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Diagnosis and Management of Paediatric Respiratory Disease.
  1. ANNE THOMSON, Consultant paediatrician

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    Diagnosis and Management of Paediatric Respiratory Disease. 2nd Ed. By Robert Dinwiddie. (Pp 352; £40 hardback.) Churchill Livingstone, 1997. ISBN 0-443-05084-8.

    An English summer day with rain pouring down outside seemed the ideal opportunity to tackle Bob Dinwiddie’s Diagnosis and Management of Paediatric Respiratory Disease. Like many single author texts this is well written, easily read, and internally consistent. The task is enormous: to cover the whole of respiratory disease in a slim volume. It is the ideal membership text with sufficient detail to provide answers for all commonplace questions and good references for further reading. The down side is that the information is sometimes rather hidden in the text and better use could be made of bullet points, diagrams, and tables.

    Paediatric respiratory disease is a fast growing subspecialty and new information from molecular genetics and biology is broadening our understanding if not yet directly affecting management. Many examples could be given: in the understanding of cystic fibrosis, the basis of wheeze and asthma, the production of mucins, and the role of defensins and antibacterial peptides in the lungs. Little of this excitement is transmitted in this text, which is a main line practical book.

    It is of course difficult to maintain a balance between being comprehensive and providing sufficient depth. The chapter on immune disease in the lung is excellent but occupies 32 pages while a similar 30 pages are devoted to asthma. The asthma chapter is disappointing. Dr Dinwiddie is clearly a “lumper” rather than a “splitter” and the interesting and controversial area of wheezing in infancy is not really addressed. I liked the short chapter on rare diseases of the lung. The choice and reproduction of radiographs was excellent throughout.

    Many single author textbooks are decidedly idiosyncratic in management recommendations such that one sometimes wonders if they are single author by default. This is decidedly not so in this text. Management suggestions are practical and straightforward and I had only small quibbles. I do not think a possible foreign body aspiration is a mandatory indication for rigid bronchoscopy but prefer to look first using a flexible ’scope under sedation and proceed only to general anaesthetic and rigid bronchoscopy if there is a foreign body present. Piperacillin should not be recommended as a first choice intravenous antibiotic in cystic fibrosis because of the high risk to patients of allergic reactions including anaphylaxis.

    Overall however this book represents mainstream British diagnosis and management and is recommended reading for those seeking further information on respiratory disease in children. Unfortunately it will not attract or stimulate the next generation of clinical scientists.

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