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CLINICAL
RESPIRATORY
MEDICINE
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CLINICAL
RESPIRATORY
FOURTH EDITION
MEDICINE
Stephen G. Spiro, BSc, MD, FRCP
Professor of Respiratory Medicine, Honorary Consultant Physician, Department of
Cancer Medicine, University College London Hospitals, National Health Service
Foundation Trust; Honorary Consultant Physician, The Royal Brompton Hospital,
London, United Kingdom
Gerard A. Silvestri, MD, MS
Professor of Medicine, Medical University of South Carolina, Charleston, South Carolina
Alvar Agustí, MD, PhD, FRCPE
Professor, Senior Consultant and Director, Thorax Institute, Hospital Clinic, University
of Barcelona, Barcelona, Spain; Scientifc Director, CIBER Enfermedades Respiratorias,
Fundacio D’Investigacio Sanitaria Illes Balears, Mallorca, Spain
1600 John F. Kennedy Boulevard
Suite 1800
Philadelphia, PA 19103-2899
CLINICAL RESPIRATORY MEDICINE, FOURTH EDITION 978-1-4557-0792-8
Copyright © 2012 by Saunders, an imprint of Elsevier Inc.
Copyright © 2008, 2004, 1999 by Mosby, Inc., an affliate of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
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broaden our understanding, changes in research methods, professional practices, or medical
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DEDICATION
To my parents, Ludwig and Anna, who supported me in my earlier years and taught me the importance
of education and knowledge. To Alison, who always gave me the time to work and enjoy my career while
she cared for the family and engaged in her own profession.
STEPHEN SPIRO
For my father, who taught me to aspire to greatness in my career while never forgetting where I came from
and those who truly matter—my family. For my mother, who passed along a love of reading and the gift of
memory. For my children, Nate and Mia, who are already better people than I could ever have hoped.
Most of all, for my wife, Joanne, whose love and support are the glue that holds it all together.
GERARD SILVESTRI
To my wife Gemma, daughters Belén and Inés, and son Alvaro, the best family any man could think of.
ALVAR AGUSTÍ
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CONTRIBUTORS
Asia A. Ahmed, MBBS, MRCP, FRCR Lukas Brander, MD
Senior Specialist Registrar in Radiology, Department of Imaging, Department of Intensive Care Medicine, Inselspital, Bern
University College London Hospital National Health Service University Hospital, University of Bern, Bern, Switzerland
Foundation Trust, London, United Kingdom Invasive Mechanical Ventilation
Percutaneous Biopsy Procedures: Techniques and Indications
Jeremy S. Brown, MBBS, PhD, FRCP
Richard K. Albert, MD Reader, Centre for Respiratory Research, University College
Chief of Medicine, Denver Health; Professor of Medicine, London, London, United Kingdom
University of Colorado, Aurora, Colorado Pneumonia in the Non–HIV-Infected Immunocompromised
Chest Pain Patient
Mark S. Allen, MD Kevin K. Brown, MD
Professor of Surgery, Chair, Division of General Thoracic Professor and Vice Chairman, Department of Medicine, Division
Surgery, Mayo Clinic, Rochester, Minnesota of Pulmonary and Critical Care Medicine, National Jewish
Diagnostic Thoracic Surgical Procedures Health, University of Colorado, Aurora, Colorado
Idiopathic Pulmonary Fibrosis and Other Interstitial
Douglas Arenberg, MD Lung Diseases
Associate Professor, Division of Pulmonary and Critical
Care Medicine, University of Michigan Medical Center, Todd M. Bull, MD
Ann Arbor, Michigan Associate Professor, Pulmonary Sciences and Critical Care
Lung Cancer: Treatment Medicine; Director, Pulmonary Vascular Center, University of
Colorado, Aurora, Colorado
Phil Bearfeld, MB, ChB, FRCA, EDIC, FFICM Pulmonary Embolism
Consultant Intensivist, Royal Free Hospital, London,
United Kingdom Felip Burgos, MSc, RPFT, RN
Hemodynamic Monitoring in Critical Illness Servei de Pneumologia i Allèrgia Respiratòria, ICT,
Departament de Medicina, Institut D’Investigacions
Thomas Benfeld, MD, DMSc Biomèdiques August Pi i Sunyer, Hospital Clínic,
Associate Professor, Department of Infectious Diseases, Universitat de Barcelona, Barcelona, Spain
University of Copenhagen, Hvidovre University Hospital, Exercise Testing
Hvidovre, Denmark
Noninfectious Conditions in Patients with Human Peter M.A. Calverley, MB, ChB, FRCP, FRCPE
Immunodefciency Virus Infection Professor of Respiratory Medicine, Institute of Ageing and
Chronic Disease, University of Liverpool; Consultant Physician,
Ilya Berim, MD Clinical Sciences Centre, University Hospital Aintree, Liverpool,
Fellow, Pulmonary and Critical Care Medicine, School of United Kingdom
Medicine and Biomedical Sciences, University at Buffalo, Bronchodilators
The State University of New York, Buffalo, New York
Community-Acquired Pneumonia Philippe Camus, MD
Professor, Division of Pulmonary and Critical Care, Centre
