Book Review

Immunopathology of Lung Disease

N Engl J Med 1996; 335:1692-1693November 28, 1996

Article

Immunopathology of Lung Disease
Edited by Richard L. Kradin and Bruce W.S. Robinson. 578 pp., illustrated. Boston, Butterworth–Heinemann, 1996. $160. ISBN: 0-7506-9282-0

Recently, there have been astounding advances in immunology with the introduction of molecular biology into this discipline. The application of this new knowledge to specific organs, such as the lung, has necessarily lagged behind, but this book attempts to provide an overview of pulmonary immunology, with particular emphasis on immunologic mechanisms in pulmonary diseases. The lungs are at the interface between the environment and the body, and in fulfilling their primary role of a gas exchanger with a delicate epithelial surface suited to gaseous diffusion, they are exposed to many noxious and infectious agents and antigens in inhaled air. Furthermore, the entire circulation passes through the pulmonary-capillary bed, providing an enormous surface for immunologic interactions. Indeed, it has been estimated that up to half of all the T lymphocytes in the body reside within the lungs at any one time. All this makes the lung an organ of critical interest to immunologists. Many pulmonary and airway diseases have an immunologic basis, and advances in immunology have greatly helped our understanding of diseases such as asthma. The importance of immunologic defense mechanisms in the lung is emphasized by the fact that pulmonary infections are such a common problem with immune deficiencies, such as human immunodeficiency virus (HIV) infection and therapeutic immunosuppression.

After an introductory chapter on the immune response, there are chapters on the specific cells involved in the immune response, such as lymphocytes, neutrophils, macrophages, and dendritic cells, but surprisingly not eosinophils, mast cells, or epithelial cells. The bulk of the book deals with immunologic processes in specific lung diseases, such as asthma, sarcoidosis, vasculitides, fibrosing lung diseases, dust-induced diseases, lung cancers, and pulmonary infections, including tuberculosis and those due to pneumocystis, fungi, parasites, and viruses. Descriptions of diseases such as HIV and connective-tissue diseases, in which an immunologic attack on the lungs is predominant, are also included. The book concludes with chapters on bronchoalveolar lavage and new techniques (molecular biology) for studying immune mechanisms, which would have been better placed at the beginning.

The contributors are internationally recognized experts, and most chapters are well written and comprehensive. There is inevitably some overlap between chapters, but this is not a bad thing, since each chapter can stand alone. Some of the chapters are of a typical textbook style, whereas others are more adventurous and highlight problems and recent advances. A common problem with multiauthored textbooks such as this is a lack of consistency in diagrams and a lack of diagrams that clarify complex immunology. A glossary of terms would also have been useful, since it is difficult to remember what all the CD numbers signify.

A particular problem of books covering rapidly advancing fields, such as immunology, is that they quickly become dated. This is certainly the case here, and there are few references more recent than 1994. Immunopathology of Lung Disease is a useful and comprehensive review of a complex field for those who want an overview. However, I suspect that it is too out of date for anyone involved in research in this complex area.

Peter J. Barnes, D.M., D.Sc.
National Heart and Lung Institute, London SW3 6LY, United Kingdom