Contents
SECTION 1: HISTORY AND DEVELOPMENT
SK Jindal
1. History of Respiratory Medicine 3
FE Udwadia
Introduction 3; The Discovery of Chemotherapy and Antibiotics 6
2. Anatomy and Architecture: A Clinical Perspective 9
SK Jindal
Lung Anatomy and Morphology 9; Architecture of Lung Parenchyma 12; Blood Supply of
Lungs 13; Lymphatic Drainage 14; Nerve Supply 15
3. Lung Development 18
Meenu Singh, Nidhi Anil, Amit Agarwal
Introduction 18
4. Genomics of Lung Diseases 24
L Keith Scott
Introduction 24; Genomics and Disease 24; Genomic Nomenclature and Investigational
Tools 25
SECTION 2: RESPIRATORY PHYSIOLOGY
SK Chhabra
5. Applied Respiratory Physics 35
SK Jindal, VK Jindal
Introduction 35; State of Matter 35; Physical Properties of Gases 36; The Gas Laws 38;
Gas Solution and Tension 39; Vapors 39; Expression of Gas Volumes and Pressures 40;
Flow of Gases 40
6. Respiratory Function and Mechanics 43
D Gupta, R Agarwal, Ashutosh N Aggarwal
Introduction 43; Ventilation 44; Pulmonary Circulation 48; Diffusion 50; Ventilation-perfusion
(V./Q. ) Relationships 51; Control of Ventilation 52
7. Gas and Fluid Exchange in the Lung 54
Marc Zelter
Gas Exchange 54; Dead Space and Alveolar Gas 56; Transfer of Gas across the Alveolar Capillary
Membrane 57; Gas Transport to and from the Periphery 58; Ventilation Perfusion Ratio 60;
Fluid, Solutes and Protein Exchange in the Lung 64; Clinical Implications 71; Measurement of
Extravascular Lung Water 72
8. Tissue Oxygenation 74
Puneet Malhotra, SK Jindal
Introduction 74; Oxygen Delivery (DO2) 74; Oxygen Consumption (VO2) 76; Assessment of
Tissue Oxygenation 78; Recent Developments 79
9. Respiratory Physiology in Specific Physiological States 81
Sunil K Chhabra, Mansi Gupta
Introduction 81; Exercise 81; Pregnancy 84; High Altitude 86; Deep Diving 88
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10. Mechanisms of Dyspnea in Respiratory Diseases 93
Sunil K Chhabra, Ashima Anand
Introduction 93; Definitions 93; Perception: The Subjective Element in Dyspnea 94; Neural
Pathways of Dyspnea 94; Pathophysiological Mechanisms of Dyspnea 97
11. Surfactant 107
Gyanendra Agrawal, SK Jindal
Introduction 107; Composition of Lung Surfactant 107; Functions of Lung Surfactant 109;
Surfactant Metabolism and Surfactant Film Formation 110; Disorders of Surfactant
Metabolism 112; Conclusion 115
12. Respiratory Defenses and Immunology 118
Padmavathi Ramaswamy, Padma Srikanth, Vijayalakshmi Thanasekaraan
Introduction 118; Particle Deposition in the Respiratory Tract 119; The Defense Mechanisms of
Conducting Zone of the Airways 119; The Defense Mechanisms of Respiratory Zone of the
Airways 124; Surfactant and Surfactant Protein A (Sp-A) 125; Respiratory Immune Mechanisms
126; Alveolar Macrophages 127; Impact of Bacteria and Viruses on Lung Immunology 130;
HLA and Mycobacterial Diseases 131
SECTION 3: PHARMACOLOGICAL AGENTS
Nusrat Shafiq, Samir Malhotra
13. Antibacterial Drugs 135
Nusrat Shafiq, Samir Malhotra
Introduction 135; Beta-lactams 135
14. Antiviral Drugs 155
Nusrat Shafiq, Samir Malhotra
Introduction 155; Mechanism of Action of Antiviral Drugs 156
15. Antifungal Drugs 159
J Whig, Bharti Mahajan, Rajesh Mahajan
Introduction 159; Specific Issues 166; Clinical Implications of the Antifungal Drugs 166
16. Anti-inflammatory Agents for Asthma 171
Nusrat Shafiq, Samir Malhotra
Introduction 171; Corticosteroids 171; Dissociated Steroids 173; Mast Cell Stabilizers 176;
Miscellaneous Drugs 177
17. Immunosuppressant Drugs 180
Nusrat Shafiq, Samir Malhotra
Introduction 180; Glucocorticoids 180; Calcineurin Inhibitors 181; Antiproliferative/
Antimetabolic Drugs 182; Immunosuppressive Cytotoxic Drugs 183; Miscellaneous
Immunosuppressants 184
SECTION 4: SYMPTOM-APPROACH TO RESPIRATORY DISEASE
Richard S Irwin
18. Cough in the Adult 189
Scott E Kopec, Deirdre L Kathman, Richard S Irwin
Introduction 189; Epidemiology 189; Physiology 189; Pathophysiology 190; Benefits of
Cough 190; Complications of Cough 190; Causes of Cough 191
19. Hemoptysis 204
Andrés F Sosa, J Mark Madison, Paulo J Oliveira
Introduction 204; Anatomy 205; Etiology and Pathogenesis 205; Treatment 213
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20. Dyspnea 222
J Mark Madison, Richard S Irwin
Introduction 222; Physiology 222; Positional and Nocturnal Dyspnea 224; Evaluating Acute
Dyspnea 224; Evaluating Chronic Dyspnea 225; Treatment 226
21. Wheeze and Respiratory Disease 229
J Mark Madison, Richard S Irwin
Introduction 229; Physiology of Wheeze 229; History and Physical Examination 229; Pulmonary
Function Testing 230; Differential Diagnosis for Wheezing 232; Approach to the Diagnosis of
Wheeze 235; Treatment 235
SECTION 5: RESPIRATORY DIAGNOSIS
SK Jindal
22. History and Physical Examination 241
PR Gupta
Introduction 241; History Taking 241; History of Previous Diagnosis and Treatment 244,
The Physical Examination 244
23. Microbiological Approach to Respiratory Infections 251
Pallab Ray
Upper Respiratory Tract Infections 251; Lower Respiratory Tract Infections 255
24. Systematic Approach to Interpretation of Plain Chest Radiographs 264
D Behera
Introduction 264; Radiology and Imaging 264
25. Pulmonary Imaging: Systematic Approach to Interpretation of Computed Tomography
of the Chest 296
Rubal Patel, Rakesh Shah, Sabiha Raoof, Suhail Raoof
Introduction 296; Technical Aspects 296; Normal Components of the Pulmonary
