Cover
About the author
CHAPTER 1: Introduction to respiratory medicine
1. About the book
CHAPTER 2: Embryology, anatomy, and physiology of the lung
1. Introduction
2. Development of the respiratory system
3. The respiratory tract
4. Muscles of respiration and mechanical ventilation
5. Structure of the lungs
6. Blood supply of the lungs
7. Nervous supply of the lungs
8. Lymphatics of the lungs
9. Control of breathing
10. Lung receptors and reflexes
11. Chemoreceptors
12. Transport of oxygen
13. Transport of carbon dioxide
14. The acid‐base balance
15. Ventilation‐perfusion mismatch
16. Lung defence
17. MULTIPLE CHOICE QUESTIONS
18. FURTHER READING
CHAPTER 3: Pharmacology of the lung
1. Drugs and the lung
2. Principles of drug deposition in lungs
3. Inhaler devices
4. Oxygen
5. Inhaled drugs
6. Drugs prescribed for smoking cessation
7. Drugs that damage the lungs
8. MULTIPLE CHOICE QUESTIONS
9. FURTHER READING
CHAPTER 4: Common respiratory investigations
1. Laboratory tests
2. Imaging of the lung
3. Lung function tests
4. Exercise testing
5. Sleep studies
6. Cardiology investigations
7. Invasive investigations
8. Miscellaneous investigations
9. MULTIPLE CHOICE QUESTIONS
10. FURTHER READING
CHAPTER 5: Common presentations of respiratory disease
1. Respiratory history
2. Breathlessness
3. Cough
4. Haemoptysis
5. Chest pain
6. Wheeze
7. Hoarse voice
8. Snoring
9. Examination of the respiratory system
10. Pre‐operative respiratory assessment
11. Post‐operative respiratory problems
12. Respiratory assessment of an acutely ill patient
13. MULTIPLE CHOICE QUESTIONS
14. FURTHER READING
CHAPTER 6: Obstructive airways disease
1. Introduction
2. Asthma
3. Chronic obstructive pulmonary disease (COPD)
4. Hyperventilation syndrome (HV)
5. MULTIPLE CHOICE QUESTIONS
6. Appendix 6.A Diagnosis of asthma
7. Appendix 6.B Management of asthma
8. Appendix 6.C Management of COPD
9. FURTHER READING
CHAPTER 7: Diffuse parenchymal lung disease
1. Introduction
2. Diagnosis of DPLD
3. Investigations in a patient suspected of a DPLD
4. Idiopathic interstitial pneumonias (IIP)
5. Non‐specific interstitial pneumonia (NSIP)
6. Cryptogenic organising pneumonia (COP)
7. Desquamative interstitial pneumonia (DIP)
8. Respiratory bronchiolitis interstitial lung disease (RB‐ILD)
9. Lymphoid interstitial pneumonia (LIP)
10. Acute interstitial pneumonia (AIP)
11. Eosinophilic lung disease
12. Sarcoidosis
13. Hypersensitivity pneumonitis (HP)
14. Lymphangioleiomyomatosis (LAM)
15. Pulmonary Langerhans cell histiocytosis (PLCH)
16. Pulmonary alveolar proteinosis (PAP)
17. Pulmonary amyloidosis
18. MULTIPLE CHOICE QUESTIONS
19. Appendix 7.A Drugs that cause peripheral eosinophilia
20. FURTHER READING
CHAPTER 8: Respiratory infections
1. Introduction
2. Respiratory tract infections
3. Pneumonia
4. Viral pneumonia
5. Bacterial pneumonia
6. Community acquired pneumonia (CAP)
7. Hospital acquired pneumonia (HAP)
8. Ventilator‐associated pneumonia
9. Aspiration pneumonia
10. Lipoid pneumonia
11. Pulmonary infections in the immunocompromised
12. Mycobacterium tuberculosis
13. Pulmonary complications of mycobacterium tuberculosis
14. Extra‐pulmonary tuberculosis
15. Opportunistic (atypical) mycobacterium
16. MULTIPLE CHOICE QUESTIONS
17. FURTHER READING
CHAPTER 9: Lung cancer
1. Introduction
2. Epidemiology of lung cancer
3. Aetiology of lung cancer
4. Pathophysiology of lung cancer
5. Clinical presentation of lung cancer
6. Clinical signs of lung cancer
7. Clinical assessment of patient with suspected lung cancer
8. Classification of lung cancer
9. Staging of NSCLC
10. Staging of SCLC
11. Management of lung cancer
12. Surgery
13. Radiotherapy
14. Chemotherapy
15. Targeted molecular therapy
16. Palliative treatment
17. Communicating the diagnosis of lung cancer
18. The lung multidisciplinary meeting
19. Tracheal and laryngeal tumours
20. Benign lung masses and solitary pulmonary nodules (SPN)
21. Common causes of SPN and benign lung mass
22. Cavitating lung lesions
23. Carcinoid tumour
24. Future developments
25. MULTIPLE CHOICE QUESTIONS
26. FURTHER READING
CHAPTER 10: Pleural disease
1. Normal pleura and pleural fluid
2. Pleural effusion
3. Pleural infection and empyema
4. Pneumothorax
5. Asbestos‐related pleural disease
6. Mesothelioma
7. MULTIPLE CHOICE QUESTIONS
8. Appendix 10.A Analysis of pleural fluid
9. Appendix 10.B Compensation for asbestos‐related disease
10. FURTHER READING
CHAPTER 11: Pulmonary embolus, pulmonary hypertension, and vasculitides
1. Introduction
2. Pulmonary embolism
3. Acute pulmonary embolus
4. Diagnosis of pulmonary embolus
5. Management of acute pulmonary embolus
6. Pulmonary hypertension
7. Classification of pulmonary hypertension
8. Pulmonary haemorrhagic syndromes
9. Granulomatosis with polyangiitis (GPA)
10. Other vasculitides
11. Anti‐glomerular basement membrane antibody (Goodpasture’s) syndrome
12. Eosinophilic granulomatosis with polyangiitis (Churg‐Strauss syndrome)
13. MULTIPLE CHOICE QUESTIONS
14. FURTHER READING
CHAPTER 12: Suppurative lung disease
1. Introduction
2. Bronchiectasis
3. Cystic fibrosis
4. Primary ciliary dyskinesia
5. Lung abscess
6. MULTIPLE CHOICE QUESTIONS
7. FURTHER READING
CHAPTER 13: Respiratory failure
1. Respiratory failure
2. Mechanisms of respiratory failure
3. MULTIPLE CHOICE QUESTIONS
4. Appendix 13.A Calculation of the alveolar‐arterial oxygen gradient
5. FURTHER READING
CHAPTER 14: Sleep‐related disorders
1. Introduction
2. Sleep physiology
3. Snoring
4. Upper airways resistance syndrome (UARS)
5. Obstructive sleep apnoea/hypopnoea syndrome (OSAHS)
6. Diagnosis of OSA
7. Intra‐oral devices
8. Narcolepsy
9. Periodic limb movement disorder (PLMD)
10. Restless leg syndrome (RLS)
11. REM behaviour disorder (RBD)/parasomnia
12. Idiopathic hypersomnia (IH)
13. Insomnia
14. Chronic sleep insufficiency
15. Central sleep apnoea (CSA)
16. Nocturnal hypoventilation
17. MULTIPLE CHOICE QUESTIONS
18. Appendix 14.A Epworth Sleepiness Scale (ESS)
19. FURTHER READING
CHAPTER 15: Occupational, environmental, and recreational lung disease
1. Occupational, environmental, and recreational lung diseases
2. Occupational lung disease
3. Pneumoconiosis
4. Hypersensitivity pneumonitis
5. Recreational drugs and the lungs
6. The environment and the lungs
7. MULTIPLE CHOICE QUESTIONS
8. FURTHER READING
CHAPTER 16: Disorders of the mediastinum
1. Anatomy of the mediastinum
2. Diagnosis of a mediastinal mass
3. Anterior mediastinal mass
4. Middle mediastinal mass
5. Posterior mediastinal mass
6. Other mediastinal conditions
7. MULTIPLE CHOICE QUESTIONS
8. FURTHER READING
CHAPTER 17: Acute lung injury and acute respiratory distress syndrome
1. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)
2. Diagnosis of ALI and ARDS
3. Incidence and mortality of ALI and ARDS
4. Pathogenesis of ALI and ARDS
5. Investigations in patients suspected of ALI and ARDS
6. Management of ALI and ARDS
7. Principles of mechanical ventilation in ARDS
8. Other therapies for ARDS
9. Morbidity and mortality in ARDS
10. Transfusion‐Related Acute Lung Injury (TRALI)
11. Acute chest syndrome with sickle cell disease
12. Smoke inhalation
13. Carbon monoxide poisoning
14. Airway trauma
15. Near‐drowning
16. Deep sea diving
17. Acute altitude sickness
18. MULTIPLE CHOICE QUESTIONS
19. FURTHER READING
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Brief history of respiratory medicine.
Chapter 04
1. Table 4.1 Interpretation of full lung function test.
Chapter 05
1. Table 5.1 Causes of breathlessness.
2. Table 5.2 Causes of haemoptysis.
3. Table 5.3 Common causes of pleuritic chest pain.
4. Table 5.4 Abnormalities on examination of the lungs.
Chapter 07
1. Table 7.1 Causes of eosinophilia.
2. Table 7.2 Some causes of hypersensitivity pneumonitis.
Chapter 08
1. Table 8.1 Causes of pneumonia.
2. Table 8.2 Non‐pulmonary tuberculosis.
Chapter 09
1. Table 9.1 Eighth edition of TNM classification of NSCLC.
2. Table 9.2 Staging using the TNM classification for NSCLC eighth edition.
3. Table 9.3 Overall 5‐year survival for NSCLC.
4. Table 9.4 Differences in 5‐year survival rates with CT staging and pathological staging.
5. Table 9.5 5‐year survival after surgery for NSCLC.
6. Table 9.6 Features of malignant and benign lung lesions.
7. Table 9.7 Risk factors for malignancy.
8. Table 9.8 Fleischner Society Guidelines for management of SPN, 2017.
Chapter 10
1. Table 10.1 Analysis of pleural fluid from thoracocentesis.
2. Table 10.2 Differential diagnosis of a transudate.
3. Table 10.3 Differential diagnosis of an exudate.
4. Table 10.4 Pathophysiology of pleural infection.
Chapter 11
1. Table 11.1 Risk factors for developing thromboembolic disease.
2. Table 11.2 Modified Wells score.
3. Table 11.3 WHO classification of pulmonary hypertension.
Chapter 12
1. Table 12.1 Aetiology of bronchiectasis.
2. Table 12.2 Investigations for the diagnosis of bronchiectasis.
3. Table 12.3 Clinical presentation of cystic fibrosis.
Chapter 13
1. Table 13.1 Arterial blood gas measurements.
2. Table 13.2 Comparison of arterial blood gases in acute and compensated respiratory and metabolic acidosis.
Chapter 14
1. Table 14.1 Differential diagnoses of excessive daytime sleepiness (EDS)/hypersomnia.
2. Table 14.2 Definitions.
3. Table 14.3 Presenting symptoms and signs of OSAHS.
4. Table 14.4 Risk factors for and clinical features of OSAHS.
Chapter 15
1. Table 15.1 Common causes of occupational asthma.
Chapter 16
1. Table 16.1 Structures in the mediastinum.
2. Table 16.2 Masaoka system.

