Book Review

Basic Mechanisms of Pediatric Respiratory Disease: Cellular and Integrative

N Engl J Med 1993; 328:978April 1, 1993

Article

Basic Mechanisms of Pediatric Respiratory Disease: Cellular and Integrative
Edited by Victor Chernick and Robert B. Mellins. 449 pp., illustrated. Philadelphia, B.C. Decker, 1991. $92. ISBN: 1-55664-137-0 (Distributed in the U.S. by Mosby-Year Book, St. Louis).

This book is unique among the currently available textbooks of pediatric pulmonary disease in that its purpose is to bridge the gap between classic physiology and the exciting insights now being revealed by cellular and molecular biology. Chernick and Mellins state in their introduction, “To be relevant at the bedside, our challenge is to relate changes in cellular physiology to organ pathophysiology.” Their aim is achieved admirably.

The book covers six main areas. It starts with a chapter on molecular-genetic approaches to pulmonary disease and ends with a section on new approaches to diagnosis and treatment. It thus transmits a sense of excitement about diagnostic and therapeutic tools that have been introduced, especially in the past decade or two. The bulk of the book is devoted to the developmental anatomy, developmental physiology, developmental biochemistry, and developmental immunology of the lung. It is thus clear that another major focus of the book is the growth and development of the lungs; this emphasis serves to preserve the book's pediatric approach. Indeed, some of the strongest chapters are those that concentrate primarily on changes occurring with growth and development. Among these are the chapters on prenatal and postnatal development of the lungs and pulmonary circulation, the upper airway, human and comparative mammalian lung mechanics, respiratory-muscle function, epithelial electrolyte transport, exercise and metabolism, and respiratory control. Nearly all the chapters try to address the differences between the immature and mature lung, however.

This book has more than 50 contributors. The obvious advantage of a book with multiple contributors is that each author is an expert in his or her field. The advantage of a single-author book is that it is often better integrated because of its uniformity of purpose and style. Chernick and Mellins have retained the best qualities of these two extremes. The chapters are written by expert scientists, they are often extremely well referenced (some chapters have more than 150 references), and they have the depth that readers are accustomed to finding in the Handbook of Physiology (Bethesda, Md.: American Physiological Society, 1959-1991). On the other hand, the underlying theme of the developmental aspects of lung disease from fetus to adult is evident throughout the book and serves to unify it.

Fellowship training programs in pediatric pulmonology usually have a core course in respiratory physiology. I would probably recommend books such as West's Respiratory Physiology (4th ed. Baltimore: Williams and Wilkins, 1989) or Murray's Normal Lung (2nd ed. Philadelphia: W.B. Saunders, 1986) as the first book in such a course because they are more basic and provide the necessary background knowledge. Basic Mechanisms of Pediatric Respiratory Disease is ideally suited to be the second book in such a course because of its uniquely pediatric approach and greater depth. This depth occasionally makes for some slow going, but that is to be expected. This same depth also makes the book ideal for those embarking on research projects, because it takes the reader to the edge of what is known, and for those writing research papers, because of its extensive references.

Julian L. Allen, M.D.
St. Christopher's Hospital for Children, Philadelphia, PA 19134

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