Parenchyma 297; Normal Lung Components of the Airways 305; Normal Lung Component of
the Pulmonary Vasculature 309; Tracheobronchial Diseases 311; Parenchymal Diseases 314;
Mediastinal Diseases 324; Miscellaneous 326
26A. Pulmonary Function Testing 331
Ashutosh N Aggarwal
Introduction 331; Spirometry 331; Peak Expiratory Flow 336; Static Lung Volumes 336; Diffusing
Capacity of Lungs 338; Exercise Testing 340; Other Tests 342
26B. Respiratory Muscle Function 346
Randeep Guleria
Introduction 346; Respiratory Muscles—Basic Physiology 347; Evaluation of Respiratory Muscle
Function 348
27. Respiratory Disability and Preoperative Evaluation 358
Gyanendra Agrawal, D Gupta
Introduction 358; Evaluation of Respiratory Disability 358; Clinical Methods of Evaluating
Impairment 358; Disease-specific Impairment Assessment 360; Disability Evaluation 361;
Preoperative Evaluation of Respiratory System 361; Postoperative Pulmonary Complications
363; Preoperative Evaluation 365; Recommended Approach 368; Optimizing the Chance
of a Successful Outcome 369
28. Arterial Blood Gases and Acid Base Balance 373
Vinaya S Karkhanis, Jyotsna M Joshi
Introduction 373; Physiology of Gas Exchange 373; Physiology of Acid Base Balance 374;
Arterial Blood Gas Analysis 378; Arterial Blood Gas Interpretation 380; Interpretation of Arterial
Blood Gas 384; Pitfalls in Arterial Blood Gas Interpretation 385; Examples 385
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29. Nuclear Imaging in Pulmonary Medicine 387
BR Mittal, Sunil HV
Introduction 387; Pulmonary Anatomy and Physiology 387; Investigations 387
30. Role of Cytology in Lung Lesions 399
Arvind Rajwanshi, Nalini Gupta
Cytological Techniques in Respiratory Cytology 399; Aspirations 402; Imprint Cytology 403;
Endoscopic Ultrasonography Guided FNA and Endobronchial Ultrasound FNA 403;
Inflammatory Diseases of the Lung 403; Neoplastic Lesions of the Lung 407
31. Bronchoscopy 418
R Narasimhan, AR Gayathri
Introduction 418; Types of Bronchoscopy 418; Patient Preparation and Anesthesia 419;
Diagnostic Bronchoscopy—Accessories 419; Indications for Diagnostic Bronchoscopy 420;
Diagnostic Procedures 424; Therapeutic Bronchoscopy 425; Electronavigation Bronchoscopy
426; Safety Factors in Bronchoscopy 426; Complications of Bronchoscopy 427
32. Interventional Bronchoscopy 429
Praveen N Mathur, FD Sheski
Definition of Interventional Pulmonology 429; Advanced Imaging Bronchoscopy 430; Advanced
Biopsy Techniques 431; Endoscopic Palliative Care 435; Nd:YAG Laser 435
33. Thoracoscopy 453
C Ravindran, Jyothi E
Introduction 453; Medical Thoracoscopy 453; Surgical Thoracoscopy 459
SECTION 6: RESPIRATORY DISEASE IN THE DEVELOPING WORLD
SK Jindal
34. The Burden and Clinical Spectrum of Respiratory Diseases 463
SK Jindal
Introduction 463; Respiratory Disease Burden 463; Clinical Spectrum of Respiratory Diseases
in India 464; Tuberculosis 464; Non-tuberculous Respiratory Diseases 464; Future Scene of
Pulmonary Medicine in India 469
35. Practical Approach to Lung Health 474
Salah-Eddine Ottmani
Introduction 474; Demand of Care for and Management of Respiratory Patients 474; Objectives
of the PAL Strategy 475; Components of the PAL Strategy 475; Adaptation of the PAL
Strategy 477; Steps to Introduce the PAL Strategy in Countries 478; Results from Country
Experiences 481
SECTION 7: TUBERCULOSIS
SK Jindal
36. Epidemiology of Pulmonary Tuberculosis 489
VK Chadha
Introduction 489; National Dynamics of Tuberculosis 489; The Epidemic Curve of TB 492;
Methods to Measure Epidemiology of TB and its Trends 493; India: A Case Study for
Measuring 500; Epidemiological Situation and Trends 500; Global Trends of Tuberculosis 506
37. Risk Factors for Tuberculosis 511
Parvaiz A Koul, Nargis K Bali
Introduction 511; Risk Factors of Developing Tuberculosis 511
38. Mycobacteria: An Overview 525
Romica Latawa, Indu Verma
Introduction 525
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39. Immunology and Pathogenesis 528
Krishna K Singh, Indu Verma
Introduction 528; Mycobacterium Tuberculosis Infection and Overview of Immunopathogenesis
528; Immune Responses to Tuberculosis 530
40. Pulmonary Tuberculosis: Clinical Features and Diagnosis 539
S Kashyap, Malay Sarkar
Introduction 539; Post Primary Pulmonary Tuberculosis 539; Symptoms and Signs 539;
Tuberculosis in the Elderly 541; Miliary TB 541; HIV and TB 542; Pleural Effusion 542;
Paradoxical Response 542; Physical Examinations 542; Diagnosis of Tuberculosis 543;
Extrapulmonary Tuberculosis (EPTB) 549
41. Molecular Diagnosis of Tuberculosis 554
Mamta Kalra, Indu Verma, Suman Laal
Introduction 554; Diagnosis of TB in Low-income Countries 554; Diagnosis of TB in Highincome
Countries 555; TB Diagnosis in HIV+ Individuals 556; Diagnosis of TB: Beyond
Microscopy 556
42. Management of Tuberculosis 568
D Behera
Chemotherapy of Tuberculosis 568; Rationale for Recommended Treatment 573;
Regimens 573; Supervision of Chemotherapy 575
43. Antitubercular Drugs 578
SK Katiyar, S Katiyar
Introduction 578; Isoniazid 579; Rifampicin 581; Streptomycin 583; Pyrazinamide 584;
Ethambutol 585; Quinolones 586; Para-aminosalicylic Acid (PAS) 586; Ethionamide/
Prothionamide 587; Cycloserine/Terizidone 587; Capreomycin 588; Thiacetazone 588; Group
5 Drugs 588; Clofazimine 589; Linezolid 589; Amoxicillin/Clavulanate 589; Imipenem/