Kathryn G. Bird, MD Hospitalier Universitaire de Dijon, Hôpital du Bocage,
Occupational Physician, Concentra, Golden, Colorado Université de Bourgogne, Dijon, France
Toxic Inhalational Lung Injury Drug-Induced and Iatrogenic Respiratory Diseases
Surinder S. Birring, MD, MRCP Paolo Carbonara, MD
Honorary Senior Lecturer Division of Asthma, Allergy and Physician, Division of Respiratory and Critical Care Medicine,
Lung Biology, King’s College London; Consultant Physician, Sant’Orsola-Malpighi Hospital, University of Bologna,
Department of Respiratory Medicine, King’s College Hospital, Bologna, Italy
London, United Kingdom Noninvasive Mechanical Ventilation
Cough
William Graham Carlos III, MD
Assistant Professor of Clinical Medicine, Indiana University
School of Medicine, Indianapolis, Indiana
Nonbacterial Infectious Pneumonia
vii
viii Contributors
Stephen D. Cassivi, MD, MSc, FRCSC Bruce H. Culver, MD
Associate Professor of Surgery, Division of General Thoracic Associate Professor of Medicine, Division of Pulmonary and
Surgery; Director of Lung Transplantation, Mayo Clinic, Critical Care Medicine, University of Washington School of
Rochester, Minnesota Medicine, Seattle, Washington
Chest Tube Insertion and Management Respiratory Mechanics
Diagnostic Thoracic Surgical Procedures Pulmonary Circulation
Pulmonary Function Testing
Rodrigo Cavallazzi, MD
Assistant Professor of Medicine, Assistant Director, Intensive Charles L. Daley, MD
Care Services, University of Louisville Health Sciences Center, Professor and Chief, Division of Mycobacterial and Respiratory
Louisville, Kentucky Infections, National Jewish Health; Professor, Division of
Pulmonary Complications of Hematopoietic Stem Pulmonary and Critical Care Medicine and Infectious Diseases,
Cell Transplantation University of Colorado, Aurora, Colorado
Tuberculosis and Nontuberculous Mycobacterial Infections
Bartolome R. Celli, MD
Professor of Medicine, Harvard Medical School, Brigham and Helen E. Davies, MD, MRCP
Women’s Hospital, Boston, Massachusetts Consultant in Respiratory Medicine, University Hospital of
Treatment of the Stable Patient with Chronic Obstructive Wales, Cardiff, United Kingdom
Pulmonary Disease Pleural Effusion, Empyema, and Pneumothorax
William Y.C. Chang, MBMCh, MA(Oxon) Chadrick E. Denlinger, MD
Research Fellow, Division of Therapeutics and Molecular Assistant Professor, Medical University of South Carolina,
Medicine, University of Nottingham, Nottingham, Charleston, South Carolina
United Kingdom Diagnostic Thoracic Surgical Procedures
Rare Diffuse Interstitial Lung Diseases
Christophe Deroose, MD, PhD
Chung-Wai Chow, MD, PhD Assistant Professor, Catholic University; Deputy Clinical Head,
Assistant Professor, Division of Respirology, Department of Positron Emission Tomography Centre, Department of Nuclear
Medicine, University of Toronto; Staff Respirologist, Division of Medicine, University Hospital Gasthuisberg, Leuven, Belgium
Respirology, Multiorgan Transplant Unit, University Health Positron Emission Tomography Imaging
Network, Toronto, Ontario, Canada
Pulmonary Host Defenses Claude Deschamps, MD
Professor of Surgery, Division of General Thoracic Surgery;
Andrew M. Churg, MD, FRCP(C) Chair, Department of Surgery, Mayo Clinic, Rochester,
Professor of Pathology, University of British Columbia; Minnesota
Pathologist, Vancouver General Hospital, Vancouver, Canada Chest Tube Insertion and Management
Macro and Micro Structure of the Lung
Christophe Dooms, MD, PhD
Jean-François Cordier, MD Assistant Professor of Internal Medicine, Catholic University;
Professor of Respiratory Medicine, Claude Bernard Lyon 1 Deputy Clinical Head, Pulmonology, University Hospital
University; Head of Department of Respiratory Medicine, Gasthuisberg, Leuven, Belgium
Reference Center for Rare Pulmonary Diseases, Louis Pradel Positron Emission Tomography Imaging
University Hospital, Lyon, France
Eosinophilic Lung Disease Gregory P. Downey, MD
Organizing Pneumonia Professor and Executive Vice President, Academic Affairs,
Division of Pulmonary and Critical Care Medicine,
Borja G. Cosio, MD, PhD, MCP Departments of Medicine and Pediatrics, National Jewish
Consultant, Department of Respiratory Medicine, Hospital Health; Professor, Department of Medicine, Integrated
Universitario Son Espases, Palma de Mallorca, Spain Department of Immunology, University of Colorado, Aurora,
Asthma: Epidemiology, Pathophysiology, and Risk Factors Colorado
Pulmonary Host Defenses
Vincent Cottin, MD, PhD
Professor of Respiratory Medicine, Claude Bernard Lyon 1 Miquel Ferrer, MD, PhD
University; Department of Respiratory Medicine, Reference Assistant Professor of Medicine, University of Barcelona; Senior
Center for Rare Pulmonary Diseases, Louis Pradel University Consultant, Respiratory Intensive Care Unit, Thorax Institute,
Hospital, Lyon, France Hospital Clinic, Barcelona, Spain
Eosinophilic Lung Disease Nosocomial Respiratory Infections
Organizing Pneumonia