List of Illustrations

Chapter 02
1. Figure 2.1 Stages of lung development.
2. Figure 2.2 The upper respiratory tract.
3. Figure 2.3 Surface anatomy of the thorax.
4. Figure 2.4 The lower respiratory tract.
5. Figure 2.5 Structure of the rib.
6. Figure 2.6 The ribs and intercostal space.
7. Figure 2.7 Diaphragm and the structures that traverse it.
8. Figure 2.8 Relationship between elastic recoil and functional residual capacity.
9. Figure 2.9 Lobes and fissures of the lungs.
10. Figure 2.10 Bronchopulmonary segments.
11. Figure 2.11 Alveolar‐capillary unit.
12. Figure 2.12 Control of breathing.
13. Figure 2.13 Oxygen‐Haemoglobin Dissociation Curve and the Bohr Effect.
14. Figure 2.14 The CO₂ dissociation curve.
15. Figure 2.15 The effect of CO₂, pH, and O₂ on ventilation.
16. Figure 2.16 Pulmonary circulation.
Chapter 03
1. Figure 3.1 Particle size and drug deposition.
2. Figure 3.2 Several types of inhaler devices.
3. Figure 3.3 Individual using an MDI.
4. Figure 3.4 Turbohaler.
5. Figure 3.5 Patient using a turbohaler.
6. Figure 3.6 Volumatic device (spacer).
7. Figure 3.7 Aerochamber.
8. Figure 3.8 Portable nebuliser.
9. Figure 3.9 Oxygen cylinder.
10. Figure 3.10 Glucocorticoid receptor complex and mechanism of action of corticosteroid.
11. Figure 3.11 Dose response curve of inhaled corticosteroids.
12. Figure 3.12 Potency of inhaled corticosteroids.
13. Figure 3.13 CT thorax showing nitrofurantoin toxicity.
14. Figure 3.14 CT showing bleomycin toxicity.
15. Figure 3.15 CXR showing radiation‐induced fibrosis.
Chapter 04
1. Figure 4.1 Diagram of normal PA CXR with labels of structures.
2. Figure 4.2 Normal PA CXR.
3. Figure 4.3 Diagram of normal lateral CXR with labels of structures.
4. Figure 4.4 Normal lateral CXR.
5. Figure 4.5 CXR showing consolidation left lower lobe with air bronchogram.
6. Figure 4.6 CXR showing pulmonary oedema.
7. Figure 4.7 CXR showing a cavitating lesion left lower lobe.
8. Figure 4.8 CT thorax showing miliary tuberculosis.
9. Figure 4.9 CXR showing right upper lobe collapse.
10. Figure 4.10 CXR (PA) showing right middle lobe collapse.
11. Figure 4.11 CXR (lateral) showing right middle lobe collapse.
12. Figure 4.12 CXR (PA) showing right lower lobe collapse.
13. Figure 4.13 CXR (PA) showing left upper lobe collapse.
14. Figure 4.14 CXR (lateral) showing left upper lobe collapse.
15. Figure 4.15 CXR showing left lower lobe collapse.
16. Figure 4.16 CXR showing right mid‐zone consolidation.
17. Figure 4.17 CXR showing idiopathic pulmonary fibrosis.
18. Figure 4.18 CXR showing hyperinflated lungs in asthma.
19. Figure 4.19 CXR showing emphysematous lungs in COPD.
20. Figure 4.20 CXR showing a right‐sided pleural effusion.
21. Figure 4.21 CXR showing elevation of the right hemidiaphragm.
22. Figure 4.22 Diagram of normal CT thorax with labels of the structures.
23. Figure 4.23 Normal CT thorax (lung windows).
24. Figure 4.24 Normal CT thorax (mediastinal windows).
25. Figure 4.25 CTPA showing bilateral filling defects in multiple pulmonary emboli.
26. Figure 4.26 HRCT of normal lung.
27. Figure 4.27 PET scan showing FDG‐avid lesion in lung cancer.
28. Figure 4.28 VQ scan showing perfusion defects consistent with pulmonary emboli.
29. Figure 4.29 Thoracic ultrasound scan of a pleural effusion.
30. Figure 4.30 Peak flow meter.
31. Figure 4.31 Peak flow readings showing diurnal variation.
32. Figure 4.32 Handheld spirometer.
33. Figure 4.33 Spirometry in a normal individual and in obstructive and restrictive lung disease.
34. Figure 4.34 Normal flow‐volume loop.
35. Figure 4.35 Flow‐volume loop in obstructive lung disease.