Cilastatin 589; Clarithromycin 589; High-dose Isoniazid 589
44. Historical and Non-pharmacological Management of Pulmonary Tuberculosis 594
KB Gupta
Introduction 594; History 594; Ancient Drugs in the Treatment of Tuberculosis 595; Sanatorium
Treatment 596; Surgery 598; Immunotherapy 599; Tuberculosis and Nutrition 600; Rehabilitation
in Tuberculosis 602
45. Prevention of Tuberculosis 608
Rajesh N Solanki, Ghanshyam B Borisagar, Jitendra A Sisodia
Introduction 608; Primordial Prevention 608; Primary Prevention 608; Secondary
Prevention 612; Tertiary Prevention 615
46. BCG Vaccine 616
PT James
Introduction 616; Complications of BCG Vaccination 619
47. Extrapulmonary Tuberculosis 622
Ashok K Janmeja, Prasanta R Mohapatra
Introduction 622; Diagnosis 622; Lymph Node Tuberculosis 623; Pleural Effusion 625,
Bone and Joint Tuberculosis 626; Central Nervous System Tuberculosis 628; Abdominal
Tuberculosis 629; Genitourinary Tuberculosis 632; Skin Tuberculosis 633; Disseminated Miliary
Tuberculosis 634; Pericardial Tuberculosis 636; Hepatic Tuberculosis 637
48. Multidrug-resistant Tuberculosis 641
Surendra K Sharma, Ninoo George
Introduction 641; Epidemiology 641; Definition 642; Causes of Drug Resistance 642; Diagnosis of
Drug-resistant TB 643; Management 644; Role of Immunotherapy 647; Resective Thoracic Surgery
648, Nutritional Support 648; Special Situations 648; Prevention of Nosocomial
Transmission of MDR-TB 649; Financial Burden of MDR-TB 650; Cure Rates in MDR-TB and
XDR-TB 651
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49. Revised National Tuberculosis Control Programme in India—DOTS and DOTS Plus 656
D Behera
Introduction 656; Revised National Tuberculosis Control Programme 657; Diagnosis
of Pulmonary Tuberculosis 662; Ziehl-Neelsen Staining Procedure 663; Treatment 668;
Management of Pediatric Tuberculosis Under RNTCP 674; Management of Extrapulmonary
Tuberculosis 676; Management of Patients with HIV Infection and Tuberculosis 677;
Recording and Reporting 680; Supervision, Monitoring and Evaluation 683; Training 686; Special
Initiatives 686; Multidrug-resistant Tuberculosis and DOTS Plus 691; Infection Control and
Hospital Waste Management 692; Information, Education and Communication 693
50. Treatment of Tuberculosis in Special Situations 695
Rajendra Prasad
Introduction 695; Pharmacokinetics of Antitubercular Drugs 695; Treatment of Tuberculosis in
Pregnancy and Lactation 696; Treatment of Tuberculosis in 696; Renal Insufficiency 696;
Treatment of Tuberculosis in Liver Disease 698
51. Tuberculosis and Human Immunodeficiency Virus Infection 701
SK Jindal
Introduction 701; Epidemiology 701; Pathogenesis 702; Clinical Effects of HIV on Tuberculosis
702; Diagnosis 704; Management 704
52. Nontuberculous Mycobacterial Infections 710
PS Shankar, SK Jindal
Introduction 710
SECTION 8: RESPIRATORY INFECTIONS
SK Jindal
53. Community-acquired Pneumonia 719
Charles Feldman, Ronald Anderson
Introduction 719; Epidemiology 719; Microbial Etiology of Community-Acquired
Pneumonia 720; Risk Factors for Community-acquired 721; Pneumonia 721; Pathogenesis of
Cap with Particular 722; Reference to the Pneumococcus 722; Diagnostic Testing 723;
Prognosis 724; Treatment of Community-acquired 726; Pneumonia 726; Prevention of
Infection—Vaccination 727
54. Pulmonary Fungal Infections 734
Arunaloke Chakrabarti
Introduction 734; Epidemiology 734; Agents Responsible 735
55. Pulmonary Mycetoma 747
Alladi Mohan, B Vijayalakshmi Devi, Abha Chandra
Introduction 747; Pathogenesis 747; Pathology 747; Clinical Presentation 748; Diagnosis 749;
Treatment 753; Prognostic Factors 754; Overall Mortality 754
56. Nosocomial Pneumonia 757
Vishwanath Gella, SK Jindal
Introduction 757; Pathogenesis 757; Diagnosis 757; Risk Stratification of Patients with
VAP 759; Treatment 760; Prevention of HAP and VAP 762
57. Viral Pneumonias 765
Arjun Srinivasan, Ritesh Agarwal
Introduction 765; Respiratory Viruses 765; Presenting Features 766; Risk Factors and Features
of Severe Disease 771; Respiratory Protection for Health 772; Care Professionals 772
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58. Pulmonary Manifestations of Human Immunodeficiency Virus (HIV) Infection 776
Zarir F Udwadia
Introduction 776; Pneumocystis Jiroveci Pneumonia (PJP) 777; Community-acquired Pneumonias
(CAPs) 778
59. Lung Abscess 780
C Ravindran, Jyothi E
Definition 780; Epidemiology 780; Classification 780; Etiology 781; Pathogenesis 781; Pathology
782; Clinical Features 783; Complications 785; Treatment 786; Prognosis 787
60. Bronchiectasis and Cystic Fibrosis 790
David Honeybourne
Bronchiectasis 790; Cystic Fibrosis 795
61. Rare Respiratory Infections 801
Mohankumar Thekkinkattil, S Arulmozhi
Introduction 801; Viral Infections 801; Bacterial Infections 801; Rare Forms of Tuberculous
Infections 802; Chlamydial Infections 802; Parasitic Infection 803; Zoonotic Bacterial
Pneumonias 804
62. Parasitic Lung Diseases 806
VK Vijayan
Introduction 806
63. Anaerobic Bacterial Infections of the Lungs and the Pleura 820
Ashok Shah, Chandramani Panjabi
Introduction 820; Historical Note 820; Pathophysiology 821; Natural History and Clinical
Classification 822; Anaerobes and Upper Respiratory Syndromes 823; Incidence 823;
Microbiology 824; Clinical Features 824; Laboratory Diagnosis 825; Radiological Manifestations
827; Treatment 827; Prognosis 828
SECTION 9: ASTHMA
