Essentials of Clinical Pulmonology 1st

Edition Pallav L Shah

Visit to download the full and correct content document:
https://textbookfull.com/product/essentials-of-clinical-pulmonology-1st-edition-pallav-l-
shah/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Pediatric Infectious Diseases : Essentials for Practice

Second Edition Samir S. Shah

https://textbookfull.com/product/pediatric-infectious-diseases-
essentials-for-practice-second-edition-samir-s-shah/

Essentials of Ultrasound Imaging Thomas L. Szabo

https://textbookfull.com/product/essentials-of-ultrasound-
imaging-thomas-l-szabo/

Essentials of Kumar & Clark’s Clinical Medicine Nicola

Zammitt

https://textbookfull.com/product/essentials-of-kumar-clarks-
clinical-medicine-nicola-zammitt/

Seeley's essentials of anatomy & physiology Tenth

Edition Cinnamon L. Vanputte

https://textbookfull.com/product/seeleys-essentials-of-anatomy-
physiology-tenth-edition-cinnamon-l-vanputte/
Pediatric Pulmonology, 2e (Dec 22,
2023)_(1610026527)_(American Academy of Pediatrics) 2nd
Edition Section On Pediatric Pulmonology And Sleep
Medicine
https://textbookfull.com/product/pediatric-
pulmonology-2e-dec-22-2023_1610026527_american-academy-of-
pediatrics-2nd-edition-section-on-pediatric-pulmonology-and-
sleep-medicine/

Difficult To Treat Asthma: Clinical Essentials Sandhya

Khurana

https://textbookfull.com/product/difficult-to-treat-asthma-
clinical-essentials-sandhya-khurana/

The Role of Technology in Clinical Neuropsychology 1st

Edition Robert L. Kane

https://textbookfull.com/product/the-role-of-technology-in-
clinical-neuropsychology-1st-edition-robert-l-kane/

L Arginine in Clinical Nutrition 1st Edition Vinood B.

Patel

https://textbookfull.com/product/l-arginine-in-clinical-
nutrition-1st-edition-vinood-b-patel/

Clinical Laboratory Chemistry 2nd Edition Robert L.

Sunheimer

https://textbookfull.com/product/clinical-laboratory-
chemistry-2nd-edition-robert-l-sunheimer/
Essentials of Clinical Pulmonology
http://taylorandfrancis.com
Essentials of Clinical Pulmonology

Edited by
Pallav L. Shah
Felix J.F. Herth
Yun Chor Gary Lee
Gerard J. Criner
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2019 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

International Standard Book Number-13: 978-1-4441-8646-8 (Pack- Hardback and eBook)

This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and
information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers
wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessar-
ily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care
professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history,
relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice
on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the
drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or
materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately
it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The
authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if
permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify
in any future reprint.

Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical,
or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without
written permission from the publishers.

For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact the Copy-
right Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and
registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.

Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without
intent to infringe.

Visit the Taylor & Francis Web site at

http://www.taylorandfrancis.com

and the CRC Press Web site at

http://www.crcpress.com
Contents

Preface ix
Editors xi
Contributors xiii

PART 1 BASIC SCIENCES 1

1 Lung anatomy and development 2

Jonathan A. Galli, Marc S. Diamond, and Gilbert E. D’Alonzo
2 Pathology 15
Beata Kosmider, Karim Bahmed, Xu Zeng, He Wang, and Thomas J. Rogers
3 Genetics of lung diseases 37
Emily S. Wan

PART 2 CLINICAL EVALUATION 43

4 History 44
Samuel Kemp and Maren Schuhmann
5 Clinical examination 49
Samuel Kemp
6 Imaging techniques 58
Arjun Nair and Joseph Jacob
7 Non-oncological pulmonary nuclear medicine 88
Deena Neriman and Leon Menezes
8 PET–CT in oncological pulmonary nuclear medicine 102
Raekha Kumar and Bhupinder Sharma
9 Pulmonary function and exercise testing 113
James H. Hull and Simon Ward

PART 3 CLINICAL PROCEDURES 127

10 Bronchoscopy 128
Zaid Zoumot and Daniela Gompelmann
11 Endosonography for pulmonary diseases: Endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) 147
Jouke T. Annema and Laurence Crombag
12 Pleural procedures 156
Luke Garske and Claire Tobin
13 Medical thoracoscopy 175
Jason Akulian and David Feller-Kopman
14 Essentials of clinical pulmonology: Interventional radiology 180
Evangelos Skondras, Fernando Rukshan, and Simon Padley

v
vi Contents

PART 4 CLINICAL ASSESSMENT AND SAFETY 193

15 Fitness for general anesthesia 194

Suveer Singh
16 Fitness to fly 199
Gary Davies and Suveer Singh
17 Guidelines for driving and drowsiness 202
Suveer Singh

PART 5 THERAPIES 207

18 Pulmonary rehabilitation 208

Richard ZuWallack
19 Non-invasive ventilation 218
Mark Weir

PART 6 UPPER RESPIRATORY DISEASE 227

20 The upper respiratory tract—Allergic rhinitis and rhinosinusitis with/without nasal polyps 228
Steve Durham and Guy Scadding
21 Sleep apnea and sleep disordered breathing 240
Maria Elena Vega Sanchez, Samuel Krachman, and Fredric Jaffe

PART 7 AIRWAY DISEASE 249

22 Asthma 250
Cole Liberator, Robert Marron, Jeffrey Barry, and Kartik Shenoy
23 Chronic obstructive pulmonary disease 270
Matthew Gordon, Patrick Mulhall, Amandeep Aneja, and Gerard J. Criner
24 Bronchiectasis 291
Fredric Jaffe, Karla M. Criner, and Chandra Dass
25 Cystic Fibrosis 303
Nicholas J. Simmonds, Laura J. Sherrard, and Scott C. Bell

PART 8 NEOPLASMS 327

26 Lung cancer 328

Pallav L. Shah and Tom Newsom-Davis
27 Rare lung tumors and metastatic disease to the lungs 354
Brett C. Bade, Muhammad Perwaiz, Marc A. Judson, and Gerard A. Silvestri
28 Mediastinal tumors 364
Daniel Körner and Hendrik Dienemann

PART 9 INFECTION 373

29 Bacterial lung infection 374

Simon Brill
30 Tuberculosis 384
Onn Min Kon and Georgina Russell
31 Respiratory fungal infection 400
Anand Shah
 Contents vii

32 Viral infections 418

Amelia Bercusson
33 Pulmonary complications of HIV infection 425
Julia Choy, Pallav L. Shah, and Anton Pozniak

PART 10 DIFFUSE LUNG DISEASE 437

34 Pulmonary sarcoidosis 438

Peter M. George and Athol U. Wells
35 Idiopathic pulmonary fibrosis 448
Peter Saunders, Richard J. Toshner, and Toby M. Maher
36 Hypersensitivity pneumonitis 460
Helen E. Jo and Tamera J. Corte
37 Connective tissue disease-associated interstitial lung disease 470
Sandra Chartrand and Aryeh Fischer
38 Pulmonary vasculitis 483
Irene J. Tan and Maria Elena Vega Sanchez
39 Rare lung diseases 492
Jay H. Ryu

PART 11 ENVIRONMENTAL AND OCCUPATIONAL LUNG DISEASE 505

40 Smoking cessation 506

Aditi Satti
41 Occupational lung disease 510
Joanna Szram
42 Asbestosis, pneumoconiosis, and other occupational lung diseases 522
Erin R. Narewski, Scott Simpson, Joseph Ramzy, Jennifer Kraft, and Richard Ngo
43 Drug-induced lung disease and radiation-induced disease 533
Erin R. Narewski and Scott Simpson

PART 12 MEDIASTINAL DISEASE 545

44 Mediastinal disease 546

Seyer Safi and Maren Schuhmann

PART 13 PLEURAL DISEASE 551

45 Pleural diseases 552

Muhammad Redzwan S. Rashid Ali, José M. Porcel, Coenraad F.N. Koegelenberg, Robert J. Hallifax,
Nick A. Maskell, and Yun Chor Gary Lee
46 Malignant pleural mesothelioma 577
Su Lyn Leong, Helen E. Davies, and Yun Chor Gary Lee

PART 14 PULMONARY VASCULAR DISEASE 589

47 Pulmonary hypertension and other disorders of the pulmonary vasculature 590

Peter M. George, Laura Price, and S. John Wort
48 Pulmonary embolism 609
Michael Kreuter and Benjamin Egenlauf
viii Contents

PART 15 CRITICAL CARE 621

49 Acute respiratory distress syndrome (ARDS) 622

Laurie E. Kilpatrick, Chandra Dass, He Wang, and Gerard J. Criner
50 Infections in critical care: Ventilator-associated pneumonia 632
Daniel Salerno

PART 16 DEVELOPMENTAL DISORDERS 639

51 Developmental disorders in adults 640

Andrew Bush

PART 17 RESPIRATORY MANIFESTATIONS OF EXTRAPULMONARY DISEASE 647

52 Bone marrow transplantation and hematological disorders 648

Chloe Anthias and Michael N. Potter
53 Skeletal disorders and neuromuscular disease 660
Anita K. Simonds
54 Cardiovascular disease 667
Resham Baruah and Rakesh Sharma
55 Pulmonary renal syndromes 691
Aron Chakera and Chris O’Callaghan

Answers 698
Index 702
Preface
There are a number of substantial reference respiratory
textbooks available, but we wanted to develop a new format
that would be suitable for a wider audience. There is sub-
stantial evidence that visual images are important for
learning, and also information needs to be in a concise
format due to the pressures of time that we all face. With this
in mind, we have tried to develop a textbook for pulmonary
medicine that will cater to doctors and nurses in training,
through to the specialist who would like a quick refresher or
a concise reference textbook. We have developed a more
visual approach to this textbook with numerous figures,
radiological images, algorithms for disease management, and
text boxes highlighting key learning points. We have also
incorporated case studies that emphasize and reinforce
key learning points and important approaches to disease
management.
We would like to thank all the contributing authors
for their contribution. The authors originate from leading
hospitals across four continents, making this textbook a
global textbook representative of the highest international
standards expected from pulmonary medicine. Without
their perseverance and dedication, there would be no final
product. I would also like to thank their families for their
patience and sacrifice, as we are only too aware of the sac-
rifices all our families have made in our advancement of
medicine and allowing us to ensure that the knowledge is
disseminated promptly.
Finally, a new book of this size with a novel approach
always requires patience, and this particular book has
evolved with three editorial teams. We would like to thank
Caroline Makepeace in believing in our vision and starting
the project, Alice Oven and then Gabriel Schenk for their
persistence and ensuring that the project comes to fruition.
Pallav L. Shah
Felix J.F. Herth
Yun Chor Gary Lee
Gerard J. Criner
ix
http://taylorandfrancis.com
Editors
Pallav L. Shah qualified from Guys Hospital Medical
School and then trained at the Royal Brompton Hospital
and did his research degree with University of London.
He is currently Professor of Medicine at Imperial
College, London. He is also a Senior Consultant
Physician at the Royal Brompton Hospital and Chelsea
and Westminster Hospital. Professor Shah is active in
both the research and the development of new treat-
ments. He has authored and edited key medical
textbooks: Gray’s Anatomy (39th and 40th editions)
and the Oxford Textbook of Medicine (6th edition). He
has been on national and global guideline groups and is
a specialist advisor to the National Institute of Clinical
Excellence (NICE) and the Commission on Human
Medicines (Cardiovascular, Diabetes, Renal, Respiratory
and Allergy Expert Advisory Group).
Felix J.F. Herth graduated at the University of Freiburg
and was trained in Karlsruhe, Heidelberg, Germany and
Boston, USA. He is Professor of Pneumology at the Uni-
versity of Heidelberg. His Department of Pulmonary and
Respiratory Critical Care Medicine focuses on the diag-
nosis and therapy of respiratory tract diseases such as
lung emphysema, cystic fibrosis, fibrosing alveolitis, and
pulmonary hypertension; on noninvasive ventilatory
support for patients with respiratory deficiency or failure;
and on sleep-related respiratory disorders. He provides
outstanding expertise in all fields of bronchoscopy,
taking a lead position in the development of devices for
diagnostic and therapeutic purposes. His research inter-
est is lung cancer, interstitial lung diseases, and
interventional bronchoscopy. Felix Herth is one of
the European health leaders working closely with the
European Health Commission.
Yun Chor Gary Lee is a chest physician and clinician
scientist with an interest in translational research of
pleural disease. His pleural program includes a labo-
ratory and a clinical research arm closely integrated
with an active tertiary clinical pleural disease service.
His work has translated to clinical practice on many
occasions and contributed directly to reducing mor-
tality, morbidity, and healthcare costs in patient care.
He has a strong record in training clinical fellows and
postdoctoral scientists. He is Professor of Respiratory
Medicine at the University of Western Australia,
Director of Pleural Services at Sir Charles Gairdner
Hospital, and leads the Pleural Medicine research
group at the Institute for Respiratory Health in Perth,
Australia.
Gerard J. Criner graduated from Temple University
School of Medicine. He is Chair and Professor of
Thoracic Medicine and Surgery at the Lewis Katz
School of Medicine at Temple University. He is also
Director of Temple Lung Center and co-director of the
Center for Lung Inflammation Research. He is on the
Board of Directors for the Global Initiative for Chronic
Obstructive Lung Disease (GOLD). He has extensive
experience in conducting, designing, and leading
multicenter trials for the past 25 years. He has been
involved in multiple National Institutes of Health
steering committees, ad hoc technical panels, and
capo work groups over the past 20 years.
xi
http://taylorandfrancis.com
Contributors

Jason Akulian Resham Baruah

Section of Interventional Pulmonology Chelsea and Westminster NHS Foundation Trust
Division of Pulmonary and Critical Care and
University of North Carolina in Chapel Hill Royal Brompton and Harefield NHS Trust
Chapel Hill, North Carolina, USA London, United Kingdom
Amandeep Aneja Scott C. Bell
Department of Pathology and Laboratory Medicine Department of Thoracic Medicine
Lewis Katz School of Medicine at Temple University The Prince Charles Hospital
Philadelphia, Pennyslvania, USA and
Jouke T. Annema QIMR Berghofer Medical Research Institute
Brisbane, Australia
Department of Respiratory Medicine
Academic Medical Center Amelia Bercusson
University of Amsterdam National Heart and Lung Institute
Amsterdam, The Netherlands Imperial College London
London, United Kingdom
Chloe Anthias
Anthony Nolan Research Institute Simon Brill
and National Heart and Lung Institute
The Royal Marsden Hospital Imperial College London
Sutton, United Kingdom London, United Kingdom
and Andrew Bush
UCL Cancer Centre National Heart and Lung Institute
London, United Kingdom
Imperial College London
Brett C. Bade and
Division of Pulmonary, Critical Care, and Sleep Royal Brompton Harefield NHS Foundation Trust
Medicine London, United Kingdom
Medical University of South Carolina
Aron Chakera
Charleston, South Carolina, USA
Department Renal Medicine
Karim Bahmed Sir Charles Gairdner Hospital
Department of Thoracic Medicine and Surgery Nedlands, Western Australia
and Sandra Chartrand
Center for Inflammation, Translational and Clinical Lung
Department of Medicine
Research (CILR) Hôpital Maisonneuve-Rosemont
Lewis Katz School of Medicine at Temple University
Université de Montréal
Philadelphia, Pennsylvania, USA Montréal, Canada
Jeffrey Barry
Julia Choy
Internal Medicine Chelsea and Westminster Hospital
Temple University Hospital London, United Kingdom
Philadelphia, Pennsylvania, USA

