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Paediatric pulmonary function testing
  1. A Brooke

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Edited by J Hammer and E Eber. Basel: Karger, 2005, €120.00 (hardback), pp 278. ISBN 3-8055-7753-2

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Paediatricians often encounter patients with respiratory problems so most will have reasonable knowledge about the common and chronic respiratory diseases; virtually every paediatric department will have its collection of peak flow devices, spirometers, and other instruments for measuring and recording pulmonary function. Research departments and tertiary respiratory centres will have specialised lung function laboratories where more sophisticated tests may provide pages of numerical data to help the clinician best treat the child. But what is the place of pulmonary function testing in the broader clinical context and what does it all mean? This book has been written to provide a comprehensive survey of pulmonary function testing and to review the latest developments in the field.

The pleasingly slim tome is one of a series of books entitled “progress in respiratory research” and is a multi-author book written by experts in the individual areas that form many of the chapters. Despite this the style is consistent and the content up to date.

As one might expect with a comprehensive review, the book divides logically into lung function testing in infants and toddlers unable to cooperate with most procedures and is followed by analysis of the traditional adult founded techniques as applied to children. Technical and procedural considerations are discussed; limitations, normative data, and aids to interpretation are proffered. These sections provide much useful theoretical and technical understanding in a reasonably digestible way; diagrams are helpful and equations are kept scarce. The book also covers the newer emerging methodologies such as exhaled breath condensate and exhaled nitric oxide testing, diffusing capacity, work of breathing, and respiratory muscle function. The final section deals with the clinical application of lung function testing to common respiratory disorders such as asthma, cystic fibrosis, neuromuscular disease, and the continuing care of neonatal survivors and lung transplant recipients. Lung function testing in critical care settings is also discussed. I found these sections the most useful part of the book. It was informative, rewarding, and at the same time surprising to read; for example, it finds no evidence to underpin the usefulness of lung function measurements (including peak flow) in the monitoring of asthma. Its suggestions for the care of children with neuromuscular disorders are sensible and appear to be broadly in step with recent American Thoracic Society guidelines.

All chapters are kicked off with a pithy abstract that lets the reader know what they are in for, which was useful, although the substance of some of the technical sections proved hard going.

While there is no doubting the quality of the book I do wonder whether it will satisfy the potentially diverse needs of the pulmonologists, technicians, and general paediatricians the book claims it is written for. I suspect general paediatricians may find the last half of the book much more useful than the first, while technicians and researchers may find the converse. I would therefore recommend the book to research departments and specialist units more than to the general readership. For those considering buying the book, the price tag of £80.00 is likely to induce some sharp inspiratory manoeuvres in the purchaser.