PRINCIPLES OF RESPIRATORY MEDICINE
PRINCIPLES OF RESPIRATORY MEDICINE
Second Edition
Editors
Farokh Erach Udwadia
MD FRCP (London & Edinburgh) Master FCCP FAMS FCPS DSc
Emeritus Professor of Medicine Grant Medical College and JJ Group of Hospitals, Mumbai Consultant Physician and Director in Charge of the ICU Breach Candy Hospital, Mumbai Consultant Physician, Parsee General Hospital Mumbai, Maharashtra, India
Zarir F Udwadia
MD DNB FRCP (London) FCCP (USA)
Consultant Chest Physician, Hinduja Hospital, Mumbai Consultant Physician, Breach Candy Hospital and Parsee General Hospital Mumbai, Maharashtra, India
Anirudh F Kohli
MD DNB DMRD
Head of Imaging, Breach Candy Hospital, Mumbai Consultant Radiologist, Jaslok Hospital Mumbai, Maharashtra, India
Khyati Shah
MBBS
Consultant Physician and Research Officer Breach Candy Hospital Mumbai, Maharashtra, India
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Principles of Respiratory Medicine
First Edition: 2010
Second Edition: 2020
9789388958585
Printed at:
The first edition of this landmark book, Principles of Respiratory Medicine, not only in India but also in Southeast Asia, has been extremely well received. A second edition is both warranted and has been eagerly awaited. This second edition has been thoroughly revised and brought up-to-date.
The revision extends to the generally accepted description of respiratory diseases common to the affluent West and the poor tropical countries. However, the revised and updated epidemiology of these diseases, their subtle variations in clinical presentation, and natural history as observed in India and Southeast Asia have merited special emphasis. The epidemiological study of respiratory diseases in these countries remains unfortunately poor and our task is therefore beset with considerable difficulty.
Respiratory diseases peculiar to India and other tropical countries have been revised wherever necessary. The chapter on Dengue has been extensively revised and we have newly included the complications of Scrub Typhus. For obvious reasons, respiratory diseases peculiar to the tropics have been given more attention than have been given by western authors. This continues to be a very important feature of this book.
Every section and most chapters of this book have been updated. Prevailing concepts in lung cancer, asthma, interstitial lung disease, and several other diseases have been discussed at length with special reference to India and Southeast Asia.
As in the first edition, the highlight of this book is the section on tuberculosis (TB). Pulmonary TB exists on an epic scale—a killer that stalks millions of Indians, not only killing many, but impoverishing many more. India accounts for more than one-third of the TB burden of the world; TB causes one death per minute in this country and over a million deaths annually. Every aspect of this disease has been revised with special regard to epidemiology, MDR-TB, XDR-TB, the relation between TB and human immunodeficiency virus (HIV) infection, the drug regimes in use, and the newer drugs available in treatment. The section on newer diagnostic aids now available, chiefly involving genetic and molecular biology, has been extensively revised.
Another noteworthy feature of this book is the large number of excellent images that illustrate the text. Every chapter of every section is illustrated wherever necessary with high-quality images contributing to a better understanding of the text.
As in the first edition to ensure conformity in content, form, and style, we did not invite contributions from colleagues working in different parts of the country. There were two exceptions—Dr Thirumali Rajgopal who contributed chapters on “Common Occupational Disease and Environmental Pollution” and Dr Camila Rodrigues who contributed a chapter on “Antibiotic Resistance and its Management”. Dr Rajgopal is the Medical Advisor to Hindustan Lever and Lever Brothers and Dr Rodrigues is the senior consultant and Head of Microbiology at the Hinduja Hospital, Mumbai, Maharashtra, India. We are extremely grateful to both these colleagues for their contribution.
What makes this book different from similar works written by Western authors is the emphasis on respiratory diseases as practiced in India, Southeast Asia, and other tropical countries.
This edition will continue to be useful to medical registrars, registrars in pulmonary medicine, postgraduate students, medical practitioners, consultants in general medicine, and pulmonologists not only in India and Southeast Asia but also to an extent in Africa and South America. It will also be of interest to our western colleagues, as in a shrinking world and the ease of travel, an awareness of different diseases in different parts of the world becomes necessary.