xiii
xiv Contributors

Tamera J. Corte Benjamin Egenlauf

Department of Respiratory Medicine Center for Pulmonary Hypertension
Royal Prince Alfred Hospital Thoraxklinik, University of Heidelberg
and Heidelberg, Germany
Faculty of Medicine David Feller-Kopman
University of Sydney
Section of Interventional Pulmonology
Sydney, Australia Division of Pulmonary and Critical Care
Gerard J. Criner The Johns Hopkins University
Department of Thoracic Medicine and Surgery Baltimore, Maryland, USA
Lewis Katz School of Medicine at Temple University
Aryeh Fischer
Philadelphia, Pennsylvania, USA Department of Medicine
Karla M. Criner School of Medicine
Lewis Katz School of Medicine at Temple University University of Colorado in Denver
Philadelphia, Pennsylvania, USA Denver, Colorado, USA
Laurence Crombag Jonathan A. Galli
Department of Respiratory Medicine Department of Thoracic Medicine and Surgery
Academic Medical Center Lewis Katz School of Medicine at Temple University
University of Amsterdam Philadelphia, Pennsylvania, USA
Amsterdam, The Netherlands Luke Garske
Gilbert E. D’Alonzo Thoracic Medicine
Department of Thoracic Medicine and Surgery The Wesley Hospital
Lewis Katz School of Medicine at Temple University Brisbane, Australia
Philadelphia, Pennsylvania, USA Peter M. George
Chandra Dass Department of Interstitial Lung Disease
Department of Radiology Royal Brompton Hospital
Lewis Katz School of Medicine at Temple University London, United Kingdom
Philadelphia, Pennsylvania, USA Daniela Gompelmann
Gary Davies Pneumology and Respiratory Critical Care Medicine
Chelsea and Westminster Healthcare Thoraxklinik, University of Heidelberg
NHS Foundation Trust and
London, United Kingdom Translational Lung Research Center Heidelberg
Helen E. Davies German Center for lung Research (DZL)
Heidelberg, Germany
Department of Respiratory Medicine
University Hospital of Wales Matthew Gordon
Wales, United Kingdom Department of Thoracic Medicine and Surgery
Marc S. Diamond Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, USA
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine at Temple University Robert J. Hallifax
Philadelphia, Pennsylvania, USA Oxford Centre for Respiratory Medicine
Hendrik Dienemann Churchill Hospital
Oxford, United Kingdom
Department of Thoracic Surgery
Heidelberg University Hospital Felix J.F. Herth
Heidelberg, Germany Pneumology and Respiratory Critical Care Medicine
Steve Durham Thoraxklinik, University of Heidelberg
Royal Brompton and Harefield Hospitals and
Translational Lung Research Centre Heidelberg
NHS Foundation Trust
and German Center for Lung Research (DZL)
Allergy and Clinical Immunology Heidelberg, Germany
National Heart and Lung Institute James H. Hull
Imperial College London Lung Function Department
London, United Kingdom Royal Brompton Hospital
London, United Kingdom
 Contributors xv

Joseph Jacob Beata Kosmider

Department of Respiratory Medicine Department of Physiology
and Department of Thoracic Medicine and Surgery
Centre for Medical Image Computing and
University College London Center for Inflammation Translational and Clinical
London, United Kingdom Lung Research (CILR)
Fredric Jaffe Lewis Katz School of Medicine at Temple University
Department of Respiratory Medicine Philadelphia, Pennsylvania, USA
and Samuel Krachman
Centre for Medical Image Computing Department of Thoracic Medicine and Surgery
University College London Lewis Katz School of Medicine at Temple University
London, United Kingdom Philadelphia, Pennsylvania, USA
Helen E. Jo Jennifer Kraft
Respiratory Medicine Department Department of Internal Medicine
and Lewis Katz School of Medicine at Temple University
Royal Prince Alfred Hospital Philadelphia, Pennsylvania, USA
University of Sydney
Michael Kreuter
Sydney, Australia Pneumology and Respiratory Critical Care Medicine
Marc A. Judson Center for Interstitial and Rare Lung Diseases
Division of Pulmonary and Critical Care Medicine Thoraxklinik, University of Heidelberg
Albany Medical College and
Albany, New York, USA Translational Lung Research Centre Heidelberg
Samuel Kemp German Center for Lung Research (DZL)
Heidelberg, Germany
Royal Brompton Hospital
London, United Kingdom Raekha Kumar
Laurie E. Kilpatrick Department of Radiology
Department of Thoracic Medicine and Surgery Northwick Park Hospital
and
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, USA Royal Marsden Hospital
London, United Kingdom
Coenraad F.N. Koegelenberg
Division of Pulmonology Yun Chor Gary Lee
Centre for Respiratory Health
Department of Medicine
Stellenbosch University School of Medicine and Pharmacology
Stellenbosch, South Africa University of Western Australia
and
and
Tygerberg Academic Hospital Department of Respiratory Medicine
Cape Town, South Africa Sir Charles Gairdner Hospital
Perth, Australia
Onn Min Kon
Su Lyn Leong
Imperial College Healthcare NHS Trust
and Department of General Medicine
National Heart and Lung Institute Rockingham General Hospital
and
Imperial College London
London, United Kingdom School of Medicine and Pharmacology
University of Western Australia
Daniel Körner Perth, Australia
Department of Thoracic Surgery
Cole Liberator
Heidelberg University Hospital
Heidelberg, Germany Internal Medicine
Temple University Hospital
Philadelphia, Pennsylvania, USA
xvi Contributors

