Clinical Management of Chronic Obstructive Pulmonary Disease.

Similowski T, Whitelaw WA, Derenne JP, eds. New York, NY 10016-0602, Marcel Dekker Inc, 2002, hardcover, 1116 pp, illus, ISBN: 0-8247-0610-2, $250.

The purpose of this book is to present a comprehensive review of the most recent strategies used to examine, and manage patients in each phase of chronic obstructive pulmonary disease (COPD). This "how-to" manual for taking care of patients with COPD does not address prevention of COPD in detail; rather, it takes the approach of improving quality of life and modifying the disease course through techniques to aid rehabilitation, to treat psychosocial issues, and to provide pharmacological management.

The first 11 chapters cover the components of examination and diagnosis for the patient with COPD and are aimed at the primary care provider. Individual chapters are devoted to clinical examination, arterial blood gas analysis, and basic spirometry and imaging interpretations. Additional information is given on the role of genetics in contributing to the risk for COPD and its potential for future therapeutic interventions. The next 9 chapters discuss the pharmacological management of stable COPD and the prevention of infections. The subject of several subsequent chapters shifts from treatment of COPD as a single entity to the treatment of COPD when other diseases or problems are present. These multisystem involvements include lung cancer, cardiac dysfunction, anxiety and depression, sleep-related respiratory disorders, and general surgery.

The management of COPD also includes enhancing respiratory muscle function and breathing patterns, addressing nutrition issues, prescribing exercise, and promoting airway clearance. Several chapters focus on these aspects of care with discussions of the role of physical therapy (when appropriate) and the effectiveness of these approaches. Other treatment methods--such as long-term oxygen therapy, noninvasive ventilatory support, and chronic mechanical ventilation in the home--are the topic of chapters related to therapeutic interventions. Finally, chapters on lung volume reduction and lung transplantation cover the surgical approach to management. The book concludes with discussions of the future of COPD management, especially concerning pharmacology, and the World Health Organization's view of the problem from a global perspective. The discussion of how "non-Western" countries, with their limited resources, respond to the problem gives the reader a different viewpoint.

This text includes a long list of contributors from all over the world. Although the explanations are brief, each chapter includes an extensive and current bibliography. Tables and illustrations are infrequent, but they assist the reader by emphasizing and summarizing important information. The presentation of material follows a logical progression; however, with so many different authors, there is much overlap and reiteration of information.

In the beginning of the book, the editors stated that this reference would not address smoking cessation or other preventive measures; therefore, it makes one wonder if a full picture of the clinical management of COPD has been presented.

The primary audience for this book is physicians, and the reader might expect to find this text in a medical library. I would not recommend this book as a textbook for physical therapist students, but I would recommend this book as a reference for clinicians who work extensively with patients with COPD or for academicians who are looking for a broad overview of medical management of COPD. The editors did have a physical therapist write the airway clearance chapter, but not the chapter on exercise.

The strength of this reference is in its evidence-based practice approach. There is even a chapter to help the reader understand how to critically analyze experimental methodology. Because each topic is extensively cited and scrutinized, which allows readers to use their professional judgment in their approach to patient management, this book may represent a model for future physical therapy reference materials.

Nancy B Schuster, PT
Community Health Services
Portland, Me

Ms Schuster is currently a Rehabilitation Supervisor at a home care agency. Her clinical interest is in the area of cardiopulmonary physical therapy.