36. Figure 4.36 Flow‐volume loop in restrictive lung disease.
37. Figure 4.37 Flow‐volume loop in mixed lung disease.
38. Figure 4.38 Flow‐volume loop in variable extra‐thoracic upper airway obstruction.
39. Figure 4.39 Flow‐volume loop in variable intra‐thoracic obstruction.
40. Figure 4.40 Flow‐volume loop in fixed large airway obstruction.
41. Figure 4.41 Static lung volumes: Total Lung Capacity (TLC), Expiratory Reserve Volume (ERV), Residual Volume (RV), Vital Capacity (VC), Functional Residual Capacity (FRC), Inspiratory Capacity (IC), Tidal Volume (TV).
42. Figure 4.42 CT‐guided FNA of lung mass with needle in pulmonary lesion.
Chapter 05
1. Figure 5.1 Observing chest expansion on inspiration.
2. Figure 5.2 Clubbing of the finger nails and tar staining.
3. Figure 5.3 Checking for CO₂ retention flap.
4. Figure 5.4 Checking for lymphadenopathy.
5. Figure 5.5 Checking for tracheal deviation.
6. Figure 5.6 Close‐up view showing how to check for tracheal deviation.
7. Figure 5.7 Unilateral (right‐sided) Horner’s syndrome showing ptosis, miosis, and aniscoria (difference in size of the pupils between the two eyes).
8. Figure 5.8 Checking for chest expansion upper anterior chest.
9. Figure 5.9 Checking for chest expansion lower anterior chest.
10. Figure 5.10 Checking for chest expansion posteriorly.
11. Figure 5.11 Percussion of the chest anteriorly.
12. Figure 5.12 Percussion of the chest posteriorly.
13. Figure 5.13 Auscultation of the lungs.
Chapter 06
1. Figure 6.1 Pathophysiology of asthma.
2. Figure 6.2 Diagram of PEF chart in poorly controlled asthma showing diurnal variation.
3. Figure 6.3 CXR in asthma.
4. Figure 6.4 HRCT in asthma.
5. Figure 6.5 Decline in lung function with smoking.
6. Figure 6.6 Pathophysiology of COPD.
7. Figure 6.7 CXR in COPD showing hyperinflation.
8. Figure 6.8 HRCT showing a large bulla in left lung in severe emphysema.
9. Figure 6.9 HRCT in ABPA showing proximal bronchiectasis.
10. Figure 6.A.1 Diagnostic algorithm for presentation with respiratory symptoms.
11. Figure 6.B.1 Summary of asthma management in adults.
12. Figure 6.C.1 Diagnostic algorithm for inhaled therapy.
Chapter 07
1. Figure 7.1 Classification of diffuse parenchymal lung disease (DPLD).
2. Figure 7.2 Pathophysiology of pulmonary fibrosis.
3. Figure 7.3 CXR of idiopathic pulmonary fibrosis (IPF).
4. Figure 7.4 HRCT thorax showing bibasal fibrosis of idiopathic pulmonary fibrosis (IPF).
5. Figure 7.5 HRCT thorax showing fibrosis and honeycombing in advanced idiopathic pulmonary fibrosis (IPF).
6. Figure 7.6 Histology of lung showing usual interstitial pneumonia (UIP) in IPF.
7. Figure 7.7 Prognosis in UIP, NSIP, and other fibrotic lung diseases.
8. Figure 7.8 CXR of non‐specific interstitial pneumonia (NSIP) showing interstitial shadowing.
9. Figure 7.9 HRCT thorax showing ground glass changes of non‐specific interstitial pneumonia (NSIP).
10. Figure 7.10 CXR in cryptogenic organising pneumonia (COP) showing areas of consolidation.
11. Figure 7.11 CT thorax showing extensive areas of consolidation in cryptogenic organising pneumonia (COP).
12. Figure 7.12 CT thorax of desquamative interstitial pneumonia (DIP) showing areas of fibrosis.
13. Figure 7.13 CT thorax of respiratory bronchiolitis‐interstitial lung disease (RBILD).
14. Figure 7.14 CXR of eosinophilic pneumonia showing interstitial shadowing.
15. Figure 7.15 CT thorax of eosinophilic pneumonia showing areas of consolidation.
16. Figure 7.16 Erythema nodosum.
17. Figure 7.17 Anterior uveitis with arrow showing hypopyon.
18. Figure 7.18 CXR of stage 1 pulmonary sarcoidosis showing BHL.