Toby M. Maher Muhammad Perwaiz

NIHR Biological Research Unit Division of Pulmonary and Critical Care Medicine
Royal Brompton Hospital Albany Medical College
and Albany, New York, USA
National Heart and Lung Institute José M. Porcel
Imperial College London Pleural Medicine Unit
London, United Kingdom Department of Internal Medicine
Robert Marron Biomedical Research Institute of Lleida
Internal Medicine Arnau de Vilanova University Hospital
Temple University Hospital Lleida, Spain
Philadelphia, Pennsylvania, USA Michael N. Potter
Nick A. Maskell Department of Haemato-Oncology
School of Clinical Sciences The Royal Marsden Hospital
University of Bristol Sutton, United Kingdom
Bristol, United Kingdom Anton Pozniak
Leon Menezes Department of HIV
Institute of Nuclear Medicine Chelsea and Westminster Hospital
University College Hospital London London, United Kingdom
London, United Kingdom Laura Price
Patrick Mulhall Royal Brompton Hospital
Department of Thoracic Medicine and Surgery London, United Kingdom
Lewis Katz School of Medicine at Temple University Joseph Ramzy
Philadelphia, Pennsylvania, USA Department of Thoracic Medicine and Surgery
Arjun Nair Lewis Katz School of Medicine at Temple University
University College Hospital London Philadelphia, Pennsylvania, USA
London, United Kingdom Muhammad Redzwan S. Rashid Ali
Erin R. Narewski Respiratory Medicine
Department of Thoracic Medicine and Surgery Sir Charles Gairdner Hospital
Lewis Katz School of Medicine at Temple University Perth, Western Australia
Philadelphia, Pennsylvania, USA Thomas J. Rogers
Deena Neriman Department of Thoracic Medicine and Surgery
Institute of Nuclear Medicine and
University College Hospital London Center for Inflammation, Translational and Clinical Lung
London, United Kingdom Research (CILR)
Lewis Katz School of Medicine at Temple University
Tom Newsom-Davis
Philadelphia, Pennsylvania, USA
Department of Oncology
Chelsea and Westminster Hospital London Fernando Rukshan
United Kingdom Department of Diagnostic Radiology
McGill University
Richard Ngo
Montreal, Canada
Department of Internal Medicine
The Philadelphia College of Medicine Georgina Russell
Philadelphia, Pennsylvania, USA Imperial College Healthcare NHS Trust
London, United Kingdom
Chris O’Callaghan
Nuffield Department of Medicine Henry Wellcome Building Jay H. Ryu
University of Oxford Roosevelt Drive Division of Pulmonary and Critical Care Medicine
Oxford, United Kingdom and
Mayo Clinic College of Medicine
Simon Padley
Rochester, Minnesota, USA
Royal Brompton Hospital
Chelsea and Westminster Hospital Seyer Safi
and Division of Thoracic Surgery
Imperial College London University Hospital Rechts der Isar
London, United Kingdom Technical University of Munich
Munich, Germany
 Contributors xvii

Daniel Salerno Laura J. Sherrard

Department of Thoracic Medicine and Surgery QIMR Berghofer Medical Research Institute
Temple University Brisbane, Australia
Philadelphia, Pennsylvania, USA and
School of Pharmacy
Aditi Satti
Queen’s University Belfast
Department of Thoracic Medicine and Surgery
Belfast, United Kingdom
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, USA Gerard A. Silvestri
Division of Pulmonary, Critical Care, and Sleep
Peter Saunders
Medicine
NIHR Biological Research Unit
Medical University of South Carolina
Royal Brompton Hospital
Charleston, South Carolina, USA
and
National Heart and Lung Institute Nicholas J. Simmonds
Imperial College London Adult Cystic Fibrosis Centre
London, United Kingdom Royal Brompton Hospital
and
Guy Scadding
National Heart and Lung Institute
Royal Brompton and Harefield Hospitals
Imperial College London
NHS Foundation Trust
London, United Kingdom
and
Allergy and Clinical Immunology Anita K. Simonds
National Heart and Lung Institute Sleep and Ventilation Unit
Imperial College London Royal Brompton and Harefield NHS Foundation Trust
London, United Kingdom London, United Kingdom
Maren Schuhmann Scott Simpson
Pneumology and Respiratory Critical Care Medicine Department of Radiology
Thoraxklinik, University Hospital Heidelberg Lewis Katz School of Medicine at Temple University
Heidelberg, Germany Philadelphia, Pennsylvania, USA
Anand Shah Suveer Singh
Royal Brompton Hospital Chelsea and Westminster Hospital
Chelsea and Westminster Hospital Imperial College
and London, United Kingdom
Imperial College London Evangelos Skondras
London, United Kingdom Imaging Department
Pallav L. Shah Harefield Hospital
Department of Respiratory Medicine Royal Brompton and Harefield NHS Foundation Trust
Royal Brompton Hospital London, United Kingdom
Chelsea and Westminster Hospital Joanna Szram
and Royal Brompton and Harefield NHS Foundation Trust
Department of Respiratory Medicine and
Imperial College London National Heart and Lung Institute
London, United Kingdom Imperial College
Bhupinder Sharma London, United Kingdom
Royal Marsden Hospital Irene J. Tan
London, United Kingdom Section of Rheumatology
Rakesh Sharma Department of Medicine
Royal Brompton and Harefield NHS Trust Lewis Katz School of Medicine at Temple University
London, United Kingdom Philadelphia, Pennsylvania, USA
Kartik Shenoy Claire Tobin
Department of Thoracic Medicine and Surgery Royal Perth Hospital
Lewis Katz School of Medicine at Temple University Perth, Australia
Philadelphia, Pennsylvania, USA
xviii Contributors

Richard J. Toshner Mark Weir

NIHR Biological Research Unit Department of Thoracic Medicine and Surgery
Royal Brompton Hospital Lewis Katz School of Medicine at Temple University
and Philadelphia, Pennsylvania, USA
National Heart and Lung Institute Athol U. Wells
Imperial College London
Department of Interstitial Lung Disease
London, United Kingdom Royal Brompton Hospital
Maria Elena Vega Sanchez London, United Kingdom
Department of Thoracic Medicine and Surgery S. John Wort
Lewis Katz School of Medicine at Temple University
Royal Brompton Hospital
Philadelphia, Pennsylvania, USA London, United Kingdom
Emily S. Wan Xu Zeng
Channing Division of Network Medicine Department of Pathology and Laboratory Medicine
Brigham and Women's Hospital
Lewis Katz School of Medicine at Temple University
Boston, Massachusetts, USA Philadelphia, Pennsylvania, USA
He Wang Zaid Zoumot
Department of Pathology and Laboratory Medicine Respiratory and Critical Care Institute
Lewis Katz School of Medicine at Temple University
Cleveland Clinic Abu Dhabi
Philadelphia, Pennsylvania, USA Abu Dhabi, United Arab Emirates
Simon Ward Richard ZuWallack
Lung Function Department Pulmonary and Critical Care
Royal Brompton and Harefield NHS Foundation Trust
Trinity Health of New England
London, United Kingdom University of Connecticut
Hartford, Connecticut, USA
 PART 1
Basic sciences

1 Lung anatomy and development 2

Jonathan A. Galli, Marc S. Diamond, and Gilbert E. D’Alonzo
2 Pathology 15
Beata Kosmider, Karim Bahmed, Xu Zeng, He Wang, and Thomas J. Rogers
3 Genetics of lung diseases 37
Emily S. Wan

