps portrayed here this month include the green Danish stamp that specifically mentions asthma and allergies, showing a sneezing patient and perhaps ragweed. The black and ochre French stamp honors Elie Metchnikoff, with the building in the background, the Pasteur Institute in Paris, where he carried out his studies that discovered phagocytosis. Metchnikoff received the Nobel Prize in 1 908 for his pioneering immunologic studies. The multicolored stamp from Dominica portrays a physician auscultating the chest of a youngster, perhaps because he is wheezing with an asthma exacerbation. The two Portuguese stamps are companions, one depicting the effects of smoking upon the heart and lungs, and the other without smoking and healthy organs.

I hope all the readers note the new and improved pages of Pediatric Annals. As you can see, we have made some changes to help make the journal a better resource for our readers. We have added color and graphics, but be assured that the content and quality of the journal are still our priorities. We will be adding new columns and features throughout the year, as well. As always, your suggestions are welcome. We hope that you continue to rely on Pediatric Annals as an important source of information and that you enjoy the new look of the journal.

10.3928/0090-4481-20030101-03

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