19. Figure 7.19 CT thorax of stage 1 pulmonary sarcoidosis showing bilateral hilar lymphadenopathy (BHL).
20. Figure 7.20 CXR of stage 2 pulmonary sarcoidosis with BHL and pulmonary infiltrates.
21. Figure 7.21 CT thorax of stage 2 pulmonary sarcoidosis with BHL and pulmonary infiltrates.
22. Figure 7.22 CXR of stage 3 pulmonary sarcoidosis showing pulmonary fibrosis.
23. Figure 7.23 CT thorax of stage 3 pulmonary sarcoidosis showing pulmonary fibrosis.
24. Figure 7.24 CXR of stage 4 pulmonary sarcoidosis showing extensive, chronic fibrosis.
25. Figure 7.25 CT thorax of stage 4 pulmonary sarcoidosis showing extensive, chronic fibrosis.
26. Figure 7.26 Histology of sarcoid lung showing granuloma with multinucleate giant cells, lymphocytes and histiocytes.
27. Figure 7.27 CXR of hypersensitivity pneumonitis (HP).
28. Figure 7.28 CT thorax of chronic hypersensitivity pneumonitis (HP) showing ground glass changes and fibrosis.
29. Figure 7.29 CXR of lymphangioleiomyomatosis (LAM) showing hyperinflation.
30. Figure 7.30 HRCT thorax of lymphangiomyomatosis (LAM) showing multiple cysts in both lungs.
31. Figure 7.31 CXR of pulmonary Langerhans cell histiocytosis (PLCH).
32. Figure 7.32 HRCT thorax of pulmonary Langerhans cell histiocytosis (PLCH) showing multiple cysts in both lungs.
33. Figure 7.33 CXR of pulmonary alveolar proteinosis (PAP) showing extensive shadowing.
34. Figure 7.34 CT thorax in pulmonary alveolar proteinosis (PAP) showing extensive ground‐glass changes.
Chapter 08
1. Figure 8.1 CXR showing left upper zone infiltration suggestive of early infection.
2. Figure 8.2 CXR showing right lower lobe consolidation.
3. Figure 8.3 CXR showing right middle and right lower lobe consolidation.
4. Figure 8.4 CXR showing right lower lobe consolidation with cavitation and a parapneumonic effusion.
5. Figure 8.5 CXR showing ground‐glass shadowing of pneumocystic jiroveci.
6. Figure 8.6 HR CT thorax showing ground‐glass shadowing of pneumocystis jiroveci.
7. Figure 8.7 CXR showing primary Mycobacterium tuberculosis infection.
8. Figure 8.8 CXR showing granulomas in the right lung.
9. Figure 8.9 CT thorax showing a calcified granuloma in the right lung.
10. Figure 8.10 CXR showing right upper lobe consolidation in active mycobacterium infection.
11. Figure 8.11 CT thorax showing miliary tuberculosis.
12. Figure 8.12 CXR of previous chickenpox pneumonia.
13. Figure 8.13 CXR showing changes of chronic mycobacterium tuberculosis infection.
14. Figure 8.14 CT thorax showing changes of chronic tuberculosis.
15. Figure 8.15 Preparation for a Mantoux test.
16. Figure 8.16 Forearm with purified protein derivative instilled intra‐dermally.
17. Figure 8.17 Quantiferon testing kit.
18. Figure 8.18 CXR showing plombage left lung.
19. Figure 8.19 CXR showing right‐sided thoracoplasty.
20. Figure 8.20 CT thorax showing ‘tree in bud’ appearance of atypical mycobacterial infection.
Chapter 09
1. Figure 9.1 Lung cancer incidence and smoking trends for adults by sex, 1948–2010 in Great Britain, from Cancer Research UK.
2. Figure 9.2 Number of deaths and age‐specific mortality rates for lung cancer in UK, 2007, from Cancer Research UK.
3. Figure 9.3 Survival in lung cancer according to stage at diagnosis.
4. Figure 9.4 Photograph showing clubbing of finger nails.
5. Figure 9.5 X ray showing hypertrophic pulmonary osteoarthropathy (HPOA).
6. Figure 9.6 Photograph showing Horner’s syndrome.
7. Figure 9.7 CXR showing a right‐sided lung mass suspicious for lung cancer.
8. Figure 9.8 CXR showing lobar (left upper lobe) collapse.
