Palliative care for lung disease

Respiratory disease. From advanced disease to bereavement

. Anna Spathis, Helen E Davies, Sara Booth. Oxford: Oxford University Press, 2011 (297 pp, $58.50). ISBN 9780199564033.

There is no shortage of material in the medical literature on the latest advances in technology. So when a book comes along in which the emphasis is on the palliation of symptoms in patients with advanced lung disease, my first thoughts were that this is a publication that will meet an unmet need.

All three authors are specialists based in the United Kingdom. Spathis is a consultant in palliative medicine, Booth has developed a breathlessness intervention service and Davies is a specialist registrar in respiratory and general medicine.

So, what does this book bring to our understanding of this subject? I suspect that readers will be both satisfied and frustrated by this offering.

The most frustrating aspect is that these descriptions are often very short on detail and not particularly relevant to the Australian medical scene. For example, the section on lung cancer makes no mention of PET (positron emission tomography) scanning in staging. In the section on cystic fibrosis no mention is made of the use of either macrolides or nebulised hypertonic saline.

The description of advanced lung diseases is followed by a discussion of the management of the common symptoms of severe lung disease. Overall, this section is far more useful for clinicians, with clear-cut recommendations regarding the investigation and management of pain, dyspnoea, constipation, mood disturbances and sleep disturbance. However, even this section is frustrating in parts. We are regularly told that health professionals are good neither at predicting prognosis nor at discussing it with patients.

The authors make unsubstantiated, unhelpful statements such as: “Anecdotally patients prognosticate more accurately than health care professionals, and those that verbalize suspicion of a short prognosis are often correct”. I find such statements of limited use in clinical practice.

I would have found this book more useful if it had concentrated on the palliative care aspects rather than on an incomplete description of advanced lung diseases.

A bargain at $58.50? I don’t think so.