Exercise-Induced Asthma: Pathophysiology and Treatment.

Rundell KW, Wilber RL, Lemanske RF Jr, eds. Champaign, IL 61825-5076, Human Kinetics, 2002, hardcover, 279 pp, illus, ISBN 0-7630-3389-0, $45.

The stated purpose of this text is to provide the most current information about exercise-induced asthma and to offer guidelines for its diagnosis and management in physically active people. The intended audience for the text is health care professionals, and the editors list several of these professions. Surprisingly and disappointingly, however, physical therapists are not listed as an intended audience. I believe that the book serves its intended purpose well and offers accurate and current information about exercise-induced asthma, with an emphasis on the physically active person and the trained athlete.

Despite the fact that the book does not refer to physical therapists throughout, it is comprehensive in its coverage of the topic. The book is clearly focused on the pulmonary system, and chapter 1 is a discussion of pulmonary physiology during exercise in people who are healthy. I found this chapter to be very useful because of its focus on the lungs and respiratory system during exercise. Chapters 2 through 7 detail the basic biomedical information regarding exercise-induced asthma, including epidemiology; pathophysiology; animal models; allergies as a provoking factor; asthma before, during, and after exercise; and diagnosis of exercise-induced asthma in the athlete.

I found chapter 6, "Asthma: Before, During, and After Exercise," and chapter 7, "Diagnosis of Exercise-Induced Asthma in the Athlete," to be extremely useful in their application of the principles of airway function to people participating in strenuous exercise. These 2 chapters discuss, at some length, the proper approaches to measuring airway function and its change during asthmagenic activity. In addition, chapter 7 provides a strong rationale for determining an appropriate exercise challenge to stimulate the asthmatic response in the trained athlete as well as for surrogate challenges. The surrogate challenges examined include: (1) pharmacological challenge using metacholine or histamine, (2) voluntary hyperventilation, particularly with cold dry air, and (3) osmotic challenges using inhaled hypertonic saline or mannitol. These 2 chapters are very well referenced, and the authors note that, although the surrogate challenges have been documented for the general public, more data need to be collected on the specificity and sensitivity of these diagnostic approaches for the athlete.

Chapter 8 discusses the approach to exercise challenge testing and then offers the rationale and evidence for various types of pharmacological therapies. In addition, unconventional therapies, both pharmacologic and nonpharmacologic, are presented briefly. The last chapter--"Asthma Medications as Ergogenic Aids"--is particularly informative because it discusses the various asthma medications and their ergogenic effects (ie, their ability to enhance physical performance). This chapter discusses not only the medications, but it also presents current positions of the International Olympic Committee (as of 2001) regarding asthma medications and their use during competition.

The book is well written and very understandable. It offers very current information from peer-reviewed sources. The chapters flow well, although readers might feel more comfortable with chapters 6 and 7 reversed, but this is a small item. Most of the illustrations are appropriately used figures from peer-reviewed articles, and the lack of photographs does not detract from the text.

Although not directed towards the physical therapist, the book would be useful for those who develop and monitor aerobic exercise regimens. The high incidence of exercise-induced asthma in the United States suggests that this book will have practical applications within such training regimens.

Jan Stephen Tecklin, PT Arcadia University Glenside, Pa

Mr Tecklin is Professor of Physical Therapy and has extensive experience in respiratory care. He is co-editor of Cardiopulmonary Physical Therapy, a textbook dealing with cardiovascular and pulmonary care and rehabilitation.

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