9. Figure 9.9 CXR showing a cavitating solitary pulmonary nodule.
10. Figure 9.10 CXR showing elevation of the right hemidiaphragm.
11. Figure 9.11 CXR showing lymphangitis carcinomatosis.
12. Figure 9.12 CT thorax showing a suspicious, spiculate mass in the right upper lobe.
13. Figure 9.13 PET scan showing an FDG‐avid lesion in the right upper lobe suspicious of lung cancer.
14. Figure 9.14 CT and PET scans showing a non‐FDG‐avid nodule in the left lung.
15. Figure 9.15 CT‐guided FNA of lung mass showing needle in the lung mass.
16. Figure 9.16 Histology of adenocarcinoma from a CT‐guided biopsy of lung mass.
17. Figure 9.17 Histology of squamous cell carcinoma from a CT‐guided biopsy of lung mass.
18. Figure 9.18 Histology of small cell carcinoma from an endobronchial biopsy.
19. Figure 9.19 CT thorax showing a hamartoma with the typical popcorn calcification.
20. Figure 9.20 CXR showing granulomas in the right lung.
21. Figure 9.21 CT thorax showing a calcified granuloma in the right lung.
22. Figure 9.22 CT showing round atelectasis which looks like a solitary pulmonary nodule.
23. Figure 9.23 CT thorax of carcinoid tumour of the lung.
24. Figure 9.24 PET scan of carcinoid tumour showing low FDG uptake.
25. Figure 9.25 Histology of carcinoid tumour.
Chapter 10
1. Figure 10.1 BTS diagnostic algorithm for investigation of a unilateral pleural effusion.
2. Figure 10.2 CXR showing a unilateral (right‐sided) pleural effusion.
3. Figure 10.3 Thoracic ultrasound scan showing a pleural effusion with underlying lung atelectasis.
4. Figure 10.4 CT thorax showing a unilateral (right‐sided) pleural effusion.
5. Figure 10.5 CT thorax showing right‐sided empyema with inserted drain.
6. Figure 10.6 Thoracic ultrasound scan of empyema with air‐bubbles post aspiration.
7. Figure 10.7 CXR of a small, unilateral (right‐sided) pneumothorax.
8. Figure 10.8 CXR showing a large, left‐sided pneumothorax with complete collapse of the left lung.
9. Figure 10.9 Measurement of the size of a pneumothorax from BTS Guidelines.
10. Figure 10.10 CXR showing a large, left‐sided emphysematous bulla.
11. Figure 10.11 CT thorax showing a large, left‐sided emphysematous bulla.
12. Figure 10.12 CXR showing surgical emphysema.
13. Figure 10.13 BTS algorithm for management of primary and secondary pneumothorax.
14. Figure 10.14 CXR showing benign, calcified, pleural plaques.
15. Figure 10.15 CT thorax showing benign, calcified pleural plaques.
16. Figure 10.16 CT thorax showing left‐sided pleural thickening.
17. Figure 10.17 CT thorax showing round atelectasis with adjacent left‐sided pleural thickening (mediastinal window).
18. Figure 10.18 CT thorax showing round atelectasis with adjacent left‐sided pleural thickening (parenchymal window).
19. Figure 10.19 Coronal reconstruction of CT thorax showing sub‐pleural reticulation and multiple, bilateral, calcified pleural plaques.
20. Figure 10.20 CT thorax showing right‐sided malignant mesothelioma associated with external compression of the superior vena cava.
21. Figure 10.21 CT thorax showing right‐sided malignant mesothelioma.
Chapter 11
1. Figure 11.1 Virchow’s triad.
2. Figure 11.2 ECG changes seen in pulmonary embolus.
3. Figure 11.3 CXR showing right lower lobe infarction after a pulmonary embolism.
4. Figure 11.4 CTPA showing bilateral filling defects seen with multiple pulmonary emboli.
5. Figure 11.5 : Ventilation perfusion scan showing perfusion defects in pulmonary emboli.
6. Figure 11.6 Ventilation perfusion scan showing VQ mismatch.
7. Figure 11.7 Regulation of pulmonary vascular tone.