SK Jindal
64. Bronchial Asthma—Epidemiology 835
SK Jindal
Introduction 835; Definition 835; Epidemiology 835; Economic Burden 835; Epidemiological
Differences 836; Factors Influencing Prevalence of Asthma 836
65. Allergic Rhinitis, Asthma and Comorbidities 840
Ruby Pawankar, Satoko Kimura, Sachiko Mori, Yukiko Yokoyama
Introduction 840
66. Asthma Diagnosis 847
Liesel D’silva, Parameswaran Nair
Introduction 847; Clinical Diagnosis 847; Tests for Diagnosis and Monitoring 847; Diagnostic
Challenges 855
67. Airway Inflammation and Remodeling 866
Ruby Pawankar, Shu Hashimoto, Bassam Mahboub, Chika Ozu
Introduction 866; Chronic Inflammation in AR and Asthma 867; Remodeling in Asthma 870
68. Control and Management of Stable Asthma 876
Sidney S Braman, David Lee
Introduction 876; The Goals of Asthma Treatment 876; Essential Components of Asthma
Care 877; Treatment Protocols for Asthma 885; Asthma Control in Developing Countries 887
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69. Management of Severe Asthma 893
Liesel D’silva, Parameswaran Nair
Introduction 893; Development of Severe Asthma 893; Phenotypes in Severe Asthma 894;
Managing Severe Asthma using Airway Inflammatory 902; Monitoring a Patient with Difficult
Asthma 903
70. Immunotherapy and Immunomodulators for Allergic Rhinitis and Asthma 909
Ruby Pawankar, Giovanni Passalacqua
Introduction 909; Subcutaneous Immunotherapy (SCIT) 909; The Sublingual Route 911;
Future Developments of SIT 913
71. Allergen Desensitization 918
Vikram Jaggi
Introduction 918; Definition 918; Historical Background 918; Mechanisms of Allergen
Immunotherapy 919; Future Directions 923
72. Bronchodilators 926
Samir Malhotra, Nusrat Shafiq
Introduction 926; Beta-2 Adrenergic Agonists 926; Methylxanthines (Xanthines) 930;
Anticholinergic Agents 931
73. Patient Education in Asthma 934
Bharat Bhushan Sharma, Virendra Singh
Introduction 934; Goals of Asthma Education Programs 934; Benefits of Asthma Education
Programs 935; Methods and Settings 935; Asthma Education Program Components 936; Patient
Education: Problems 936
74. Childhood Asthma 939
Meenu Singh
Epidemiology 939; Definition 940; Pathophysiology 940; Diagnosis 941
75. Allergic Bronchopulmonary Aspergillosis 947
Ritesh Agarwal
Introduction 947; Epidemiology of ABPA 948; Pathogenesis of Abpa 949; Pathology of
ABPA 949
SECTION 10: CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Sundeep Salvi
76. Chronic Obstructive Pulmonary Disease: The Neglected Epidemic 971
Sundeep Salvi
Mortality Due to Chronic Obstructive 971; Pulmonary Disease 971; Morbidity Due to
COPD 971; The Economic Burden of COPD 971; Risk Factors for COPD 971, Primary and
Secondary Prevention of COPD 973
77. Health and Economic Burden of Chronic Obstructive Pulmonary Disease 975
Monica Barne, Sundeep Salvi
Introduction 975; Mortality Due to COPD 975; Prevalence of COPD 979; Disability-adjusted
Life Years Due to COPD 983; Economic Burden of COPD 984
78. Risk Factors for Chronic Obstructive Pulmonary Disease 987
Sneha Limaye, Sundeep Salvi
Introduction 987; Tobacco Smoking 987; Indoor Air Pollution as a Risk Factor for COPD 988;
Outdoor Air Pollution and COPD 989; COPD Associated with Occupational Exposures 989;
Copd Associated with Pulmonary Tuberculosis 989; Chronic Asthma as a Risk Factor for
COPD 990; Genetic Factors 991; Socioeconomic Status 991
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79. Pathophysiology of Chronic Obstructive Pulmonary Disease 993
Bill Brashier, Sundeep Salvi
Introduction 993
80. Pulmonary Function Testing in Chronic Obstructive Pulmonary Disease 1015
Tavpritesh Sethi, Anurag Agrawal
History and Evolution 1015; The Clinical Need for Pulmonary Function Tests 1016; Physiological
Principles 1016; Clinical Applications 1019; Measuring Small Airway Disease: Impulse
Oscillometry 1022; Other Tests 1023; The Future 1025
81. Systemic Manifestations and Comorbidities 1027
SK Jindal, PS Shankar
Introduction 1027; Pathogenesis 1027; Systemic Manifestations 1028; Therapeutic
Considerations 1030
82. Role of Infections in Chronic Obstructive Pulmonary Disease 1033
Suruchi Mandrekar, Sundeep Salvi
Introduction 1033; Do Bacteria Cause/Initiate COPD? 1033
83. Treatment of Chronic Obstructive Pulmonary Disease 1041
Peter J Barnes
Introduction 1041; Risk Factors and their Prevention 1041; Other Drug Therapies 1049;
Non-pharmacological Treatments 1050; Managing Chronic Disease 1051; Treatment of Acute
Exacerbations 1051; Treatment of Cor Pulmonale 1052; Future Therapies 1052
84. Acute Exacerbations of Chronic Obstructive Pulmonary Disease 1056
Raja Dhar, AG Ghoshal
Introduction 1056; COPD Exacerbation 1056; Assisted Ventilation 1061
85. Long-term Oxygen Therapy 1065
R Agarwal, SK Jindal
Selection of Patients 1065; Benefits 1066; Perspectives of Domiciliary Oxygen Use in India 1071
86. Patient Education in Chronic Obstructive Pulmonary Disease 1073
Tushar Sahasrabudhe
Introduction 1073; Education about the Disease 1073; Education to Help Reduce COPD 1075;
Exacerbations 1075; Education for Improving Baseline Lung 1075; Function 1075; Pulmonary
Rehabilitation 1076; Education and Discussion on Daily Life 1077; Issues 1077; Discussion on
Special Issues 1077; Prevention of COPD 1078; Early Detection of COPD 1078
87. End-of-life Communication and Palliative Care in Advanced COPD 1080
Sujeet Rajan
