Pulmonary function tests in clinical and occupational lung disease [antikvár]

FOREWORD Whenever a medical book is published, the proper questions are, does the medical profession need it, and what new information does it offer? Over the past four decades when pulmonary function testing has increasingly flourished (after a century's hiatus), usable guides have been slow to appear. Each pulmonary function laboratory had its own guidehnes and techniques. Only recently with the recommendations produced by the American Thoracic Society have the equipment and procedures become more standardized. Still remaining are the determination of the best tests and agreement on reference values for normal population groups. The latter is the more formidable task because of the variation among diflferent ethnic groups, equipment, procedures, and especially the variation from the average even among the so-called normal subjects. This book does not provide final answers to these questions. It does, however, make two major contributions. First, it offers insight into current methods and applications of the maturing discipline of pulmonary function testing. Second, the book has a unique epidemiologic perspective that is applicable both to general clinical medicine as well as to the burgeoning field of occupational lung disease. Thus, it will aid those interested in assessing the respiratory physiologic status of an individual as well as those concerned with evaluating and categorizing groups such as industrial employees. It is logical that the writers have addressed in detail how to distinguish between normal and abnormal pulmonary function test values. For this purpose, they have examined how these reference values were derived. Ideally, comparison of the person's serial test resuhs over time is preferable to comparison with a predicted mean test value. Too often, the predicted value is the only one available to the physician for comparison, so it is critical to have dependable prediction values. Longitudinal studies are urgently needed to evaluate currently available prediction standards based on cross-sectional investi- gations. The longitudinal studies will also aid in disability evaluation by determining impairment from prolonged occupational exposure to noxious agents separate from the aging process alone. To answer the opening question, this book then fills a need of physicians interested in learning how to best use the facilities now available in modern pulmonary function laboratories. Further, the book fulfills its promise to provide new information. The new role of the computer in aiding pulmonary function testing, the value of testing as an epidemiologic tool, and determination of physiologic impairment and occupational disability are several examples of valuable additions to our existing knowledge. A hope of many concerned with chronic pulmonary diseases is that pulmonary function testing will be more widely used in clinical medicine. By targeting those at risk, especially cigarette smokers and those exposed to environmental air pollution, early diagnosis of lung airway and parenchymal disease may be possible at a more treatable stage. In the interests of cost control, such testing can consist of spirometry with maximum expiratory flow curves. This book provides useful information for spirometry as well as more complex testing. The founder of pulmonary function testing, the Reverend John Hutchinson, designed an improved spirometer, established normal standards for the vital capacity, and tested several thousand English persons of assorted occupations. I believe this book would reserve his blessing albeit a question from him as to why it took 140 years for it to appear. lames F. Morris, M.D. Professor of Medicine Oregon Health Sciences University Chief, Pulmonary Disease Section Veterans Administration Hospital Portland, Oregon