We have included one more author in this second edition—Dr Khyati Shah, the research officer at Breach Candy Hospital, Mumbai, Maharashtra, India. She has been responsible for the organization of the numerous sections and chapters, the corrections and repeated revisions, the numerous references in each section and chapter, the insertion of the many images at the appropriate places throughout the volume, the correction of page proofs again and again and the meticulous attention to detail in the production of this work. Without her devotion, diligence, cheerful disposition, and invaluable help, this book would not have been possible.
We owe a great deal of gratitude to Mr Sanjiv Mehta, CEO of Hindustan Lever, India, who has been kind enough to give an extraordinarily generous subsidy toward the publication of this work. The price of this book has thereby been substantially reduced so as to bring it within the reach of all students and colleagues in this profession.
We also thank Mrs Vera F Udwadia for her help in correcting the page proof. We also thank Mr Neeraj Chawan for helping to type the manuscript. We thank the various authors whose works we have consulted in the preparation of this book and to those publishers who have granted permission to use some figures, images, and tables from their books/journals.
Finally, we thank Jaypee Brothers Medical Publisher (P) Ltd. for their unstinted help and cooperation in publishing this book.
Farokh Erach Udwadia
Zarir F Udwadia
Anirudh F Kohli
Preface to the First Edition
The prime reason for writing a book on pulmonary medicine is our firm conviction that a description of respiratory diseases occurring in India is best written by experienced physicians working for decades in the same country. The contents of such a text we felt would also by and large be applicable to other developing and poor countries of the world. Considering the fact that far more people live in the underprivileged regions of the world compared to the affluent West, the raison d’être for such a text seemed unquestionable.
We knew that our task was indeed daunting and we made it doubly so by deciding not to invite contributions from colleagues working in various regions of the country. We were determined to accomplish the work by ourselves, so as to finish the task quickly, and to ensure a uniformity of style, language, content and a focussed dedication, all so essential to achieve what we set out to do. The work started in the spring of 2009 and was submitted for publication by August 2010. We however allowed for two exceptions when we invited Dr Thirumalai Rajgopal to contribute two chapters on ‘Common Occupational Lung Diseases’ and ‘Environmental Pollution’ and Dr Camilla Rodrigues to write on ‘Antibiotic Resistance and its Management’.
In India we encounter almost all the respiratory diseases found in the West. In addition, we live among respiratory diseases which are peculiar only to India and other developing tropical countries, that are uncommon in the West. It is therefore important that physicians practising in these countries are trained in the understanding, diagnosis, and management of both these groups of diseases. The authors sincerely hope that this book achieves this objective. We have not compromised on the generally accepted description of respiratory diseases common to both the affluent West and to poor tropical countries. However, the epidemiology of these diseases, their often subtle variations in clinical presentation, and natural history as observed in the Indian and Southeast Asian context have been clearly emphasized.
Respiratory disorders peculiar to India and other tropical countries have, for obvious reasons, been dealt with in considerable detail. For example, pulmonary infections in the tropics, together with pulmonary complications of tropical diseases is a subject that deserves far more attention than what has been accorded by western authors. Parasitic infections of the lungs, the lung in fulminant malaria, in amoebic infection, in salmonellosis, leptospirosis, dengue, in other fulminant, and not so fulminant infections in the tropics, have been discussed in special detail because they are both frequent and important.
The increasing menace of lung cancer in India has been given special emphasis; with a comparison of recent epidemiological data on lung cancer in various parts of India vis-à-vis Southeast Asia, China, and several other countries of the world.
Both chronic obstructive pulmonary disease as well as asthma have a significant morbidity and mortality rate in India, Southeast Asia, and also in the West. These topics have been discussed at length with special reference to India and Southeast Asia.
A highlight of the book is a discussion on the threat of pulmonary tuberculosis and its unsolved challenges. Pulmonary tuberculosis dominates medicine in India and other developing countries. It exists on an epic scale with India accounting for a third of the world's TB burden. Every aspect of this disease has been dealt with, including a detailed epidemiological description, MDR and XDR tuberculosis, tuberculosis in relation to the HIV epidemic, the new diagnostic aids involving the use of genetics and molecular biology, and also the future needs to counter the unsolved challenges of this disease.
We have also included, among others, sections on basic ‘Lung Physiology’, ‘Clinical Approach to Respiratory Disease-Symptoms and Signs’, ‘Occupational and Environmental Lung Diseases’, ‘Infectious Diseases’ and a section on ‘HIV and the Lung’.