Introduction 1080; Advanced Terminal COPD 1080; Prognosis of Advanced COPD 1080; Good
Death in COPD: Implications 1081; Principles of End-of-life Communication in COPD 1082
88. Smoking/Tobacco Control 1085
Virendra Singh, Bharat Bhushan Sharma
Introduction 1085; Tobacco Smoking 1085; Smoking Control Interventions 1089
89. Pulmonary Rehabilitation 1097
Rachael A Evans, Roger S Goldstein
Symptoms and Disability Associated with Chronic Obstructive Pulmonary Disease 1097;
The Role and Definition of Pulmonary 1098; Rehabilitation 1098; Future Work 1106
90. Upper and Central Airway Obstruction 1109
VR Pattabhi Raman
Introduction 1109; Acute UAO 1112; Chronic UAO 1113; Therapeutic Considerations 1120
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91. Bronchiolar and Bullous Lung Diseases 1123
Gyanendra Agrawal, Dheeraj Gupta
Introduction 1123; Bronchiolitis 1123; Bullous Disease of the Lung 1132
92. Immunomodulators in Respiratory Diseases 1138
Agam Vora
Introduction 1138
SECTION 11: INTERSTITIAL LUNG DISEASE
Dheeraj Gupta
93. Approach to Diagnosis of Interstitial Lung Disease 1145
Dheeraj Gupta
Introduction 1145; Etiology and Classification 1145; Epidemiology 1147; Pathology 1147;
Pathogenesis 1148; Diagnostic Approach 1149; Management 1151; Acute Exacerbation of
ILD 1155; Prognosis 1155
94. Pathology of Interstitial Lung Disease 1160
Amanjit Bal, Kusum Joshi
Idiopathic Interstitial Pneumonia 1160; Idiopathic Bronchiolocentric Interstitial Pneumonia
(BRIP)/Airway Centered Interstitial Fibrosis 1167; Drug Induced Interstitial 1168; Lung Disease
(DIILD) 1168; Connective Tissue Disorder Associated Interstitial Lung Disease 1169;
Hypersensitivity Pneumonitis (HP) 1170; Lymphangioleiomyomatosis (LAM) 1170; Pulmonary
Langerhans Cell Histiocytosis (LCH) 1171
95. Idiopathic Interstitial Pneumonias 1174
H Shigemitsu, Ngozi Orjioke
Introduction 1174; Epidemiology 1174; Classification 1174; Clinical Features 1174; Histological
Features 1176; Treatment 1177; Idiopathic Pulmonary Fibrosis (IPF) 1177; Nonspecific Interstitial
Pneumonias (NSIP) 1180; Desquamative Interstitial Pneumonia (DIP) 1181; Respiratory
Bronchiolitis-associated Interstitial Lung Disease (RB-ILD) 1182; Cryptogenic Organizing
Pneumonia (COP) 1182; Acute Interstitial Pneumonia (AIP) 1184; Lymphoid Interstitial
Pneumonia (LIP) 1185
96. Sarcoidosis 1188
Dheeraj Gupta, Om P Sharma
Introduction 1188; History and Epidemiology 1188; Risk Factors 1189; Pathogenesis and
Immunology 1191; Pathology 1192; Clinical Features 1192; Diagnosis 1199; The Tuberculosis
Enigma 1201; Treatment 1202; Prognosis and Mortality 1207; Future Directions 1208
97. Pulmonary Eosinophilic Disorders 1217
Subhash Varma, Aditya Jindal
Introduction 1217; Pulmonary Eosinophilic Disorders 1218; Approach to Diagnosis and
Conclusion 1225
98. Infiltrative and Deposition Diseases 1229
Pralay Sarkar, Arunabh Talwar
Introduction 1229; Pulmonary Amyloidosis 1229; Lysosomal Storage Disorders 1236
SECTION 12: DISORDERS DUE TO ENVIRONMENTAL AND CLIMATE FACTORS
SK Jindal
99. Outdoor Air Pollution and Respiratory Health 1255
Sara Maio, Sandra Baldacci, Marzia Simoni, Fabio Cibella, Giovanni Viegi
Introduction 1255; Outdoor Air Pollution Effects 1255
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100. Indoor Air Pollution and Respiratory Health 1266
Marzia Simoni, Sara Maio, Sandra Baldacci, Fabio Cibella, Giovanni Viegi
Introduction 1266; Prevention and Conclusion 1272
101. Environmental Risk Factors for Respiratory Disease 1275
Kalpana Balakrishnan
Introduction 1275; Environmental Risk Factors 1275
102. Climate Change and Lung Disease—With Special Focus on Developing Countries 1288
Kin Bong Hubert Lam, Jon G Ayres
Climate Change: An Introduction 1288; Future Projections of Climate Change 1289; Impact of
Climate Change on Health 1289; Climate Change and Lung Disease 1289; Synergy between
Air Pollution and Temperature 1292
103. High Altitude Problems 1296
Ajay Handa
Introduction 1296
104. Aviation and Space Travel 1301
Ajay Handa
Air Travel 1301; Space Travel 1303
105. Diving Medicine 1307
Angeline Lazarus, Richard Mahon
Historical Background 1307; Diving Physics and Physiology 1307; Types of Diving 1308;
Diving-related Injuries/Illnesses 1309; Decompression Sickness 1310; Barotrauma 1312; Nitrogen
Narcosis 1314; Pulmonary Edema 1314; Treatment of Decompression Disorders 1314; Longterm
Effects of Diving 1316
SECTION 13: OCCUPATIONAL DISORDERS
PS Shankar
106. Lung Diseases in Coal Workers 1325
Harakh V Dedhia, Daniel E Banks
Introduction 1325; Clinical Features of Coal Dust Exposure 1326; Pathology of CWP 1328;
Management of CWP 1332
107. Silicosis 1335
PS Shankar, SK Jindal
Introduction 1335
108. Berylliosis 1345
PS Shankar
Introduction 1345; Pathogenesis 1345; Clinical and Radiological Features 1346; Diagnosis 1346;
Treatment 1347
109. Hard Metal Lung Diseases 1348
Dilip Maydeo, Nikhil Sarangdhar
Introduction 1348; Etiology and Pathogenesis 1348; Clinical Features 1349; Diagnosis 1349;
Treatment 1350
110. The Health Risks of Asbestos Exposure Inhalation 1351
Daniel E Banks, Harakh V Dedhia
Introduction 1351; Asbestos Fibers 1352
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111. Occupational Asthma 1367
Gajanan S Gaude
Introduction 1367; Historical Aspects 1367; Definitions 1367; Epidemiology 1368;
Work-exacerbated Asthma 1368; Agents Causing Occupational Asthma 1368; Pathogenetic
