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John West’s classic texts Respiratory Physiology: The Essentials and Pulmonary Pathophysiology: The Essentials are read by almost all respiratory medicine specialists at some stage of their training. This new book is aimed at medical students. It condenses both into one volume and adopts a case based approach. Each chapter opens with a clinical vignette to introduce a physiological topic. While this might appear attractive in placing the physiology in a clinical context, abandoning the clear and logical route taken by the previous volumes does make the new book very hard work to read. In the first chapter we meet a competitive cyclist and, before the end of the first page, we are on to her exercise test results and discussing anaerobic thresholds. After the inevitable mountaineering trip in chapter 2, subsequent chapters start with the stories of patients with COPD, asthma, pulmonary fibrosis, pulmonary embolism, pulmonary oedema, pneumoconiosis, and ARDS. Some of the chapters work well; others feel as if several different sections of the previous books have been pasted together, between a case history to start and an extract from a textbook of clinical respiratory medicine to end. Nevertheless, this book contains a wealth of material and will repay careful study by those adopting a case based approach to medicine. For my money, I would start with Respiratory Physiology: The Essentials, even though it costs about the same as the new two-in-one integrated version.