However, for the lay person, or scientists interested in developing novel drugs to treat respiratory disease, these books are not as accessible because their interest is generally confined to a high level overview of the diagnosis and treatment of respiratory disease with a greater desire to simply understand the disease or steps they can take to prevent it. And that is where Breathing in America: Diseases, Progress, and Hope enters the picture.
Edited by Dean E. Schraufnagel, with contributions from 55 experts in the field of respiratory medicine, and sponsored by the American Thoracic Society, this book was published to coincide with the 2010 Year of the Lung Campaign, which was convened by a coalition of lung health advocates.
The book provides basic guidance to patients, the media and the general public in the United States and complements its predecessor focused on the European region, the European Lung White Book, published by the European Respiratory Society. Both books describe the causes, means of prevention and treatment for a wide range of respiratory diseases, and include epidemiological data.
Breathing in America is divided into 25 chapters, with 23 of the chapters each covering a specific respiratory disease, including common ones like asthma and COPD; diseases induced by environmental exposure to particulates, toxins, or infectious agents; the genetic disease cystic fibrosis; orphan diseases, including pulmonary hypertension and bronchiectasis; and one chapter devoted to very rare lung diseases.
The first chapter provides background information on the lung and an overview of the range of respiratory diseases known to exist. A table classifying the various respiratory diseases in terms of their mechanisms–e.g., asthma and COPD decrease air movement in the lungs while pneumonia is an infection in the lung—is an especially nice reference tool.
While the authors typically provide definitions for technical terms, at times this chapter uses too much technical jargon, which could potentially overwhelm the novice reader but will be appealing to the medically literate. For the reader who is generally unfamiliar with respiratory diseases, I would like to see the introduction highlight the drug development and approval process to provide context for why it takes so long to get new treatments to the patients.
The disease chapters include many colorful charts showing the incidence of disease over time or by subpopulation; images providing historical context or showing people being treated for disease; and tables cataloguing causes and prevalence of disease. These figures are appealing and rapidly convey information that would become tedious and bog down readers if integrated into in the text, although some of the figures on incidence of disease do need to be updated with more recent data.
Each short, 10-to-15 page chapter is divided into sections covering the types of patients affected by the disease, what is known about the cause, how it can be prevented, treated or managed, and what research or steps should be taken to improve management of the disease. The chapter authors define technical terms as they arise and are careful to explain complex topics in down-to-earth terms. A brief list of web sites and references is provided at the end of each chapter for those interested in further exploration of the topic.
Although each chapter is written by a different author, or authors, the editors did an excellent job of ensuring that the language and content is consistent throughout. Each chapter functions on a stand-alone basis, meaning that some topics arise in multiple chapters.
I was initially disappointed not to find a chapter devoted to bronchitis, emphysema, and alpha-1 antitrypsin (AAT) deficiency; however, it turns out that all three are covered within the chapter on COPD. The next edition should really include an index, since without one, identifying the chapters in which certain topics are covered is impossible.
One feature in each chapter that I found very compelling was the use of case studies. These one page synopses describe the symptoms, history of hospitalization and treatments of a patient suffering from the disease, as well as the ultimate outcome and course of the disease. The case studies complement the text and personalize the disease for the reader, ultimately making it more understandable. I also liked the discussion of genetic factors that may influence susceptibility to each disease, as well as the use of biomarkers for diagnosis or treatment.
The last chapter springboards to the challenges that remain and what we may expect in the future. A key message in this chapter is that for the US pharmaceutical industry to remain competitive, and for innovative medicines to continue to reach patients, we need to continue to support funding for research.
No book is perfect, and one expects that subsequent editions will not only provide updated content, but also improvements on the original. In addition to an index, a glossary defining technical terms may also be helpful to the nontechnical reader. Also, the editors may want to reconsider the cover art, which shows a family wearing face masks, an image that could potentially evoke emotions that contrast with the title’s emphasis on hope.
Finally, while the book contains considerable discussion of approved therapeutics and those in development to treat each disease, there were notable absences. For example, the treatment of IPF through the use of stem cells is discussed, even though it is far from reaching the market, while there is no mention of pirfenidone, for which an application has been filed for approval.
I would also like to have seen some discussion of inhaled anticancer agents to treat lung cancer, as well as the use of the approved iloprost and treprostinil drugs for pulmonary hypertension. But these observations are minor, and I endorse this book because it is well positioned to raise much needed awareness of respiratory disease to the general public as well as for pharmaceutical development professionals to learn about unmet medical needs in pulmonary disease.
David Cipolla is Senior Director of Pharmaceutical Sciences at Aradigm.
Editor’s note: a free online version of Breathing in America is available from the American Thoracic Society, and a hard copy can be ordered, at:
