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Chronic obstructive pulmonary disease is often considered a rather dated disease but its prevalence continues to increase and the range of treatments to expand. Over the next 20 years the burden in developing countries will increase as they reap the effects of recent years of increased cigarette smoking. Timothy Howes has reviewed the available information in a clear and approachable short book. The text covers areas such as epidemiology, pathophysiology, diagnosis and prevention, before moving on to practical areas of management. The management covers important newer areas such as pulmonary rehabilitation, non-invasive ventilation and surgery for COPD as well as pharmacological treatment. The text is well referenced through a useful list of further reading at the end of each chapter. The radiographs need better reproduction to be very useful.
The major part of COPD management at present is in primary care. A great deal of effort goes in to trying to prevent exacerbations which lead to expensive admissions to hospital and carry a high mortality. The effectiveness of some therapies in this area is described clearly. Hospital at home and early discharge teams have developed in many areas and this is included in the useful chapter on the primary-secondary care interface. However, this chapter repeats some of the treatment material from other chapters and tends to set primary care apart. Other chapters seem aimed more at secondary care with over five pages on lung reduction surgery and two out of the three final case studies decidedly hospital based. In England and Wales the arrangements for oxygen prescribing have just changed from primary to secondary care and this will warrant further coverage in subsequent editions.
While there is plenty of useful information here it would be good to see more emphasis on a multidisciplinary approach and the issues of primary care where the majority of chronic obstructive pulmonary disease management should be based.
Timothy Q Howes (with a contribution from David Bellamy) 224pp Price £24.99 ISBN 0340816953 London: Hodder Arnold
Competing interests Dr John Rees has received honoraria lectures from pharmaceutical companies involved in the therapy of COPD.