Essential respiratory medicine. Shanthi Paramothayan

Chapter 1. Introduction to respiratory medicine

The respiratory system is essential for gas exchange in a multicellular organism. The lungs are also important as a defence against infectious microorganisms. Worldwide, diseases of the respiratory system cause significant morbidity and mortality; this includes infectious diseases, malignancies, allergic diseases, autoimmune disorders, and occupational diseases. Diseases of other parts of the body, for example, rheumatological and renal conditions, often affect the lungs.

Respiratory diseases can present acutely with severe, life-threatening breathlessness, for example, when someone develops a pulmonary embolus or a pneumothorax, or more insidiously with a steady decline in lung function over time, as occurs in chronic obstructive pulmonary disease or parenchymal lung diseases. In the United Kingdom (UK), respiratory diseases account for one-third of acute admissions to hospitals and for more than a quarter of all deaths in hospitals. Respiratory tract infections are the commonest conditions seen in General Practice.

In the last half a century there has been a decline in the prevalence of certain diseases, such as pneumoconioses, and other occupational lung diseases because of the recognition of the harm caused by exposure to certain agents at work. The introduction of masks, better ventilation, and other safety measures at work, together with appropriate legislation, has been the key to this success.

In the next few decades it is likely that asbestos- associated diseases (asbestosis and mesothelioma) will reduce in incidence and prevalence in the UK because of the prohibition of the use of asbestos. Asbestos, however, is still used in several developing countries. The recognition that air pollution is responsible for respiratory diseases will, hopefully, lead to cleaner air, especially in urban areas.

However, there has been an increase in the prevalence of allergic asthma, and there are various hypotheses to explain this increase. Mycobacterium tuberculosis has still not been eradicated, resulting in millions of deaths across the globe. Tuberculosis, also called ‘phthism’, ‘consumption’, or the ‘white plague’, was found in the spines of Egyptian mummies dating back to 3200—2400 все and is associated with poverty and deprivation.

Respiratory diseases are managed jointly by respiratory physicians, specialist nurses, physiotherapists, and occupational therapists in a multi-disciplinary way. Other specialists, including radiologists, pathologists, oncologists, thoracic surgeons, palliative care physicians, intensivists, and physiologists (for example, lung function technicians) are also essential in the management of patients with respiratory diseases. Patients who are acutely ill are managed in hospital, often on specialist respiratory wards, sometimes in single rooms if infectious, and in the Intensive Care Unit if respiratory support is required.

There has been increasing understanding of the physiology of the respiratory system and the pathophysiology of respiratory diseases in the last few centuries. Table 1.1 summarises some of the key developments in respiratory medicine.

About the book

Respiratory diseases are common, and this textbook offers a practical guide to those who care for patients with respiratory diseases. This textbook is aimed at medical students studying for their MBBS examination and postgraduate doctors of all grades, especially those studying for postgraduate examinations, including the MRCP examination. This book will also be useful for non-respiratory doctors, specialist nurses, physiotherapists, occupational therapists, pharmacists, respiratory physiologists, and physicians associates.

This text covers the entire respiratory curriculum and contains information that is useful and relevant to everyday clinical practice, with a focus on clinical presentation and management. Essential basic anatomy, physiology, pharmacology, and pathology are introduced to help understand the clinical presentation. A structured approach is taken to explain how to construct a sensible differential diagnosis of common respiratory conditions. There is a clear explanation of the common diagnostic tests required to make a diagnosis, including the interpretation of lung function tests. The mechanism of action of drugs commonly prescribed to treat respiratory diseases is discussed, with a description of their common side effects and interaction with other medications. The evidence- based management of common conditions is discussed with reference to the current British Thoracic Society (BTS) and National Institute for Health and Care Excellence (NICE) guidelines. Common pitfalls in diagnosis and management are highlighted.

Table 1.1 Brief history of respiratory medicine.

Year Development Scientist

Greece, 460-370 bce

Beginning of modern medicine


Greece, 304-250 bce

Some understanding of the physiology of the lung


Greece, 129-165 bce

Anatomy of trachea, larynx, and lungs understood Believed air had substance vital for life


Egypt, 1210-1288

Some understanding of pulmonary circulation

Ibne Nafis

Italy, 1500

Understood anatomy and physiology of lungs Determined sub-atmospheric pressures inflated lungs

Leonardo da Vinci

Belgium, 1543

Tracheostomy used for ventilation

Andreas Vesalius

UK, 1700

Constructed first air pump for physiological research

Robert Hooke

France, 1778

Discovered role of oxygen

Antoine Lavoisier

France, 1816

Invention of stethoscope

René Laennec

Scotland, 1832

Invention of negative pressure tank-type ventilator

John Dalziel

Germany, 1882

Tuberculosis bacterium discovered

Robert Koch

Germany, 1895

First chest X-ray

Wilhelm Rotgen

UK, 1928

First non-invasive ventilation


USA, 1963

First human lung transplant

James Hardy

UK, 1972

First computed tomography scan

Godfrey Hounsfield

The book contains several boxes, tables, and algorithms set out in a clear, and concise way. It also contains several good quality colour photographs, and radiological and histological images to support the information in the text.

There are multiple choice questions which can be used by the reader to check their understanding, with a clear explanation of the correct answer. There is also a list of references for suggested further reading.

Supplementary material includes videos demonstrating how to take a history and conduct a clinical examination ( Paramothayan/Essential_Respiratory_Medicine). There are also videos showing how to carry out common tests, such as peak flow, spirometry, the skin prick test, the Mantoux test, the shuttle test, and how to fit a patient for a sleep study.



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