Book Review

Autoimmune Aspects of Lung Disease

N Engl J Med 1998; 339:1864December 17, 1998

Article

Autoimmune Aspects of Lung Disease
Edited by D.A. Isenberg and S.G. Spiro. 276 pp., illustrated. Boston, Birkhäuser Verlag, 1998. Swiss Fr. 238. ISBN: 3-7643-5719-3

It is hard to imagine that just a short time ago it was possible to think about lung disease with little attention to immunity and inflammation. After all, pulmonary pathophysiology was, and remains, best described in biomechanical and biochemical terms. Asthma is a disease of the airways, with impaired air movement that results in increased expiratory pressures and lung volumes and disastrous air trapping. Occupational lung diseases often result in diffuse scarring that leads to decreased lung volumes. Tumors are space-occupying lesions of the lung airway or parenchyma. In pneumonia, air exchange is impaired even as the febrile patient's metabolic rate requires improved oxygenation. And in many conditions, a mismatch between ventilation and perfusion causes predictable hypoxia and respiratory acidosis.

All these statements are true, yet they are hardly adequate descriptions. For the lung, like the skin and the gut, is a remarkably active immunologic organ, blessed with a vast blood supply and challenged by a massive interface with a frequently toxic and septic environment. In Autoimmune Aspects of Lung Disease, 23 authors address the consequences of the responses of the immune system at this interface. The results are fascinating, well written, and comprehensive.

The book has many notable strengths. The chapters on rheumatic disease and vasculitides are especially clear and comprehensive. Robinson's treatment of the immunologic basis of asthma is excellent, and Bernstein's discussion of drug-induced lung disease summarizes a great deal of disparate information nicely. The bookend chapters, a review of the lung and the immune system by Catterall and Sheffield and a summary by Isenberg and Spiro, are clear and insightful. Furthermore, the book has been edited well. There is little redundant material, and there are few gaps. The graphics are clear, appropriate, and informative.

In fact, my only quibble with this book is its relatively narrow title. Although the chapters on rheumatic disease and vasculitides clearly fall within the autoimmune focus of the title, the book also contains excellent minireviews of asthma, cystic fibrosis, human immunodeficiency virus–induced lung disease, granulomatous disorders, drug-induced lung disease, and lung cancer, among others. Are these autoimmune diseases? Well, perhaps they are, but not without some further explanation. A more accurate title for the book — and one that would have attracted a wider readership — would have been, “The Lung and the Immune System.”

Jay E. Slater, M.D.
Food and Drug Administration, Rockville, MD 20852