Mechanisms of Occupational Asthma 1371; Diagnosis 1374; Management 1375; Prognosis 1377;
Prevention 1377
112. Hypersensitivity Pneumonitis 1380
PS Shankar
Definition 1380; Etiology 1380; Pathogenesis 1382; Pathology 1382; Clinical Presentation 1382;
Investigations 1383; Diagnosis 1384; Prognosis 1385; Prevention 1385; Management 1385
113. Toxic Inhalations and Thermal Lung Injuries 1387
VK Vijayan, N Goel, R Caroli
Introduction 1387; Determinants of Inhalational Lung Injury 1387; Clinical Presentations of
Inhalational Injury 1388; Specific Inhaled Toxins 1390; Systemic Illnesses from Inhaled
Toxins 1395; Smoke Inhalation Lung Injury 1396; Approach to a Victim of Inhalation
Injury 1397; Management 1397
114. Drug-induced Respiratory Disease 1401
William J Martin II
Introduction 1401; Drugs Associated with Respiratory Toxicity 1401; Diagnosis and
Management of Drug-induced Respiratory Disease 1405
SECTION 14: PULMONARY NEOPLASMS
D Behera
115. Epidemiology and Etiopathogenesis of Lung Cancer 1411
Navneet Singh
Introduction 1411; Epidemiology 1411; Risk Factors 1412; Molecular Biology 1415
116. Pathology of Lung Tumors 1420
Ashim Das
Introduction 1420; Minor Groups 1420; Evolution of WHO Classification 1421; Neuroendocrine
Lesions of Lung 1426; Staging of Lung Tumors 1427
117. Lung Cancer: Clinical Manifestations 1429
Javaid Ahmad Malik
Introduction 1429; Local Manifestations 1429; Metastatic Manifestations 1430; Endocrine
Syndromes 1436; Neurological Syndromes 1438; Hematological Syndromes 1439; Skeletal 1439;
Miscellaneous Syndromes 1440
118. Diagnosis and Staging of Lung Cancer 1444
Ajmal Khan, Navneet Singh
Introduction 1444; Diagnosis of Lung Cancer 1444; Staging of Non-small Cell Lung
Cancer 1446; Staging of Small Cell Lung Cancer 1453
119. Approach to Management of Lung Tumors 1457
Navneet Singh, D Behera
Introduction 1457; Diagnostic Work-up 1457; Treatment Planning 1458; Palliation 1463
120A. Solitary Pulmonary Nodule 1470
Alladi Mohan, B Vijayalakshmi Devi, Abha Chandra
Introduction 1470; Terminology 1470; Epidemiology 1471; Etiology 1471; Clinical
Evaluation 1471; Imaging Studies 1472; Management 1478
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120B. Hematopoietic and Lymphoid Neoplasm of Lungs 1482
Pankaj Malhotra
Introduction 1482; Lymphomas 1482; Lymphomatoid Granulomatosis (LYG) 1488; Secondary
Involvement of Lung by Other Systemic Hematopoietic and Lymphoid Disorders 1488;
Pyothorax Associated Lymphomas 1489
121. Mediastinal Disorders 1492
Arjun Srinivasan, SK Jindal
Introduction 1492; Imaging of Mediastinum 1493; Differential Diagnosis 1494;
Mediastinitis 1495; Tumors and Cysts of Mediastinum 1496; Anterior Mediastinal Mass 1497;
Tumors of the Middle Mediastinum 1500; Tumors of the Posterior Mediastinum 1501; Tumors
of Autonomic Nervous System 1501; Superior Vena Cava Syndrome (SVCS) 1502
122. Diseases of Thoracic Cage 1504
Balamugesh T
Introduction 1504; Kyphoscoliosis 1504; Pectus Excavatum 1506; Pectus Carinatum 1508;
Ankylosing Spondylosis 1508; Obesity 1508; Flail Chest 1509; Miscellaneous Conditions 1509
123. Diseases of Diaphragm 1513
Balamugesh T
Introduction 1513
SECTION 15: PULMONARY CIRCULATORY DISORDERS
Ritesh Agarwal
124. Diffuse Alveolar Hemorrhage Syndromes, Wegener’s Granulomatosis and
Other Pulmonary Vasculitis 1523
Eleni Stagaki, Vlasis Polychronopoulos
Diffuse Alveolar Hemorrhage Syndromes 1523; Wegener’s Granulomatosis and
Other Pulmonary Vasculitides, 1525; ANCA 1527
125. Pulmonary Hypertension: A Third World Prospective 1535
Zeenat Safdar
Introduction 1535; Clinical Features 1536; Diagnostic Evaluation 1536; Pathophysiology 1539;
Management 1539
126. Pulmonary Thromboembolism 1546
Devasahayam J Christopher, Richa Gupta
Introduction 1546; Epidemiology 1546; Pathophysiology 1546; Risk Factors 1547; Clinical
Features 1549; Diagnosis 1550; Clinical Probability Assessment 1552; Diagnostic Strategies 1553;
Assessment of Prognosis 1553; Management 1555
127. Pulmonary Vascular Malformations 1562
Gautam Ahluwalia
Introduction 1562; Pathogenesis 1563; Clinical Features 1563; Investigations 1564;
Management 1564; Other Pulmonary Vascular 1565; Malformations 1565
SECTION 16: RESPIRATORY SLEEP DISORDERS
Ashutosh N Aggarwal
128. Approach to Respiratory Sleep Disorders 1571
Ahmad Abdelwahed, Jeremy A Weingarten
Introduction 1571; Sleep History 1571; Physical Examination for Respiratory Sleep
Disorders 1572; Nocturnal Polysomnography 1573; Portable Monitoring 1574; Sleep
Questionnaires 1576; Respiratory Disorders During Sleep 1576; COPD 1577
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TEXTBOOK OF PULMONARY AND CRITICAL CARE MEDICINE
129A. Obstructive Sleep Apnea-hypopnea Syndrome—A Developing Countries’ Perspective 1580
Harmanjit Singh Hira
129B. Obstructive Sleep Apnea 1593
Macy MS Lui, Mary SM Ip
Introduction 1593; Epidemiology and Risk Factors 1593; Pathogenesis of OSA 1595; Clinical
Features 1596; Diagnosis 1597; Morbidities Associated With OSA 1599; Treatment 1600
SECTION 17: RESPIRATORY CRITICAL CARE
R Agarwal, SK Jindal
130. Respiratory Failure 1609
Karthik Gnanapandithan, Ritesh Agarwal
Definition 1609; Classification 1609
131. Acute Respiratory Distress Syndrome 1618
Jean I Keddissi, D Robert McCaffree
132. Sepsis 1631
Sean E Hesselbacher, Kalpalatha K Guntupalli
Introduction 1631
133. Nonpulmonary Critical Care 1647
Adebayo Esan, Lavanya Irugulapati, Liziamma George
Introduction 1647; Gastrointestinal Disease in Critical Care 1647; Hematology in Critical
Care 1656; Renal Disease in Critical Care 1661; Endocrine Emergencies in Critical Care 1664;
Neurological Disorders in Critical Care 1670
134. Poisoning, Envenomation and Environmental Injuries 1687
Dhruva Chaudhry, Inder Pal Singh, Deepak Govil
Introduction 1687; Poisoning 1687; Stings and Envenomation 1699; Environmental
Injuries 1702
135. Obstetric Critical Care 1709
Hrishikesh S Kulkarni, Dilip R Karnad, Kalpalatha K Guntupalli
Introduction 1709; Obstetric Hemorrhage 1710; Acute Hypertensive Disorders in Obstetric
Critical Care 1713; Venous Thromboembolism (VTE) in Pregnancy 1716; Cardiac Disease in
Pregnancy 1716; Respiratory Disorders in Pregnancy 1719; Amniotic Fluid Embolism 1719;
Liver Dysfunction in Pregnancy 1720; Renal Dysfunction in Pregnancy 1720; Infection in
Pregnancy 1721
136. Cardiac Emergencies in the Intensive Care Unit: Cardiac Arrhythmias 1726
Mohamed S Rahman, M Eyman Mortada
Introduction 1726; Premature Ventricular Complexes (PVCs) 1726; Accelerated Idioventricular
Rhythm 1726; Wide Complex Tachycardia 1728; Supraventricular Tachycardia 1733;
Bradycardia (Heart Rate <60 bpm) 1742
137. Cardiac Emergencies in the Intensive Care Unit: Cardiogenic Shock and
Acute Coronary Syndrome 1746
M Fuad Jan, Suhail Allaqaband
Introduction 1746; Etiopathogenesis 1746; Clinical Presentation and Diagnosis 1748;
Treatment 1749; Acute Coronary Syndrome 1751; Management of ACS 1752
138. Pulmonary Hypertension in the Intensive Care Unit 1767
Neil Ninan, Amber Monson, Arthur Sung
Introduction 1767; Histopathology 1768; Right Heart Physiology 1768; Diagnostic
Modalities 1771; Biochemical Markers 1772; Therapy 1772; Specific ICU Diagnosis and
Management Issues 1773
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CONTENTS
139. Pediatric Critical Care 1778
Ali M Nadroo, Nitin P Ron, Pramod Narula
Introduction 1778; Persistent Pulmonary Hypertension of the Neonate (PPHN) 1779;
Apnea 1781; Respiratory Distress Syndrome (RDS) 1784; Surgical Disorders Presenting as
Respiratory Distress in a Neonate 1786; Acute Pulmonary Disorders in the Pediatric
Patient 1789
140. Mechanical Ventilation: General Principles and Modes 1799
GC Khilnani, Vijay Hadda
Introduction 1799; Basic Aspects of Mechanical Ventilation 1800; Modes of Mechanical
Ventilation 1802; Newer Modes of Mechanical Ventilation 1807; Initiating Mechanical
Ventilation 1810; Complications of Mechanical Ventilation 1813
141. Noninvasive Ventilation 1818
GC Khilnani, Vijay Hadda
Introduction 1818; Technical Aspect of Noninvasive Ventilation 1818; Steps to Sucessful
Provision of NIPPV 1821; Clinical Uses of NIPPV: Evidence and Recommendations 1823
SECTION 18: RESPIRATORY MONITORING
R Agarwal, SK Jindal
142. Blood Gas Monitoring 1833
Chandana Reddy, R Agarwal
Introduction 1833; Invasive Technique 1833; Noninvasive Blood Gas Monitoring 1835
143. Cutaneous Capnography 1841
Ankur Mehta, Prashant Chhajed
Introduction 1841; Medical Applications of PcCO2 Monitoring 1843
144. Role of Ultrasonography in Critical Care Medicine 1851
Pralay Sarkar, Seth J Koenig, Paul H Mayo
Introduction 1851; Training in Critical Care Ultrasonography 1851; Technical Considerations
1854; Thoracic Ultrasonography 1860; Critical Care Echocardiography 1870;
Abdominal Ultrasound: Scope in ICU 1880; Ultrasound Assessment of Venous 1884;
Thromboembolism 1884; Ultrasound Guidance for Procedures 1886; Ultrasound Guidance of
Thoracentesis 1889; Ultrasound Guidance of Pericardiocentesis 1890; Ultrasound Guidance of
Paracentesis 1891; Ultrasound for Airway Management 1891; Ultrasound for Confirmation of
Gastric Tube Placement 1892; Lumbar Puncture 1892; Other Procedures 1892
145. Interpretation of Chest X-rays in the ICU 1898
Sagar Naik, Sabiha Raoof, Rakesh Shah, Suhail Raoof
Introduction 1898
146. Right Heart Catheterization 1910
Vishal K Patel, Anthony Saleh
Introduction 1910
SECTION 19: GENERAL ISSUES IN THE INTENSIVE CARE UNIT
Ritesh Agarwal, SK Jindal
147. Nutritional Management and General Care in the Intensive Care Unit 1921
Navneet Singh
Malnutrition in Critical Illness 1921; Assessment of Nutritional Status in Critically Ill
Patients 1922; Goals and Principles of Nutritional Support 1923; Timing of Initiation of
Nutritional Support 1924; Route of Administration of Nutritional Support 1924; Quantity and
Volume of Nutrition Support 1926; Delivery of Enteral Nutrition and its Determinants 1927;
General Care in ICU 1929
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TEXTBOOK OF PULMONARY AND CRITICAL CARE MEDICINE
148. Airway Management 1933
Arjun Srinivasan, Ritesh Agarwal
Airway Assessment 1933
149. Complex Airways Diseases 1941
Rubal Patel, Ann L Rutt, Arthur Sung
Introduction 1941; Anatomy 1943
150. Analgesia and Sedation in the ICU 1956
Karan Madan, Ritesh Agarwal
Introduction 1956; Teamwork (Multidisciplinary Management) and Patient Focussed Care 1956;
Initial Evaluation and Medication Reconciliation 1957; Consequences of Off-target 1957; Sedation
and Analgesia 1957; Need for Frequent Patient Assessment 1957; Assessment of Pain, Sedation
and Agitation in The ICU 1957; Use of Validated Scales and Tools 1957; Management of
Analgesia and Sedation in The ICU 1961
151. Weaning from Mechanical Ventilation 1974