Lung anatomy and development
JONATHAN A. GALLI, MARC S. DIAMOND, AND GILBERT E. D’ALONZO
LUNGS
Introduction: Lobes and pleura
The lungs, the principal organs of respiration, are located on
either side of the heart within the thorax. The hilum, or root
of the lung, is the pathway through which airways and
vessels traverse and communicate with the lungs. The lungs
are conical in appearance and take on a shape congruent
with surrounding structures (i.e., a concave base due to the
adjacent dome of the diaphragm). The right lung is divided
into two interlobular fissures into an upper, middle, and
lower lobe. The horizontal fissure separates the right upper
lobe from the other lobes, while the oblique fissure divides
the right middle and lower lobes. The horizontal and oblique
fissures intersect at the midaxillary line. The left lung, in
contrast, is divided into only an upper and lower lobe. The
oblique fissure of the left lung separates the left upper and
lower lobes (Figure 1.1).
Each lung is concealed by an inner visceral pleura and an
outer parietal pleura. Both pleural surfaces are lined by
mesothelium, a squamous epithelium with long microvilli.
The pleural space contains a thin film of serous fluid (pleural
fluid) that acts as a lubricant between the surfaces. In adults,
the normal volume of pleural fluid is between 15 and 20 mL.
An abnormal collection of air within the pleural space is
termed a pneumothorax and may result from penetrating
chest trauma, iatrogenic injuries (i.e., during central venous
catheter insertion), or ruptured blebs (Figure 1.2).
Bronchopulmonary segments
Bronchopulmonary segments are regions of the lung supplied
by a specific tertiary bronchus and arteries. They represent
functional, anatomic, and surgical subunits of the lung. The
right lung has a total of 10 bronchopulmonary segments (3 in
the upper lobe, 2 in the middle lobe, and 5 in the lower lobe).
In comparison, in most adults, the left lung has only eight
bronchopulmonary segments (four in the left upper lobe and
four in the left lower lobe) due to merging that occurs between
some segments during development. The anatomic location
2
1
of the various bronchopulmonary segments is depicted in
Figure 1.3.
Learning point
• The right lung is comprised of 10 bronchopulmonary
segments, whereas the left lung contains 8 bron-
chopulmonary segments.
AIRWAYS
The airways of the human respiratory system are comprised
of a complex array of networks that together allow for the
essential process of gas exchange. The crudest way to sub-
divide this system is by delineating the extrathoracic from
intrathoracic airways. The extrathoracic airway includes the
supraglottic, glottis, and infraglottic regions. The intratho-
racic airway originates at the trachea and further divides into
numerous bronchial generations that ultimately terminate at
the alveoli. In this chapter, we will focus primarily on the
intrathoracic airways.
Trachea
The trachea, a fibromuscular and cartilaginous tube, is the
most proximal (cephalad) airway structure of the intrathoracic
airway. The trachea originates from the cricoid cartilage at
the level of the sixth cervical vertebra and extends inferiorly to
the main carina at the level of the fifth thoracic vertebra. The
adult trachea is 10–12 cm in length, with a diameter ranging
from 15 to 20 mm. The trachea contains 16–20 “C”-shaped
cartilaginous rings. The posterior wall of the trachea lacks
cartilage and is instead supported by a thin layer of smooth
muscle (Figure 1.4). As a result, the appearance of the trachea
on computed tomography may vary with respiration due to
invagination of the posterior wall that occurs with expiration.
The absence of cartilage in the posterior wall is of cli-
nical importance in understanding the differing patterns of
involvement in various tracheal abnormalities. Relapsing
 Airways 3

Right lung Left lung

Right upper lobe Left upper lobe

Midaxillary line

Horizontal fissure

Right middle lobe Oblique fissure

Oblique fissure
Left lower lobe
Right lower lobe

Cardiac notch

Figure 1.1 Lobes and fissures of the left and right lungs.

123 doe^john Date 04.05.2008 [09:08:15]

--,--,---- [M] Age:---

Figure 1.2 Chest radiograph from a patient who presented to the emergency department with acute onset dyspnea found to
have a primary spontaneous pneumothorax of the left lung.
4 Lung anatomy and development

Right lung-lateral aspect Left lung-lateral aspect

Apical Apico-
posterior

Posterior
Anterior Anterior Superior

Superior
Lateral Superior
lingular Antero-
medial
Medial Lateral
basal
Anterior basal
basal Inferior
Lateral lingular
basal

Note: Note:
posterior basal and medial basal posterior basal segment is
segments are obscured from view obscured from view

Figure 1.3 Diagram of the bronchopulmonary segments. The right lung normally contains 10 different bronchopulmonary
segments, while the left lung contains 8.

Pseudostratified ciliated columnar epithelium

Cartilage

Tracheal lumen

Posterior wall of trachea

(thin smooth muscle layer lacking cartilage)

Figure 1.4 Histologic cross-sectional picture of the adult trachea. Note the C-shaped cartilaginous ring that spares the posterior
wall of the trachea.

polychondritis and tracheobronchopathia osteochondro-

plastica, two rare disorders affecting cartilage, result in tra-
cheal abnormalities that notably spare the posterior wall.
If posterior tracheal wall involvement is seen, alternative
etiologies (i.e., amyloidosis, sarcoidosis) unrelated to carti-
lage dysfunction should be explored.
Learning point
• The posterior wall of the trachea lacks cartilage.
Conditions that affect the cartilage of the trachea
(i.e., tracheobronchopathia osteochondroplastica)
will characteristically spare the posterior wall.

Left and right mainstem bronchus
The carina branches off to form the cartilaginous left and right
mainstem bronchus, respectively. The left mainstem bronchus
is longer than the right mainstem bronchus because it must
traverse underneath the aortic arch on its path to the left lung.
The right mainstem bronchus is at greater risk for entrance of
aspirated contents due to its shorter length, wider diameter,
and more vertical alignment in comparison to the left
mainstem bronchus. Therefore, it is not uncommon for
aspiration pneumonia to occur in the dependent regions of the
right lung (Figure 1.5). The right mainstem bronchus further
divides into the right upper lobe bronchus and the bronchus
intermedius. The left mainstem bronchus, in contrast, divides
to form the left upper and left lower lobe bronchi (Figure 1.6).
Learning point
• Aspirated contents preferentially enter the depen-
dent portions of the right lung via the right mainstem
bronchus due to its shorter length, wider diameter,
and more vertical alignment in comparison to the left
mainstem bronchus.
Figure 1.5 Chest radiograph of a 38-year-old male with aspiration pneumonia related to a drug overdose. Aspirated contents
preferentially enter the right lung via the right mainstem bronchus due to its shorter length, wider diameter, and more vertical
alignment in comparison to the left mainstem bronchus.
Airways 5
Airway divisions
From the trachea to the alveoli, the airway undergoes
repeated dichotomous branching to form at least 23 distinct
generations. The first 14 generations (referred to as the
conducting zones) include the trachea, bronchi, and terminal
bronchioles. The conducting zones do not contain alveoli,
are incapable of participation in gas exchange, and thus
constitute the anatomic dead space. The last generations
(referred to as the transitional and respiratory zones) are
comprised of the respiratory bronchioles, alveolar ducts, and
alveolar sacs (Figure 1.7).
Learning point
• The walls of bronchioles characteristically lack a fibro-
cartilaginous layer.
The structural characteristics of the airway wall evolve
with subsequent branching and formation of smaller sub-
divisions (Table 1.1). The large airways of the conducting
zone (the trachea and bronchi) share a pseudostratified cil-
iated columnar epithelium. The cilia have a characteristic
CJW
Portable
Erect
6 Lung anatomy and development

Trachea

Right mainstem bronchus Left mainstem bronchus

Left upper lobe bronchus

Right upper lobe bronchus

Bronchus intermedius Left lower lobe bronchus

Figure 1.6 Airway divisions of the left and right mainstem bronchus.

Tertiary bronchus

Bronchiole

Terminal bronchiole
Respiratory bronchiole
Alveolar duct

Alveolar sac
CO2

O2
Alveolus
Capillaries

Respiratory zones Conducting zones

Figure 1.7 Diagram of the conducting and respiratory zones.

Table 1.1 Comparison of airway wall characteristics at key anatomic sites

Cartilage Epithelium Smooth muscle Specialized secretory cells

Trachea/Bronchi + Pseudostratified ciliated columnar + Goblet cells
Bronchioles − Cuboidal ciliated + Clara cells
Alveoli − • Squamous (type I cells) >90% − Type II surfactant cells
alveolar surface
• Cuboidal (type II cells)
 Airways 7

microtubule formation (two central signets surrounded by
nine peripheral doublets) (Figure 1.8). In addition, the epi-
thelium contains secretory cells known as goblet cells that
produce and release mucous. The production of mucous
along with the rhythmic movement of cilia allow for retrieval
and a “sweeping” of inspired dust particles up and out of the
respiratory tract. Basal cells, another specialized cell-type in
the epithelium, function as reserve cells capable of differen-
tiating into goblet or columnar epithelial cells. Distal to the
epithelium is the submucosal layer (comprised of smooth
muscle and mucous glands) and, finally, the fibrocartilaginous
layer that provides a supporting framework (Figure 1.9).

100 nm 1/7/0 REMF

Figure 1.8 Electron micrograph image of respiratory cilia in cross-section. Note the characteristic microtubule arrangement of
motile cilia (nine peripheral doublets + two central singlets).

Bronchus Bronchlole
GC

CL

Mucosa CC

BC
BM

SM
Submucosa

MG

Fibrocartilaginous
layer CA

(a) (b)

Figure 1.9 Diagram of the cellular components comprising the airway wall. Note the contrasting structures present in the large
airways (panel a) compared to the smaller airways (panel b). CC, ciliated columnar epithelial cell; GC, goblet cell; BM, basement
membrane; BC, basal cell; SM, smooth muscle; MG, mucous gland; CA, cartilage; CL, Clara cell.
8 Lung anatomy and development
Learning point
• At the level of the alveolus, the smooth muscle com-
ponent of the airway wall disappears and is replaced
primarily by type I pneumocytes.
The bronchioles have distinct airway wall features that
distinguish them from the large conducting airways. The
bronchioles lack the fibrocartilaginous layer present in the
walls of the trachea and bronchi. In addition, the smooth
muscle layer thins at the level of the bronchioles and the
epithelium transitions to a ciliated cuboidal epithelium. Clara
cells, a cuboidal nonciliated secretory cell, are present in
terminal bronchioles and assist with detoxification of toxic
substances via the cytochrome P-450 system. Goblet cells
occur less frequently and ultimately disappear at the terminal
bronchioles. At the level of the alveolus, the smooth muscle
layer disappears and the epithelium evolves to principally a
squamous (type 1 epithelial) cell layer.
ALVEOLAR–CAPILLARY UNIT
The evolution of terminal bronchioles into respiratory
bronchioles marks the transition to the respiratory zones.
Alveoli begin to appear here, with distal branches eventually
terminating into rich networks of interconnected alveoli
with surrounding capillary networks. Small channels in the
epithelium known as interalveolar pores of Kohn are also
present. This alveolar–capillary unit that forms is the loca-
tion for gas exchange in the lung, which is achieved by
passive diffusion.
The alveoli contain a thin epithelial layer that encompasses
an immense surface area, allowing for tremendous efficiency
in the gas exchange process (Figure 1.10). The alveolar surface
area in humans has been estimated at 50–75 square meters,
which is approximately the size of half a tennis court. The slim
alveolar epithelium is chiefly composed of squamous type I
pneumocytes (>95%) and, to a lesser extent, cuboidal type II
pneumocytes. Type I pneumocytes have a simplistic design,
Alveolar Type II
space
Capillary
Type I
RBC
IS
RBC
Interstitial space
Type II
Alveolar
space
Figure 1.10 Diagram of the normal alveolar structure with
surrounding capillaries and interstitial space. RBC, red blood
cell.
as evidenced by a thin cytoplasmic layer, small nucleus, and a
modest collection of organelles. This basic configuration,
while detrimental to metabolic activity, is an optimal conduit
for efficient gas exchange. Type I cells are prone to damage
given their thin design and the immense surface area they
cover; however, their simple intracellular machinery does not
allow for repair by mitosis (cell division).
Type II pneumocytes, cuboidal-shaped alveolar epithelial
cells, contain a breadth of intracellular organelles allowing
for increased functionality. Type II pneumocytes perform
two primary duties: repairing the alveolar epithelium by
differentiating into type I pneumocytes and producing pul-
monary surfactant. Pulmonary surfactant is primarily com-
posed of dipalmitoylphosphatidylcholine, a lipid molecule
that prevents alveolar atelectasis by reducing alveolar sur-
face tension. Surfactant deficiency in infancy is associated
with respiratory distress syndrome of the newborn, while
excessive surfactant accumulation in adulthood may lead
to pulmonary alveolar proteinosis. The epithelial repair
mechanism performed by type II pneumocytes takes two to
five days to occur and under normal conditions is adequate
for maintenance of the alveolar epithelium. In periods of
extreme stress (i.e., acute respiratory distress syndrome)
excessive destruction of type I cells lead to a “leaky” alveolar
epithelium and subsequent development of alveolar edema,
which hinders gas exchange (Figure 1.11).
Learning point
• Dipalmitoylphosphatidylcholine (DPPC), a lipid mol-
ecule that reduces alveolar surface tension, is the
primary component of pulmonary surfactant.
The capillary endothelium, a key element of the alveolar–
capillary unit, contains loose junctions, allowing for nearly
unrestricted flow of solutes and smaller molecules between the
blood and the interstitial space. The interstitium of the alve-
olar septum is thin and contains a variety of cells, including
fibroblasts, lymphocytes, mast cells, granulocytes, and plasma
cells. Alveolar macrophages are important immune cells that
travel freely across the surface of the epithelium via their
pseudopodia. Their exceptional phagocytic capabilities act as
an important host defense against inhaled pathogens.
PULMONARY CIRCULATION
Type I
The pulmonary circulation encompasses an intricate arrange-
ment of vasculature that primarily functions to deliver
deoxygenated blood to the alveoli for gas exchange. The
pulmonary arterial circulation receives the entire cardiac
output (about 6 L/min in adults) from the right side of the
heart. The main pulmonary artery, the largest vessel of the
pulmonary circulation, originates from the right ventricle and
splits to form the left and right pulmonary artery, respectively.
Smaller generations of pulmonary arteries, located in the
center of lobules, follow an analogous course with adjacent
 Pulmonary circulation 9

Erect port 9:40 AM

Figure 1.11 Chest radiograph from a 32-year-old man with acute respiratory distress syndrome (ARDS) from pneumonia.
Additionally, the patient had apical pneumothoraces bilaterally. In ARDS, a “leaky” alveolar epithelium is caused by excessive
destruction of type I pneumocytes. This results in the development of noncardiogenic pulmonary edema.

bronchi and branch parallel to them. The pulmonary arteries
lead into arterioles and eventually terminate with the for-
mation of a thin-walled dense capillary network surrounding
the alveolar walls.
After gas exchange occurs at the alveolar–capillary unit, the
capillary network forms into venules that coalesce into pul-
monary veins. Pulmonary veins, in contrast to pulmonary
arteries, course through connective tissues between lobules
independent from the parallel course of bronchi and arteries.
The pulmonary veins develop into larger superior and inferior
pulmonary veins for each respective lung (four total), which
lastly return oxygenated blood to the left atrium of the heart.
The bronchial circulation, a second pulmonary blood
supply, provides nutrients to the airways and connective
tissue of the lung. The bronchial arteries originate from
either the thoracic aorta or the upper intercostal arteries
(Figure 1.12). The bronchial arteries also contribute to the
blood supply of the visceral pleura via anastomoses that form
with pulmonary arteries. Of note, only blood received from
the bronchial arteries is oxygenated. The bronchial veins
return only a small portion of blood supplied by the bron-
chial arteries, with the remainder entering into the pulmo-
nary veins (a region of normal admixture of oxygenated and
deoxygenated blood).

