Book Review

Diseases of the Bronchioles

N Engl J Med 1994; 331:1319-1320November 10, 1994

Article

Diseases of the Bronchioles
Edited by Gary R. Epler. 444 pp., illustrated. New York, Raven Press, 1994. $105. ISBN: 0-7817-0123-6

Except when caused by noxious gases or fumes, bronchiolar diseases have long been viewed as diseases of childhood that are caused mainly by microbes. Recently, bronchiolar diseases have been recognized as clinically important diseases affecting all age groups. Only in the past decade have the clinical and pathological features of many of these diseases been characterized sufficiently for us to begin to understand them in an orderly fashion. To my knowledge, this textbook offers the only thorough discussion of diseases of the bronchioles. In the preface, Dr. Epler states that he designed the book to be a comprehensive reference for the clinical and pathological features of human bronchiolar diseases as we currently understand them. I believe he accomplished this task quite well. Various chapters have great strengths and some weaknesses, but I view the book as a welcome addition to my library.

Diseases of the Bronchioles is a multiauthored work and is therefore written in multiple styles. Some chapters are excellent. Others are boring, and there is considerable overlap and repetition. However, most chapters are well written, and the many illustrations and tables are usually clear. Dr. Epler's choice of contributors is very good.

The organization of the book is unusual. It is divided into four sections, with the first devoted to anatomy, pathology, research, and a clinical classification of the bronchiolar diseases. The next two sections consider bronchiolar diseases first as “airway disorders” and then as “interstitial diseases.” From a pathogenetic standpoint, I would consider all forms to be bronchiolar and most forms to be capable of causing interstitial disease, depending on the severity of the injury, the chronicity of the injury, and the ability of the lung to repair itself. This division appears artificial but is perhaps used to separate bronchiolitis obliterans from bronchiolitis obliterans organizing pneumonia. The second section includes descriptions of smoker's bronchiolitis, mineral-dust bronchiolitis, diffuse panbronchiolitis, and the spectrum of idiopathic and known causes of bronchiolitis obliterans. The third section discusses respiratory bronchiolitis (a form of smoker's bronchiolitis) but is largely devoted to a discussion of the idiopathic and known causes of bronchiolitis obliterans organizing pneumonia. The fourth and final section deals with bronchiolar disease in children.

Several chapters are superb. Chapter 8, by Finklestein and Cosio, is excellent. It beautifully integrates descriptions of pathology, pathogenesis, and clinical disease. Similarly, Izimi's succinct chapter on a global view of idiopathic bronchiolitis obliterans organizing pneumonia is excellent. If I had to select one chapter as outstanding, it would be the one by Cordier, Peyrol, and Loire, which focuses on bronchiolitis obliterans organizing pneumonia as a model of inflammatory (airway) lung disease. This chapter is a synthesis of recent data on lung injury and repair that portrays the events resulting in clinical disease.

The weakest chapters are on imaging. Often there appears to be confusion about whether the author is discussing bronchiolitis obliterans organizing pneumonia or bronchiolitis obliterans. Many illustrations are good and will prove useful, however.

I recommend this book to all clinicians and clinical scientists with an interest in lung diseases. It is not likely to be helpful to generalists or basic researchers. It is a book that begins to illuminate what little we know about diseases of the bronchioles.

Jack D. Fulmer, M.D.
University of Alabama at Birmingham, Birmingham, AL 35294