Ajmal Khan, Karthik Gnanapandithan, Ritesh Agarwal
Introduction 1974; Pathophysiology of Weaning 1975; Outcome of Weaning 1976; Assessment
for Weaning 1976; Techniques of Weaning 1977
152. Extracorporeal Life Support for Severe Acute Respiratory Failure 1983
Steven A Conrad
Introduction 1983; Clinical Trials of Extracorporeal Support 1983; Pre-ECMO Management 1984;
Patient Selection 1985; Techniques of ECLS 1985; Vascular Cannulation 1988; Management
During Support 1989; Transitioning from ECMO 1990
153. Hyperbaric Oxygen Therapy 1992
PS Tampi, SK Jindal
Introduction 1992; History of Hyperbaric Medicine 1992; Indications 1994; Contraindications
1996; Complications, 1996; Hyperbaric Chambers 1996; Techniques of Hyperbaric
Oxygenation 1997
SECTION 20: PLEURAL DISORDERS
George D’Souza
154. Pathophysiology of Pleural Effusion 2001
Srinivas Rajagopala
Introduction: Anatomy of the Pleura 2001
155. Approach to Pleural Effusion 2005
George D’Souza
Introduction 2005; Mechanisms of Pleural Effusion 2005; Formation 2005
156. Tubercular Pleural Effusion 2018
Pranab Baruwa, Kripesh Ranjan Sarmah
Pathology and Pathogenesis 2018; Clinical Features 2019; Management 2024; Complication of
TB Pleural Effusion 2025
157. Parapneumonic Effusion and Empyema 2030
Devasahayam J Christopher
Introduction 2030; Definitions 2030; Pathogenesis 2030; Epidemiology 2031; Bacteriology 2031;
Clinical Features and Diagnosis 2033; Pleural Fluid Analysis 2034; Treatment 2035
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CONTENTS
158. Pneumothorax 2041
Uma Devaraj, George D’Souza
Introduction 2041; Primary Spontaneous Pneumothorax 2043; Secondary Spontaneous
Pneumothorax 2049
159. Malignant Pleural Effusions 2055
Srinivas Rajagopala, George D’Souza
Introduction 2055; Etiology of Malignant Effusions 2055; Pathogenesis of Metastasis and
Effusions 2056; Clinical Presentation 2056; Radiological Findings 2056; Diagnosis 2058;
Management 2060; Long-term Ambulatory Pleural Drainage 2065; Prognosis 2065
160. Malignant Pleural Mesothelioma 2068
Arun S Shet, George D’Souza
Introduction 2068; Epidemiology 2068; Pathogenesis 2069; Clinical Presentation 2071; Diagnostic
Approach 2073; Treatment 2074
SECTION 21: PULMONARY MANIFESTATIONS OF SYSTEMIC DISEASES
Dheeraj Gupta, SK Jindal
161. Pulmonary Involvement in Collagen Vascular Disease 2081
Om P Sharma
Introduction 2081; Rheumatoid Arthritis 2081; Scleroderma 2086; Sjögren’s Syndrome 2088;
Systemic Lupus Erythematosus 2089; Dermatomyositis (DM) and Polymyositis (PM) 2092;
Ankylosing Spondylitis 2093; Mixed Connective Tissue Disease (MCTD) 2094; Treatment 2095
162. Pulmonary Manifestations of Systemic Diseases: An Approach 2099
Ajmal Khan, SK Jindal
Endocrinal Disorders 2099; Gastrointestinal Diseases 2101; Hepatic Disorders 2103; Renal
Diseases 2105; Other Systemic Diseases 2106
163. Pulmonary Manifestations in Cardiovascular and Neuromuscular Diseases 2110
Ajmal Khan, SK Jindal
Cardiovascular Diseases 2110
164. Pulmonary Involvement in Tropical Diseases 2118
S Jain, SK Jindal
Introduction 2118; Malaria 2118; Typhoid 2120; Leptospirosis 2121; Dengue 2122;
Amebiasis 2122
165. Pregnancy and Pulmonary Diseases 2125
Lakhbir K Dhaliwal, Preeti Verma
Pulmonary Physiological Changes During Pregnancy 2125
166. Rare Lung Diseases 2143
Sanjeev Mehta, PS Shankar
Part I: Pulmonary Alveolar Phospholipoproteinosis 2143
Part II: Pulmonary Calcification and Ossification Syndromes 2146
Part III: Pulmonary Alveolar Microlithiasis 2147
SECTION 22: PERSPECTIVES IN PULMONARY AND CRITICAL CARE MEDICINE
SK Jindal
167. Ethics in Respiratory Care 2151
Basil Varkey
Scope of Ethics 2151; The Four-principle Approach to Medical Ethics (Principlism) 2152; Ethics
in End-of-life (EOL) Care 2155; A New Covenant and a Conceptual Model for Patient
Care, 2159
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TEXTBOOK OF PULMONARY AND CRITICAL CARE MEDICINE
168. End-of-life Care 2163
Jeba S Jenifer, SK Jindal
Prognostication 2163; Barriers 2163; Components of EOL Care 2164; Common Symptoms in
EOL 2164
Appendix 1: End-of-life Care—Religious Beliefs and Practices in India 2174; Hinduism 2174;
Islamic Rites and Rituals as per Islamic Principles (Qur’an and Shariyat as Observed in
India) 2174; The Sikh Traditions 2175; The Jain Rites 2175; Christian Rituals and Practices 2176
169. Health Economics of Pulmonary Care 2177
C Sudheendra Ghosh
Introduction 2177
SECTION 23: SURGICAL ASPECTS OF RESPIRATORY DISEASE
SK Jindal
170. Surgery for Tuberculosis and Infective Lung Conditions 2185
RK Dewan
Historical Aspects 2185; Types of Surgical Procedures Performed for Tuberculosis 2186
171. Surgical Aspects of Obstructive Lung Diseases 2191
Donald Ray Lazarus, Suryakanta Velamuri
Introduction 2191; Lung Volume Reduction Surgery 2191
172. Thoracic Trauma 2200
RS Dhaliwal, Bhalinder Dhaliwal
Introduction 2200; Pathophysiology 2200; Effects on Lungs and Chest Wall 2201; Blunt Chest
Trauma 2202; Penetrating Chest Injuries (PCI) 2205; Management of Thoracic Trauma 2206
173. Lung Transplantation 2211
Sachin Kumar, Ritesh Agarwal
History of Lung Transplantation 2211; General Indications 2211; Contraindications 2212; Waiting
List and Organ Allocation 2213; Immunosuppressive Treatment 2214; Complications 2214;
Outcomes 2219; The Future of Lung Transplantation 2219; Lung Transplantation in India 2220
Index 2225