Commentaries and clinical tips for assessing respiratory diseases

 

Challenging concepts in respiratory medicine: cases with expert commentary.

Schomberg L, Sage E, Hart N, editors. Oxford University Press, 2017 (£49.99; 304 pp). ISBN: 9780199657742

 

Challenging concepts in respiratory medicine: cases with expert commentary comprises a series of 22 case histories in respiratory and sleep medicine, including details of the history, examination, investigations and treatment of respiratory diseases. In association with the case histories, there are learning points, clinical tips and expert comments, most of which are made by clinicians from the United Kingdom.

The cases presented vary from relatively common scenarios (eg, bacterial lung infection) to complex and highly specialised cases (eg, HIV-related lung disease, central sleep apnoea, transplant, and non-surgical management of early stage lung cancer). The case history related to severe asthma mainly discusses the potential role of omalizumab and mepolizumab; the use of these monoclonal antibodies is a highly specialised area of respiratory medicine, which may not be relevant to most general practitioners and physicians. Further, the comprehensive discussion of chronic obstructive pulmonary disease deals with potential bullectomy, which is a rarely performed procedure that belongs to the domain of subspecialty respiratory physicians. Overall, the cases are very well presented and the commentaries and clinical tips are accurate and useful. However, in view of the subspecialised nature of the cases, most of them are essentially irrelevant to GPs or physicians outside of respiratory medicine. Indeed, a number of the cases are potentially irrelevant to some respiratory physicians as well. In my opinion, this book would be a valuable addition to the library of a respiratory medicine hospital department or the personal library of an advanced trainee in respiratory medicine; perhaps, it would also be useful for a respiratory physician who may not have access to the regular education program of a teaching hospital.

Published in 2017, this series of cases is very up to date. For example, the case regarding central sleep apnoea includes the early termination of the trial of adaptive servo ventilation as a result of increased mortality in the adaptive servo ventilation arm — the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients with Heart Failure (SERVE-HF) study. However, the ability of a printed text to remain up to date with further developments is always concerning, particularly for a book describing cases. It remains to be seen whether this format of clinical education can remain relevant and capable of change over time.