Book Review

Primary Pediatric Pulmonology

N Engl J Med 2001; 345:624-625August 23, 2001

Article

Primary Pediatric Pulmonology
Edited by Allen J. Dozor. 296 pp., illustrated. Armonk, N.Y., Futura, 2001. $88. ISBN: 0-87993-464-6

There are at least four large, comprehensive textbooks on lung disease in children. Primary Pediatric Pulmonology is more a handbook of pediatric lung disease and focuses on evaluation and treatment of common disorders. Thus, the book is unique in concept, but does it achieve its goal?

The 14 chapters are by experts in the field. The first chapter, on the evaluation of chronic or recurrent respiratory symptoms in children, contains numerous practical points. Next comes a chapter on noisy breathing and stridor in infants, which contains fewer key points and is vague on the time required for spontaneous resolution of laryngomalacia. What do you tell the parents? However, there follows an excellent discussion of apnea in infants. The sudden infant death syndrome is discussed briefly, but there is no mention of the significant reduction in incidence when sleeping babies are placed in the supine rather than the prone position (the “back to sleep” initiative). This is an important practical point for the primary care physician.

Obstructive sleep apnea in children is well covered. The chapter on wheezing and croup in infants is also excellent; it contains a list of important questions related to wheezing and a useful algorithm for diagnosis. Discussion of the treatment of bronchiolitis is disappointing. The primary care physician needs to know what drugs to use and why as well as the dose, route of administration, and duration of treatment. This information could have been easily presented either by highlighted key points or in tabular form.

The next three chapters deal with childhood asthma. They discuss epidemiology, morbidity, mortality, and urgent and hospital care of asthma. The discussion of the management and prevention of asthma is practical and gives a stepwise approach to the use of “controller” and “reliever” drugs and guidelines for referral to an asthma specialist.

The final chapters discuss bronchopulmonary dysplasia, cystic fibrosis, pneumonia, and tuberculosis. The chapter on cystic fibrosis, one of the most thoughtful in the book, is written specifically for the primary care physician. The book ends with a novel chapter on pediatric office-based smoking intervention. Both active and passive smoking are major public health problems, and the addiction frequently has its origins in adolescence. Very useful “ask hints,” “advise hints,” and “assist hints” are found in the chapter.

This book, meant for primary care physicians, suffers from some of the problems of larger textbooks. Sometimes the main focus of the book seems lost, and there are important omissions, such as hyaline membrane disease, pneumothorax, meconium aspiration, bronchitis, and bronchopneumonia. I suspect that primary care physicians are more involved with such lung diseases than pulmonologists. Some of the individual chapters are outstanding, but overall I can give this book only a lukewarm recommendation.

Victor Chernick, M.D.
University of Manitoba, Winnipeg, MB R3A 1S1, Canada