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The Pediatric Lung.

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The Pediatric Lung. Wilmott RW. (Pp 331; S Fr 228.00). Switzerland: Birkhäuser Verlag, 1997. ISBN 3 7643 5703 7.

The field of paediatric respiratory medicine is changing rapidly and a textbook like this provides a useful update on advances in the field. The series deals with respiratory pharmacology and pharmacotherapy and the editor has chosen not to concentrate on the management of one chronic illness but to deal with many therapeutic interventions in acute and chronic respiratory illness in children. As one would expect, there is a strong emphasis on cystic fibrosis (mucoactive agents, aerosol therapies, gene therapy, and pharmacological strategies to tackle the basic defect in cystic fibrosis). Asthma management is extensively covered (aerosol delivery, corticosteroids, acute severe asthma, and a review of new therapies). The book will undoubtedly be useful to the respiratory paediatrician, but there are chapters which will appeal to the paediatric intensivist or neonatologist (management of viral pneumonia, surfactant, and nitric oxide).

The topics chosen for each chapter are generally appropriate, though one might question whether an entire chapter should be given over to nedocromil sodium. The coverage of “hot topics” in cystic fibrosis and asthma is particularly good. The format of this book leads to some repetition—for example, amiloride and DNase therapy are both dealt with more than once. Some of the sections dealing with basic science are over referenced and may be inaccessible to many clinicians.

The chapter format is the traditional “expert review”. Some reference is made to meta-analysis but there is little to guide the reader to the many important systematic reviews in the field (such as antenatal steroids and hyaline membrane disease). In most cases the authors’ evident enthusiasm for their subject is tempered by an awareness that assessment of many new therapies is incomplete. In the chapter on the use of nitric oxide we are told that “. . . not one controlled trial of inhaled NO therapy has yet shown an improvement in clinical outcome . . .”. Since this book was published, one such trial has been completed (N Engl J Med1997;336:597–604) and has shown a reduction in the percentage of infants requiring extracorporeal membrane oxygenation (ECMO) from 64% to 46%.

At 228 Swiss francs this book is not cheap, but it will cost you less than attending several international conferences to get the same information.

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