Book Review

Occupational and Environmental Respiratory Diseases

N Engl J Med 1995; 333:1431November 23, 1995

Article

Occupational and Environmental Respiratory Diseases
Edited by Philip Harber, Marc B. Schenker, and John R. Balmes. 1038 pp., illustrated. St. Louis, Mosby, 1995. $139. ISBN: 0-8016-7728-9

The respiratory tract is the organ most at the mercy of environmental factors because of its requirement for a continuous sampling of air, a need that increases many fold with exercise and work. The skin can be covered and washed, and we have some control over what enters the gastrointestinal tract. But we have to breathe the air wherever we are — at work, at home, or at play — and along with it, anything and everything that is contained in that obligatory environmental sample. It is therefore no surprise that respiratory disease is central to considerations of occupational and environmental exposures.

Occupational and Environmental Respiratory Diseases is a comprehensive and authoritative textbook that explores these diseases from the perspectives of history, clinical and epidemiologic methods, exposure-assessment methods, disease entities, causative agents, industrial and environmental sources, and clinical, regulatory, and engineering strategies for management. Although weighted heavily to occupational disease, the book fills the need in this field for a multidisciplinary textbook that analyzes and integrates such diverse subjects as sources and agents of respiratory disease, exposures, toxic mechanisms, health effects, and methods of management of airborne health hazards in the workplace and elsewhere.

Each chapter is well organized, clearly and liberally illustrated, and well referenced. The chapters are authored by experts, so that aspects of mineralogy, physiology, epidemiology, toxicology, clinical medicine, and environmental-control measures are presented in great detail with much supporting data for each agent or class of agents. The chapters in each of the 12 major sections have been skillfully integrated by one of the three editors. The book offers both an explanation of the topic and an introduction to the supporting scientific literature. Rarely does one find such a smooth blending of the clinical and environmental sciences and practices.

This textbook is both a source and a resource. Chapter tables provide specific data on epidemiologic studies, acceptable exposure standards, toxic mechanisms, and clinical findings. In addition to the bibliographies, there is an extensive appendix listing biologic responses to specific agents, their occupational sources, references to over 250 key studies, and governmental data sources. The index allows one to look up topics according to the agent, industry source, toxic effect, clinical manifestation, or regulatory control, thus making the book easy to use as a reference tool.

This work is a basic textbook for physicians who diagnose, treat, and strive to prevent diseases of the respiratory tract. Primary care physicians will find the descriptions of the clinical methods of detection useful and may wish to verify whether a possible exposure related by a patient could be contributing to the reported symptoms and observed abnormalities on x-ray films or screening pulmonary-function tests. Pulmonary-medicine specialists will find the detailed presentations and the up-to-date references valuable in quantifying the respiratory disease, analyzing the differential diagnosis, organizing and interpreting a diagnostic workup, and formulating a regimen of treatment and prevention. Reading this book will alert occupational physicians to the potential hazards of workplace products and processes and provide guidance in designing medical surveillance and prevention programs. Occupational health nurses and industrial hygienists will gain a fuller understanding of the medical conditions their treatment and monitoring programs are designed to prevent. Research scientists can gain access to current scientific literature, identify relevant and timely unanswered questions, and place their findings in context with clinical and environmental issues. Finally, students interested in learning about this important field of public health will be pleased by the breadth and depth of coverage of medical and environmental issues relating to the etiology and pathogenesis of respiratory diseases as well as the public health approaches necessary for the prevention and control of these largely untreatable diseases.

Gareth M. Green, M.D.
Harvard School of Public Health, Boston, MA 02115