8. Figure 11.8 CXR showing right ventricular hypertrophy in a patient with severe pulmonary hypertension.
9. Figure 11.9 ECG changes seen in pulmonary hypertension.
10. Figure 11.10 Histology showing intimal proliferation in pulmonary hypertension.
11. Figure 11.11 Histology showing changes of pulmonary arterial hypertrophy.
12. Figure 11.12 CXR of a patient with granulomatosis with polyangiitis.
13. Figure 11.13 CXR showing acute haemorrhage in right lung in a patient with HHT.
14. Figure 11.14 CXR showing changes of chronic pulmonary haemorrhage.
Chapter 12
1. Figure 12.1 Progression of bronchiectasis with cycle of infection and inflammation.
2. Figure 12.2 Electron microscopy image of cilium (diagram).
3. Figure 12.3 CT showing dilated bronchi in bronchiectasis.
4. Figure 12.4 Coronal CT thorax showing bronchiectasis.
5. Figure 12.5 CT thorax showing cylindrical bronchiectasis.
6. Figure 12.6 The structure of the cystic fibrosis transmembrane conductance regulator.
7. Figure 12.7 CXR of patient with CF showing extensive bronchiectasis.
8. Figure 12.8 CT of patient with CF.
9. Figure 12.9 CXR of patient with PCD showing dextrocardia.
10. Figure 12.10 CXR of right‐sided lung abscess.
11. Figure 12.11 CT of right‐sided lung abscess.
12. Figure 12.12 CT of left lung abscess.
Chapter 13
1. Figure 13.1 Patient using a nasal cannulae.
2. Figure 13.2 Patient using a simple face mask.
3. Figure 13.3 Patient using a reservoir (re‐breathe) mask.
4. Figure 13.4 Patient being fitted with a CPAP device.
5. Figure 13.5 A range of venturi valves.
6. Figure 13.6 The venturi principle.
7. Figure 13.7 A non‐invasive ventilator.
8. Figure 13.8 NIV pressures.
9. Figure 13.9 Oxygen Alert Card.
Chapter 14
1. Figure 14.1 Brain wave activity during normal sleep.
2. Figure 14.2 Increase in upper airway resistance during sleep.
3. Figure 14.3 Mandibular advancement device (MAD).
4. Figure 14.4 Normal upper airway.
5. Figure 14.5 Narrowed upper airway in apnoea‐hypopnoea syndrome.
6. Figure 14.6 An individual being fitted with a home (limited) sleep study.
7. Figure 14.7 An oximeter being fitted for a home (limited) sleep study.
8. Figure 14.8 Home (limited) sleep study tracing showing obstructive sleep apnoea.
9. Figure 14.9 Full polysomnography tracing showing obstructive sleep apnoea.
10. Figure 14.10 CPAP machine and circuit.
11. Figure 14.11 Individual having CPAP fitted.
12. Figure 14.12 Sleep tracing showing obstructive, central, and mixed apnoea.
Chapter 15
1. Figure 15.1 Chest X‐ray of asbestosis and mesothelioma.
2. Figure 15.2 CT thorax of asbestosis.
3. Figure 15.3 CXR showing progressive massive fibrosis.
4. Figure 15.4 CXR showing silicosis and progressive massive fibrosis.
5. Figure 15.5 CT thorax showing silicosis and progressive massive fibrosis.
6. Figure 15.6 CT thorax showing changes associated with hard metal sensitivity.
Chapter 16
1. Figure 16.1 Outline of the mediastinum.
2. Figure 16.2 Compartments of the mediastinum on a lateral CXR.
3. Figure 16.3 Common mediastinal masses in the anterior, middle, and posterior mediastinum.
4. Figure 16.4 CXR of thymoma.
5. Figure 16.5 CT thorax showing thymoma.
6. Figure 16.6 CXR showing retrosternal thyroid.
7. Figure 16.7 CT thorax with contrast showing lymphadenopathy.
8. Figure 16.8 CXR showing a pericardial cyst.
9. Figure 16.9 CXR showing a neurofibroma.
10. Figure 16.10 CT thorax showing a neurofibroma.
11. Figure 16.11 CXR showing a pneumomediastinum.
12. Figure 16.12 CT thorax showing a pneumomediastinum.
Chapter 17
1. Figure 17.1 Chest X‐ray showing ARDS.
2. Figure 17.2 High resolution CT scan showing ARDS.