Superior left
bronchial artery
(directly from aortic arch
T6 at level of T5 or T6)
Right bronchial artery
(from fifth or sixth
posterior intercostal artery) Inferior left
bronchial artery
(directly from aortic arch
at level of T5 or T6)

T8

T10

Anterior to bronchi Descending aorta

Posterior to bronchi

Figure 1.12 Bronchial artery circulation. Note that the right bronchial artery arises from an intercostal artery, while the superior
and inferior left brachial arteries arise directly from the aorta.
10 Lung anatomy and development

LYMPHATICS OF THE PULMONARY 1

SYSTEM
The intricate pulmonary lymphatic system plays important
roles in both defense and thoracic fluid homeostasis. The
circulation of the lymphatic system is unidirectional and
commences with the drainage of interstitial fluid that has
seeped from capillaries and drains into lymphatic capillaries
followed by lymphatic vessels. The lymphatic vessels are
equipped with smooth muscle and valves, which efficiently
transport lymph through septal structures toward the hilum.
The main lymphatic channels course superiorly and follow
the tracheobronchial tree. The left-sided channels ultimately
drain into the thoracic duct, whereas the lymphatic channels
on the right drain directly into the right subclavian vein.
The network of thoracic lymph nodes serves to filter
lymph fluid collected by the lymphatic vessels. The lymph
nodes follow a bronchial distribution and are located adja-
cent to major bronchi and associated subsegments. As the
lymphatic system passes superiorly and centrally, the nor-
mal lymph node diameter increases, with subcarinal and
paratracheal lymph nodes measuring 5–10 mm. The Inter-
national Association for the Study of Lung Cancer has
proposed a regional thoracic lymph node station map to
standardize lymph node labeling and to assist with oncologic
staging (Figure 1.13).
Learning point
• Lymphatic channels on the left drain into the thoracic
duct. In contrast, on the right, they drain directly into
the right subclavian vein.
LUNG INNERVATION
The lungs are innervated by the autonomic nervous system,
which provides both sympathetic and parasympathetic nerve
fibers. The vagal nerve (cranial nerve X) provides parasym-
pathetic innervation to the lungs, while sympathetic fibers
originate from the upper thoracic and cervical ganglia. At the
2R 2L
4R 4L
7
10R 10L
11R 11L
Figure 1.13 Diagram of the thoracic lymph node staging map
with locations of lymph nodes accessible by endobronchial
ultrasound-guided transbronchial needle aspiration.
hilum, these fibers combine to form the pulmonary nervous
plexus, which provides innervation to the bronchial tree and
visceral pleura.
The sensory (afferent) and motor (efferent) fibers of the
respiratory nervous system interact to provide mechanisms
capable of adjusting to various mechanical and chemical
conditions. Sensory receptors of the lung have broadly been
divided into three groups: SARs, RARs, and unmyelinated C
fibers. C fibers comprise the majority of afferent fibers in the
lung (75%) and respond to numerous stimuli including
cigarette smoke, histamine, bradykinin, prostaglandin, and
serotonin. The major stimuli and associated reflex effects for
each afferent receptor are summarized in Table 1.2. The
motor (efferent) fibers contain both sympathetic and para-
sympathetic components and affect the smooth muscle tone
of both airways and blood vessels.
A third nervous system of the lung has been described
and is called the nonadrenergic, noncholinergic (NANC)
system. The neuromodulators vasoactive peptide (VIP) and

Table 1.2 Stimuli and reflexes for major afferent receptors in the lung

C Fibers SAR RAR

Myelinated − + +
Major stimuli • Δ Lung volume • Δ Lung volume • Δ Lung volume
• Chemical stimuli • Chemical stimuli • Chemical stimuli
• Δ Temperature
Reflex effects • Bronchoconstriction • Bronchodilation • Bronchoconstriction
• Vasodilation • Tachycardia • Cough
• Bradycardia • ↑ Inspiratory effort • ↑ Mucous secretion
• Apnea
• ↑ Mucous secretion
Another random document with
no related content on Scribd:
 Not of wars and wars’ alarms,
Yours the songs of woman’s charms,
Your tones silk-fitting rosy lips
From which the kissing lyric slips.

When he limped along the trail

That his wild men might not fail
Of the sacrament which saves
And lights the shadowed way of graves
Did the halt monk, thinking how
His Saint Francis on the bough
Gathered all the gracious birds,
Preached to them the gospel’s words,
Still his earnest heart to hear
Your lover-calls sing out their cheer,
And for one heart-beat clean forgot
The Christ-fervor of his thought,
Hearing words that thrilled his soul
Ere he wore the hallowed stole,
Among red roses there in Spain
Where he’ll never walk again?

But these tongues you cannot speak,

Hebrew, Latin, Spanish, Greek;
’Tis in Anglo-Saxon tongue
Your name-calls are sweetly sung.

If from Saxon land you hail,

Not the Mayflower was your sail;
But some daring Cavalier
Loved your song and brought you here,—
Fervid, knightly, militant,
Still his heart your raptures chant;
And from his sorrows maybe came
Your minors, wavering like flame
Which marked the ashes that remain
When wild men have burned and slain;
 In your tones the Southern tongue,
Chivalry forever young,
Love the only noble theme
When we’re waking, when we dream?

But your secret still allures,

Whence came those sweetheart names of yours?

You, the American of birds,

You are singing English words;
So where Shakespeare’s tongue we speak
There your secret we must seek.

But your name? that tells it all;

Changes to your tongue befall,
And you can speak each language new
Or sing the last light wind that blew;
You hearken, and new gossipings
Are music-scattered by your wings;
You overhear and feel no shames;
And call out loud the lovers’ names.

In some dear later days you heard

This you sing in true love’s word.

I think that in our war’s some year

Your throat was taught these words so dear;
When Grant’s and Lee’s were names of dread,
Where billowed fields with sweetheart dead.

Your “Peter! Peter,” there you learned

As “Gertie! Gertie” to him yearned.
It was a time when sorrow rent
Full many a heart of sweet content.

’Twas beneath sweet Southern pines;

They walked softly on the spines,
While you, silent, on your nest
 Heard these names, and all the rest
Which passioned from their lips that time
You caught their name-calls in your rhyme;
E’en that night ’neath star-bright skies
Your joy-song sang their sweet Good-bys.

You’re an emigrant, as we;

Other states our birth-states be,
And we bring out memories here,
Bright with smile, or darked with tear;
So in California’s sun
Sings your song, back there begun.

But do you know, O song-heart brave,

That Peter’s in an unknown grave,
Where the Rappahannock flows;
No more fearing war’s dread blows?
And not a mound to mark the place
Where went out his sweetheart face;
And not a bough where some song-mate
Might his hero deeds relate,
And recall in bird-sweet lay
How called he Gertie’s name that day?

And Gertie grieved where the lagoons

Sluggish gulfward with their tunes,
And with breaking heart grew old
Waiting for her soldier bold,—
Dying lonely, lonely past,
Calling “Peter” to the last.

Where she’s resting no one notes,

Save your song-mates with sweet throats.

Do you know? Is that the note

Which sometimes saddens from your throat,
And makes my heart slow down a throb,
And my words hush in a sob?
That’s the Gertie, that’s the Peter
Who go rapturing through your meter!
Since within your song they live
Where skies such sunny brightness give,
Maybe in the Sky of skies
Love calls, hearing love’s replies;
Through some angel-mocking bird
All the earth-old sweetness heard,—
Gertie! Peter! still as dear
As when called their love-names here?

So our thoughts, as your fleet wings

Above the dark earth lightly springs,
Think that skies of brightness say,
“Love is love for aye and aye!”
And this Gertie and this Peter
Gentles love through angel-meter,
Which the grace of God outrhymes,
Calling, calling endless times!