The volume begins with the section ‘Imaging Techniques and Imaging of the Chest’. Of all the recent discoveries in respiratory medicine, the most iconic is the discovery of spiral computed tomography in the 1990s. Continuing technological advances have further enhanced the imaging of the microarchitecture of the lung and have enabled a reconstruction of images that allow a three-dimensional view of a lung pathology and of pathologies involving the mediastinum. The advent of virtual bronchoscopy permits a view of the whole bronchial tree and its surrounding structures. These, together with the use of ultrasonography, ventilation-perfusion lung scans, magnetic resonance imaging (MRI), and positron emission tomography (PET scans) in respiratory medicine have been briefly described with suitable illustrations in this section. What is more, every single chapter of every section is illustrated wherever necessary with high-quality images that contribute to the further understanding of different respiratory diseases. We feel that the visual image is as important as the written word and often is longer lasting in the mind's eye.
Principles of Respiratory Medicine is a book written by clinicians for clinicians, and though not encyclopedic in content, is comprehensive in its scope. The varying emphasis given to different respiratory diseases is related to respiratory medicine as observed and practiced in India and to an extent in Southeast Asia and other tropical countries. In this respect, the book differs significantly from many others written by western authors.
This is a landmark book not only in India but probably also in Southeast Asia. It will prove to be of considerable benefit to medical registrars, registrars in pulmonary medicine, postgraduate students, medical practitioners, consultants in general medicine, and to pulmonologists practising in these countries as well as to some extent in Africa and South America. It will also be of interest to our colleagues in the West, for surely they would be keen to know the pattern of respiratory diseases in the other half of the world—in the teaming populations of poor tropical countries. Also, ours is a shrinking world and the frequency and the ease of travel from one continent to another has increasingly resulted in the need for a global awareness—an awareness of different diseases in different parts of the world.
We have based this book on current knowledge, evidence, experience, and recent advances, all perhaps in equal measure. Yet it behoves the reader to bear in mind that what is true today may not be true tomorrow, for the history of medicine, including respiratory medicine, is a chronicle of change. We leave the reader with the words of Sir Francis Bacon… ‘Read not to contradict and confute, nor to believe and take for granted, nor to find talk and discourse, but to weigh and consider’.
We owe a great deal of gratitude to a number of individuals, some of whom deserve special mention. We owe an immense debt of gratitude to Mr Shreyas Doshi of Shrenuj and Company who has been kind enough to give an extraordinarily generous subsidy towards the publication of this work. The price of the book has thereby been substantially reduced to bring it within the reach of all students and colleagues in the profession.
Our sincerest thanks above all to Dr Khyati Mehta, our research assistant, without whose devotion, diligence, cheerful disposition, and invaluable help this book would never have been possible. She has been largely responsible for the organization of the numerous sections and chapters, the insertion of so many images and illustrations at appropriate places throughout the volume and meticulous attention to detail in the production of this work. Her help with the page-proofs, with the huge number of references, and her cordial liaison with our publishers have been of immense help. She indeed is as much a part of the book as the authors inscribed on the cover.
Our sincerest thanks to Dr Thirumalai Rajgopal for his chapters on ‘Common Occupational Lung Diseases’ and ‘Environmental Pollution’. We also thank Dr Camilla Rodrigues for her chapter on ‘Antibiotic Resistance and its Management’.
We are grateful to AV Graphic Designers Pvt Ltd (Mumbai) for creating excellent illustrations and tables that have been used throughout the book. Their cooperation and punctuality during the production of this work was outstanding. Our thanks to Dr Maansi Parekh for her help with the images and to Ms Kinni Makwana who has provided us with four special illustrations.
We thank Mrs Vera F Udwadia for her help in the correction of the page-proofs. We also thank Mr Neeraj Chavan for his help in typing the manuscript. We thank the many authors whose work we have consulted during the preparation of this book, in particular the text on Clinical Respiratory Medicine edited by Albert RK, Spiro SC and Jett R. We would also like to extend our thanks to those publishers and authors who have granted permission for some figures, images, and tables from their books/journals.
Finally, our sincerest thanks to the team at Oxford University Press in Delhi and Mumbai for their unstinted help and cooperation in publishing this work.
Farokh Erach Udwadia