Chronic obstructive pulmonary disease

By Thomas Similowski, William A. Whitelaw, Jean-Philippe Derenne, eds. New York, NY: Marcel Dekker, 2002, 1072 pp; $250

COPD is currently the sixth-leading cause of death worldwide, and it has been estimated that it will climb to the third spot by 2020. Current treatment is, without doubt, unsatisfactory; in spite of the recent Global Initiative on Chronic Obstructive Lung Diseases guidelines, a nihilistic approach is often adopted. The very fact that nearly 1,100 pages are required for Clinical Management of Chronic Obstructive Pulmonary Disease reflects on the far-from-happy situation that we are in today. Having said that, this brilliant and decidedly valuable tome systematically takes the reader from diagnosis through management, and includes a panoramic view of the approach to management throughout the globe.

Three distinguished editors have succeeded in recruiting recognized experts from all over the world to present up-to-date and well-established information that can easily be assimilated by the reader. This elegantly structured book has 10 parts, which have further been subdivided into 45 chapters. The first part, centered on diagnosis and follow-up, comprises 10 chapters that systematically acquaint the reader with the clinical approach to a patient with COPD. The diagnostic aspects include essential investigations such as pulmonary function and imaging, while the follow-up section contains information ranging from assessment and management of dyspnea to the impact of health-related quality of life studies in COPD, to disability evaluation. An entire chapter is included on treatment recommendations for the general practitioner.

A separate section explores treatment approaches based on the pathophysiology of COPD, including therapeutic perspectives on genetics and another on the role of antioxidant therapy. Pharmacologic therapy is covered in seven chapters, and not only deals with individual pharmacologic agents but also carries an innovative description of methodology for therapeutic trials in COPD. In addition to bronchodilators and steroids, the roles of other therapeutic strategies such as vasodilators, analeptics, and mucolytics are covered. Prevention of infection and management of associated conditions including lung cancer, anxiety, and depression and the effect of COPD on sleep are also described. Two chapters deal with the effect of COPD on the heart, an aspect that tends to be overlooked by pulmonologists. A section covering the influence of other factors, including the impact of respiratory muscle performance, nutrition, and physiotherapy, seeks to focus the reader's attention on facets other than just pharmacology. A section entitled "Instrumental Treatments" includes lucid and well-written reviews of oxygen therapy, noninvasive ventilation, and the role of tracheostomy, but in this case one gets a fleeting impression that there may have been a time lag between writing and publication. A concise account of the role of surgery in COPD is presented and includes worthwhile information on the current state of lung volume reduction surgery and lung transplantation. "Management of the COPD Patients Undergoing Surgery" guides the pulmonologist through the preoperative evaluation as well as postoperative treatment modalities.

A 21-page "must-read" section on future strategies lets us "gaze into the crystal ball" and gives us a glimpse of, and raises hope for the things to come; however, a separate section on acute exacerbation of COPD would have further enriched the book. The last part, comprising five chapters, gives us an overview of the different approaches to the management of COPD throughout the world. It carries a segment comparing the guidelines of different regional societies, and also highlights the importance that the World Health Organization assigns to this disease.

Clinical Management of Chronic Obstructive Pulmonary Disease is a well-compiled and comprehensive treatise that focuses on this enormous problem, and emphasizes the need to do much more. The Executive Editor (Claude Lenfant) and publishers of the Lung Biology in Health and Disease series, and the editors of this superb monograph should be applauded for this very timely effort, which will be of immense help to all students of this crippling disease.

Ashok Shah, MD

Delhi, India

COPYRIGHT 2003 American College of Chest Physicians
COPYRIGHT 2003 Gale Group