Nunn and Lumb’s Applied Respiratory Physiology 9th Edition

Book Preface

Over the past five decades Nunn’s Applied Respiratory Physi-ology has developed into a renowned textbook on respira-tion, providing both physiologists and clinicians with a unique fusion of underlying principles and their applica-tions. After writing four editions, Dr John Nunn retired in 1991, and a new author was required. As Dr Nunn’s final research fellow in the Clinical Research Centre in Harrow, AL was honoured to be chosen as his successor. AL has now also completed four editions and has chosen a suc-cessor to lead the project into the future whilst maintaining the fundamental ethos of the book. As practising clinicians with a fascination for physiology, the authors of the ninth edition have again focussed on combining a clear, logical and comprehensive account of basic respiratory physiology with a wide range of applications, both physiological and clinical. This approach acknowledges the popularity of the book amongst doctors from many medical specialities, but also provides greater insight into the applications of respiratory physiology to readers with a scientific back-ground. The clinical chapters of Part 3 are not intended to be comprehensive reviews of the pulmonary diseases considered, but rather to provide a detailed description of physiological changes, accompanied by a brief account of the clinical features and treatment of the disease.

In this edition, the number of references provided has been reduced by around a third in recognition of the ease with which online searches may now be performed. Refer-ences retained are either historical or seminal papers, or re-cent high-quality publications. Key references are identified by bold type in the reference list following each chapter. These highlighted references either provide outstanding re-cent reviews of their subject or describe research that has made a significant impact on the topic under consideration.
Advances in respiratory physiology since the last edition are too numerous to mention individually. Appreciation of the impact of air quality on the lungs continues to develop, and there is increasing awareness of the global health burden of pollution. Chapter 20 has been updated in recognition of this and the publication of new worldwide guidelines on pollution levels. The harmful effects of hyperoxia are be-coming more accepted in clinical practice, and the physio-logical mechanisms of these are described in Chapter 25. There is much recent literature on this topic, exemplified by the U-shaped curve of oxygen levels and mortality in critical care patients (see Fig. 25.6). The optimal strategy for artificial ventilation in healthy lungs, for example, during anaesthesia, remains disputed; the section in Chapter 21 has been updated to reflect the physiological effects of these strategies, for example, the recent focus on driving pressure as the potentially damaging component. The role of intra-operative ventilation strategy in the prevention of postop-erative pulmonary complications is becoming more clear.

In keeping with its increasing worldwide prevalence, the effects of severe obesity on the respiratory system are now brought together into a new chapter for this edition. Chapter 15 covers the predictable aspects of obesity on res-piration, such as the effect of the mass of the chest wall and abdomen on lung mechanics and lung volumes. Less pre-dictable topics include the effects of obesity hormones on respiratory control. The chapter also covers the impact of childhood obesity on lung development, which may lead to lung dysanapsis in which airway and gas exchange tissues grow disproportionately.
For this edition the book is printed with a larger page format to improve the clarity of the figures and tables, and remains available in both print and electronic format. This allows readers wishing to dip into the book access to chapter summaries or individual chapters. For those who own a print copy, online access is automatically available. This content includes additional chapters and self-assessment material, useful for students approaching exams and, new for this edition, a series of 24 mini-lectures by AL to en-hance the information provided in print.

We wish to thank the many people who have helped with the preparation of the book at Elsevier and our colleagues who have assisted our acquisition of knowledge in subjects not so close to our own areas of expertise. We are indebted to Professor Peter Slinger for his kind words in the Foreword and would like to thank Drs B. Oliver, J. Black, K. McKay and P. Johnson for permission to use the images in Figure 28.3. Last, but by no means least, we thank our families for their continuing encouragement and for tolerating preoc-cupied and reclusive parents/spouses for so long. AL’s daughter Jenny, when aged 5, often enquired about his ac-tivities in the study, until one evening she nicely summa-rized the years of work by confidently stating that ‘if you don’t breathe, you die’. So what were the other 423 pages about?

Andrew Lumb and Caroline Thomas Leeds 2019