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Nunn's applied respiratory physiology, 5th edition

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    Nunn's applied respiratory physiology, 5th edition andrew b lumb. (Pp 640; £59.50). 2000. Oxford: Butterworth-Heinemann. ISBN: 0-7506-3107-4.

    The first edition of this famous book was published in 1969 and rapidly established itself alongside works by Comroe and Cotes as required reading for respiratory physiologists and especially for anaesthetists. This new edition—the original author having handed the torch to Lumb, maintains the high standards of its predecessors. As the editions have appeared changes in the arrangement of sections of the book have been made. These are most marked in this edition: basic principles, applied physiology, and the physiology of pulmonary disease now being the sections that contain the 33 chapters. The last section is a new venture and contains much new material. To keep the book to about 700 pages Lumb has excised some material that was in the earlier editions. This is recognised by the original author in his foreword. Casual readers will notice few changes—"tho' much is taken, much abides” and the quality is undiminished.

    The book begins with a chapter, by the original author, on the atmosphere. This is outstanding and should be read by all physiologists. Did you know that half the expected life of this planet has passed? I didn't and it is a sobering thought. The author makes the point that our atmosphere has dictated our physiology. Current concerns about antioxidants in the diet and their role in protecting the airways against free radical attack are presaged by this chapter. For details of oxygen radical formation see page 496: the chemistry is complex but elegantly explained. Section 1 continues with accounts of lung structure, elastic forces, resistance to gas flow, the control of breathing (up to date and particularly clear) and thence to the matching of ventilation and perfusion. This has always been a difficult chapter and some changes can be recognised. It is still difficult but recent advances in modelling of and the use of the MIGET technique have done much to simplify the theory. Discussion of the Riley, Fenn, Cournard model has been reduced—this may come as a relief to some although, to paraphrase Saunders, this area has provided many with much quiet intellectual amusement (and instruction) at the cost of a few pencils and some reams of paper only! Those proposing to follow a career in respiratory physiology should read the account given in earlier editions of this book. The “applied” sections of earlier editions appealed, I suspect, more to anaesthetists than to physicians. This should no longer be the case. Pregnancy, sleep, air pollution, and smoking for example are all now given chapters of their own: indeed, only one chapter is headed “anaesthesia”. The third section provides an account of most of that which a respiratory physician or anaesthetist should know about pathophysiology. The chapter on acute lung injury is particularly good with an excellent account of the role of cytokines.

    The book concludes with five appendices dealing with the maths and physics. The appendix on nomograms and correction charts will appeal to many: the great Siggaard-Anderson pH-Pco 2nomogram remains as does the invaluable Pao 2–Fio 2 shunt nomogram (much photocopied!).

    Reading this book has been a pleasure. It is the best single volume account of pure and applied respiratory physiology now available. At £59.50 it is a bargain—buy it!

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