CHAPTER 1
Introduction to respiratory medicine

The respiratory system is essential for gas exchange in a multicellular organism. The lungs are also important as a defence against infectious microorganisms. Worldwide, diseases of the respiratory system cause significant morbidity and mortality; this includes infectious diseases, malignancies, allergic diseases, autoimmune disorders, and occupational diseases. Diseases of other parts of the body, for example, rheumatological and renal conditions, often affect the lungs.

Respiratory diseases can present acutely with severe, life‐threatening breathlessness, for example, when someone develops a pulmonary embolus or a pneumothorax, or more insidiously with a steady decline in lung function over time, as occurs in chronic obstructive pulmonary disease or parenchymal lung diseases. In the United Kingdom (UK), respiratory diseases account for one‐third of acute admissions to hospitals and for more than a quarter of all deaths in hospitals. Respiratory tract infections are the commonest conditions seen in General Practice.

In the last half a century there has been a decline in the prevalence of certain diseases, such as pneumoconioses, and other occupational lung diseases because of the recognition of the harm caused by exposure to certain agents at work. The introduction of masks, better ventilation, and other safety measures at work, together with appropriate legislation, has been the key to this success.

In the next few decades it is likely that asbestos‐associated diseases (asbestosis and mesothelioma) will reduce in incidence and prevalence in the UK because of the prohibition of the use of asbestos. Asbestos, however, is still used in several developing countries. The recognition that air pollution is responsible for respiratory diseases will, hopefully, lead to cleaner air, especially in urban areas.

However, there has been an increase in the prevalence of allergic asthma, and there are various hypotheses to explain this increase. Mycobacterium tuberculosis has still not been eradicated, resulting in millions of deaths across the globe. Tuberculosis, also called ‘phthism’, ‘consumption’, or the ‘white plague’, was found in the spines of Egyptian mummies dating back to 3200–2400 BCE and is associated with poverty and deprivation.

Respiratory diseases are managed jointly by respiratory physicians, specialist nurses, physiotherapists, and occupational therapists in a multi‐disciplinary way. Other specialists, including radiologists, pathologists, oncologists, thoracic surgeons, palliative care physicians, intensivists, and physiologists (for example, lung function technicians) are also essential in the management of patients with respiratory diseases. Patients who are acutely ill are managed in hospital, often on specialist respiratory wards, sometimes in single rooms if infectious, and in the Intensive Care Unit if respiratory support is required.

There has been increasing understanding of the physiology of the respiratory system and the pathophysiology of respiratory diseases in the last few centuries. Table 1.1 summarises some of the key developments in respiratory medicine.

Table 1.1 Brief history of respiratory medicine.

Year	Development	Scientist
Greece, 460–370 BCE	Beginning of modern medicine	Hippocrates
Greece, 304–250 BCE	Some understanding of the physiology of the lung	Erisistratus
Greece, 129–165 BCE	Anatomy of trachea, larynx, and lungs understood Believed air had substance vital for life	Galen
Egypt, 1210–1288	Some understanding of pulmonary circulation	Ibne Nafis
Italy, 1500	Understood anatomy and physiology of lungs Determined sub‐atmospheric pressures inflated lungs	Leonardo da Vinci
Belgium, 1543	Tracheostomy used for ventilation	Andreas Vesalius
UK, 1700	Constructed first air pump for physiological research	Robert Hooke
France, 1778	Discovered role of oxygen	Antoine Lavoisier
France, 1816	Invention of stethoscope	René Laennec
Scotland, 1832	Invention of negative pressure tank‐type ventilator	John Dalziel
Germany, 1882	Tuberculosis bacterium discovered	Robert Koch
Germany, 1895	First chest X‐ray	Wilhelm Rötgen
UK, 1928	First non‐invasive ventilation	Drinker‐Shaw
USA, 1963	First human lung transplant	James Hardy
UK, 1972	First computed tomography scan	Godfrey Hounsfield

About the book

Respiratory diseases are common, and this textbook offers a practical guide to those who care for patients with respiratory diseases. This textbook is aimed at medical students studying for their MBBS examination and postgraduate doctors of all grades, especially those studying for postgraduate examinations, including the MRCP examination. This book will also be useful for non‐respiratory doctors, specialist nurses, physiotherapists, occupational therapists, pharmacists, respiratory physiologists, and physicians associates.

This text covers the entire respiratory curriculum and contains information that is useful and relevant to everyday clinical practice, with a focus on clinical presentation and management. Essential basic anatomy, physiology, pharmacology, and pathology are introduced to help understand the clinical presentation. A structured approach is taken to explain how to construct a sensible differential diagnosis of common respiratory conditions. There is a clear explanation of the common diagnostic tests required to make a diagnosis, including the interpretation of lung function tests. The mechanism of action of drugs commonly prescribed to treat respiratory diseases is discussed, with a description of their common side effects and interaction with other medications. The evidence‐based management of common conditions is discussed with reference to the current British Thoracic Society (BTS) and National Institute for Health and Care Excellence (NICE) guidelines. Common pitfalls in diagnosis and management are highlighted.

The book contains several boxes, tables, and algorithms set out in a clear, and concise way. It also contains several good quality colour photographs, and radiological and histological images to support the information in the text.

There are multiple choice questions which can be used by the reader to check their understanding, with a clear explanation of the correct answer. There is also a list of references for suggested further reading.

Supplementary material includes videos demonstrating how to take a history and conduct a clinical examination (http://www.wiley.com/go/Paramothayan/Essential_Respiratory_Medicine). There are also videos showing how to carry out common tests, such as peak flow, spirometry, the skin prick test, the Mantoux test, the shuttle test, and how to fit a patient for a sleep study.

Essential Respiratory Medicine

About the author

Acknowledgements

About the companion website

CHAPTER 1
Introduction to respiratory medicine

About the book