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Pulmonary Physiology and Pathophysiology, An Integrated, Case-Based Approach FREE TO VIEW

Martin Miller, MD
Chest. 2004;126(4):1393. doi:10.1378/chest.126.4.1393
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By John B. West, MD, PhD, DSc. Baltimore, MD: Lippincott, Williams and Wilkins, 2001, 162 pp; $31.95

I recall my first year of medical school, working through mountains of new information under the auspices of learning the basic sciences. Although fascinating, these tasks often seemed far removed from the ultimate goal of solid patient care and understanding of disease. Included in this early process was an introduction to Dr. West’s textbook Respiratory Physiology. While this book introduced me to the wonders of pulmonary physiology, it also left me yearning for more. With Pulmonary Physiology and Pathophysiology, An Integrated, Case-Based Approach, Dr. West aims to fill that need by directly associating the basic science of respiratory physiology with patient care.

The book is divided into nine case-based chapters, each followed by a series of questions helping to review the principles covered within the chapter. Each of these chapters begins by presenting a pertinent case, and then flows smoothly into coverage of evaluation, management, and outcome for that patient. Appropriate history and physical examination findings are well characterized prior to descriptions of other more sophisticated diagnostic evaluations. Particularly successful is the content in the second half of each chapter. Here, important physiologic tenets are introduced, well explained (including useful figures and tables), and often elegantly related back to the different aspects of the patient’s clinical evaluation.

Large arrays of pulmonary physiologic fundamentals are touched on throughout the text. For example, the first case involves a patient with normal physiology in relation to exercise. This leads into discussions of numerous important issues, including descriptions of ventilation; diffusion; oxygen delivery, uptake, and consumption; the oxygen dissociation curve; and finally carbon dioxide liberation. The fact that all these subjects are covered quite effectively in one case is a testament to the value of this book. Another case presents a well-trained mountain climber at high altitude, and subsequently discusses hypoxia, the alveolar gas equation, acid-base physiology, and ventilatory control systems. I particularly enjoyed case three, which deals with COPD. Not only is a good clinical narration given along with the unfortunate but all-too-common outcome, but also a nice pathologic discussion is followed by introductions to pulmonary function testing, pressure-volume curves, ventilation/perfusion mismatch, and pulmonary blood flow. Later chapters include cases on asthma, pulmonary fibrosis, pulmonary embolism, pulmonary edema, pneumoconiosis, and acute respiratory failure.

Paradoxically, the few failings of this book are closely related to its successes. Dr. West covers a large amount of material in a short time. While most of the explanations are clear, the reader (especially one first learning respiratory physiology) may find some discussions difficult to grasp. This includes the section on pulmonary vascular resistance in chapter six, as well as the short attention paid to measurement of shunt in chapter seven that may cause the beginner to flounder. Clinically, the book can seem simplistic to a seasoned physician, and sometimes unrealistic. For instance, case five examines a patient with interstitial pulmonary fibrosis who has a terrific outcome with corticosteroid treatment, which might mislead medical students into anticipating uniformly wonderful outcomes in this often-devastating disease. Clearly, the book is not intended to focus on the different controversies surrounding clinical pulmonary medicine. Lastly, the questions can at times be confusing and lack sufficient explanation in the text.

Despite these few shortcomings, Pulmonary Physiology and Pathophysiology, An Integrated, Case-Based Approach is an excellent resource. I would especially recommend this text to medical students and residents, as well as individuals involved in teaching respiratory physiology. In addition, Dr. West’s latest book may also serve as a convenient review for those further along in the practice of medicine.




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