Nunn's Applied Respiratory Physiology, 5th Edition. By Andrew B. Lumb. Oxford, Butterworth-Heinemann, 2000. Pages: 687. Price: $115.00.
For over 30 yr, John Nunn's Applied Respiratory Physiology has served as a standard reference for generations of physicians wishing to ground their clinical practice firmly on a physiologic foundation. Its enduring popularity is a testimony to Dr. Nunn's skills as communicator and scientist and his unflagging energy in keeping abreast of developments in the field. Many investigators, including myself, have presented work at scientific meetings and then were immediately accosted by Dr. Nunn, pencil and pad in hand, wanting to get the details right so that the results could be included in the next edition of his text.
In this new edition, Dr. Nunn, upon his retirement, passes the torch to a practicing clinician with research interests, Dr. Andrew Lumb. Reflecting this change, this edition is more clinically focused, with a greater emphasis on the pathophysiology of pulmonary disease, which is now accorded a separate section. Readers will find this reorganization of material welcome. New chapters discuss specifically airway diseases, and, in an interesting conjunction, breathing in closed environments, ranging from closed-circle anesthesia to space habitation. At the same time, core information, such as the classic description of oxygen's journey from environment to mitochondria, is preserved from earlier editions, including the beloved elegant line drawings and diagrams, which prove that the current fad of multicolored text and figures is not necessary to convey information effectively.
Considering the wide range of disciplines now important to pulmonary physiology (from molecular biology to physics), keeping a single-authored text up-to-date is a daunting task indeed. Happily, Dr. Lumb is usually up to the challenge. For example, the chapter on the effects of anesthesia on the respiratory system nicely summarizes the recent literature, a feat that some recent editions of standard anesthesia texts have been unable to achieve. Although discussion of significant developments in other areas (such as recent work detailing the importance of nongravitational factors in determining pulmonary blood flow) is sometimes omitted, this does not detract from the overall utility of the text. Some may wish for a more detailed treatment of current “hot topics,” such as ventilator-induced lung injury, but to me, much of this book's charm lies in its evenhanded treatment of a wide range of subjects ranging from the topical to the obscure. Plenty of texts talk about ventilators in excruciating detail, but where else can you learn about earth's prebiotic atmosphere (a sort of steamy seltzer), how oxygen tension was monitored in diesel-powered submarines (during long dives, cigarettes wouldn't ignite), or why the supersonic Concorde was designed with small windows (to slow the rate of decompression at high altitudes in case of window failure)?
In these days of gene therapy and molecular medicine, it is frightening how little many in the current generation of medical students and residents understand about basic principles of respiratory physiology. This perhaps should not be surprising, considering that many of their teachers, who are often more concerned with ion channels or clinical practice, do not understand them either. For this reason, this wonderful book is more important that ever. Every anesthesia resident should read it, and every anesthesiologist should have a copy nearby.