Respiratory system

The Respiratory System presents the fundamentals of respiratory anatomy and physiology and relates those fundamentals to clinical application. The preface acknowledges that the intended audience includes students in allied health fields, such as respiratory care and nursing, who have not yet had clinical experience. The first chapter briefly discusses circulation and cellular respiration, including the role each plays in maintaining homeostasis, and identifies some basic components of a physical examination used to assess the adequacy of ventilation and oxygenation. A brief illustration of chest radiograph interpretation is also included. Basic gas laws are referenced along with common respiratory symbols and terms. Chapter 2 describes the fundamentals of respiratory system anatomy. Upper airway anatomy is effectively introduced through a discussion on obstructive sleep apnea. However, the illustrations in this chapter lacked attention to detail. For example, the 3 components of the pharynx are not defined in Figure 2.1, which illustrates head and neck anatomy. The description of lobar anatomy is also incomplete, as the chapter neglects to state that there are 3 lobes on the right and 2 on the left. Figure 2.12 shows the lobes but does not label them or identify the fissures. The remaining chapters focus on the physiology of disease processes, and numerous clinical scenarios are used as examples. For example, the concepts of the Laplace law and differentiation between static and dynamic lung compliance are introduced through a discussion of elasticity and surface tension as components of lung compliance. The authors describe the pathophysiology of respiratory distress syndrome and show the relevance of the theory. Asthma, as an obstructive disorder, is used to characterize abnormal physiology of airflow, airway resistance, and work of breathing. There is also a discussion of common bronchodilators and inflammatories. In defining lung volumes and capacities the text uses case studies of pneumothorax and pneumonia to underscore the importance of understanding nonuniform distribution of ventilation within the lungs and its effect on gas diffusion during disease. Oxygen delivery is presented through a description of cardiopulmonary circulation, with pulmonary embolus setting the stage nicely for a clinical discussion of ventilation-perfusion mismatch and shunting theories. The Fick law is incorporated to explain the relationship between the variables that influence the rate of diffusion. Abnormalities in gas diffusion and oxygen distribution to the cellular level are clinically depicted with a discussion on fibrosing alveolitis. The description of the oxyhemoglobin dissociation curve identifies conditions (eg, carbon monoxide poisoning) that alter its shape. Also discussed are myoglobin, fetal hemoglobin, various abnormal hemoglobins, and carbon dioxide transport, including the dynamic buffering system and the Henderson-Hasselbalch equation. There is also a discussion box on arterial blood gas interpretation. In this book blood gas values are presented in kPa rather than in mm Hg, which is the standard unit used in most United States hospitals, so a conversion factor should have been provided. A case scenario of chronic obstructive pulmonary disease describes the role of central and peripheral chemoreceptors in hypercapnic and hypoxic stimulation of respiratory drive. Brainstem herniation from increased intracranial pressure is presented as a sample cause of brainstem dysfunction and the resulting impact on the control of breathing. Also outlined are the major afferent neural influences on ventilation patterns and the 3 classes of vagal mechanoreceptor in the lung. The last chapter describes and illustrates aspects of pulmonary function testing, such as flow-volume loops, carbon monoxide diffusion capacity, nitrogen washout, and exercise testing. This chapter is directed toward students of respiratory care; it will not be useful for clinicians who perform pulmonary function tests, because it lacks necessary information on procedures and interpretation. The appendix briefly discusses basic physics related to the respiratory system and gas laws. I think the authors succeeded in providing an integrated approach based on function. The book’s general appearance is inviting. The writing style is relaxed but occasionally awkward, which may require rereading certain sections. I noticed no typographical errors. This is a British publication and the spellings of some words may be surprising at first glance (eg, “oedema”). The book’s overall arrangement is appropriate but a few chapters were incorrectly organized. For example, the introductory chapter includes certain clinical assessment variables that may not yet be understood by the reader. The material, in general, is well selected and fundamental to the allied health disciplines. The key points of each chapter are not included in the information boxes. Instead, one disease process is depicted over the course of several boxes, as the disease relates to each portion of the chapter. For example, in Chapter 4, which discusses airflow, the first box describes a 25-year-old man who presented with signs and symptoms of asthma. The second box discusses the physiology of asthma. The third box lists factors that can provoke an asthma attack. And the last box lists accepted asthma treatments. At the end of each chapter there is a self-assessment case study and criticalthinking questions regarding the case study. Then there is a second set of self-assessment questions relating to the knowledge the reader was expected to gain from the chapter. I think those features will add to the reader’s understanding of important concepts. I found no statements that I believed to be plainly inaccurate, but in the introductory chapter the list of common respiratory medications indicates that isoproterenol is commonly used in the United States as a agonist. Listing the more common agonists such as albuterol and salmeterol would be more appropriate. The book’s arguments are presented accurately and most are presented clearly, with sound support and logic. The conclusions are convincing, original, and important to allied health care providers. However, in