When “Gertie,” “Peter” you so lift

As if the very stars you’d sift,
Down to their souls to voice their bliss,
O mocking-birds, do you know this?

A JOLLY GOOD FRIENDSHIP IS BETTER THAN ALL

(A BALLADE)
By Henry Meade Bland

You may travel in China, Luzon, or Japan;

Or lodge on the plains of the Ultimate West;
You may lounge at your ease on a rich divan;
And drink of red wine at a king’s behest,
Then lie by the hour in slumberous rest,
And be of deep joy a subservient thrall,
Yet awake with a feel that is clearly confessed,
 That a jolly good friendship is better than all!

You may sail from your home-port a half-a-world span,

And touch the Sweet Isle with joy in your breast;
You may sing as you sail, and shout as you scan
The white airy foam-flakes that ride the fair crest
Of orient wave: but, truly the test
Of laughters and pleasures that come at a call
Is fellowship rising in full easy zest—
A jolly good friendship is better than all!

You may listen to Melba or Sembrich and plan

With a five-dollar note to corner the best
Of Caruso’s high-piping; and be in the van
Of those who would fain with great Patti be blest:
But you’ll learn when you come to the end of your quest,
And find that the sweetest in cabin or hall,
No matter what note or what harmony stressed,
The lilt of good friendship is better than all!

ENVOI

Aye, rarer than any rare vintage e’er pressed

For banqueter merry or bold bacchanal;
Aye, better than nectar e’er dream of or guessed—
A jolly good fellowship is better than all.

THE TRAILMAN
(Lines written in 1909 in honor of John Muir)
By Henry Meade Bland

A spirit that pulses forever like the fiery heart of a boy;

A forehead that lifts to the sunlight and is wreathed forever in joy;
A muscle that holds like the iron that binds in the prisoner steam;
Yea, these are the Trailman’s glory; Yea, these are the Trailman’s
dream!
An eye that catches the splendor as it shines from mountain and sky;
And an ear that awakes to the song of the storm as it surges on high;
A sense that garners the beauty of sun, moon, or starry gleam;
Lo, these are the Trailman’s glory; Lo, these are the Trailman’s
dream!

The wild, high climb o’er the mountain, the lodge by the river’s brim;
The glance at the great cloud-horses, as they plunge o’er the range’s
rim;
The juniper’s balm for the nostril, the dash in the cool trout stream;
Yea, these are the Trailman’s glory; Yea, these are the Trailman’s
dream!

The ride up the wild river-canyon where the wild oats grow breast
high;
The shout of the quail on the hillside; the turtle dove flashing by;
An eve round the fragrant fire, and the tales of heroic theme;
Lo, these are the Trailman’s glory; Lo, these are the Trailman’s
dream!

THE HYMN OF THE WIND

By Howard V. Sutherland

I am the Wind, whom none can ever conquer;

I am the Wind, whom none may ever bind.
The One who fashion’d ye,
He, too, has fashion’d me—
He gave to me dominion o’er the air.
Go where ye will, and ye shall ever find
Me singing, ever free,
Over land and over sea,
From the fire-belted Tropics to the Poles.

I am the Wind. I sing the glad Spring’s coming;

I bid the leaves burst forth and greet the sun.
I lure the modest bloom
 From out the soil-sweet gloom;
I bid the wild-bird leave the drowsy South.
My loves are violets. By my pure kisses won,
They spring from earth, and smile,
All-innocent, the while
I woo them in the aisles of pensive woods.

I am the Wind. From dew-pearl’d heights of wonder

I fall like music on the listening wheat.
My hands disturb its calm
Till, like a joyous psalm,
Its swaying benediction greets the sky.
I kiss the pines that brood where seldom falls
The solace of the light,
And the hush’d voice of Night
Soothes the awed mountains in their somber dreams.

I am the Wind. I see enorme creations

Starring the vault above ye, and below.
Where bide the Seraphim
In silent places dim
I pass, and tell your coming in the end.
Omniscient I, eternal; and I know
The gleaming destiny
That waits ye, being free,
When ye have pass’d the border-line of Death.

I am the Wind—the Lord God’s faithful servant;

’Twixt earth and sky I wander, and I know
His Sign is ever found
The blue-veil’d earth around,
As on the furthest spheres that whirl in space,
All things are His; and all things slowly go
Through manifold degrees
Of marvelous mysteries,
From life to highest life, from highest life to Him.

I am the Wind. I know that all is tending

To that bright end; and ye, through years of toil
Shall reach at last the height
Where Freedom is, and Light;
And ye shall find new paths that still lead up.
Be free as I; be patient and have faith;
And when your scroll is writ
And God shall pass on it,
Ye need not fear to face Him—He is Love.

DRIFTING
By Thomas Buchanan Read

My soul to-day
Is far away,
Sailing the Vesuvian Bay;
My wingèd boat,
A bird afloat,
Swims round the purple peaks remote:—

Round purple peaks

It sails and seeks
Blue inlets and their crystal creeks,
Where high rocks throw,
Through deeps below,
A duplicated golden glow.

Far, vague and dim

The mountains swim;
While on Vesuvius’ misty brim,
With outstretched hands,
The gray smoke stands
O’erlooking the volcanic lands.

Here Ischia smiles

O’er liquid miles;
And yonder, bluest of the isles,
 Calm Capri waits,
Her sapphire gates
Beguiling to her bright estates.

I heed not, if
My rippling skiff
Float swift or slow from cliff to cliff;—
With dreamful eyes
My spirit lies
Under the walls of Paradise.

Under the walls

Where swells and falls
The Bay’s deep breast at intervals
At peace I lie,
Blown softly by,
A cloud upon this liquid sky.

The day, so mild,

Is Heaven’s own child,
With Earth and Ocean reconciled;—
The airs I feel
Around me steal
Are murmuring to the murmuring keel.

Over the rail

My hand I trail
Within the shadow of the sail,
A joy intense,
The cooling sense
Glides down my drowsy indolence.

With dreamful eyes

My spirit lies
Where Summer sings and never dies,—
O’erveiled with vines,
She glows and shines
Among her future oil and wines.
 Her children, hid
The cliffs amid,
Are gamboling with the gamboling kid;
Or down the walls,
With tipsy calls,
Laugh on the rocks like waterfalls.

The fisher’s child,

With tresses wild,
Unto the smooth, bright sand beguiled,
With glowing lips
Sings as she skips,
Or gazes at the far-off ships.

Yon deep bark goes

Where traffic blows,
From lands of sun to lands of snows;—
This happier one,
Its course is run
From lands of snow to lands of sun.

O happy ship,
To rise and dip,
With the blue crystal at your lip!
O happy crew,
My heart with you
Sails, and sails, and sings anew!

No more, no more
The worldly shore
Upbraids me with its loud uproar;
With dreamful eyes
My spirit lies
Under the walls of Paradise!

JOHN ANDERSON, MY JO
 By Robert Burns

John Anderson, my jo, John,

When we were first acquent,
Your locks were like the raven,
Your bonnie brow was brent;
But now your brow is beld, John,
Your locks are like the snaw;
But blessing on your frosty pow,
John Anderson, my jo.

John Anderson, my jo, John,

We clamb the hill together;
And monie a canty day, John,
We’ve had wi’ ane anither;
Now we maun totter down, John,
But hand in hand we’ll go;
And sleep thegither at the foot,
John Anderson, my jo.

RECESSIONAL
By Rudyard Kipling

God of our fathers, known of old—

Lord of our far-flung battle-line,
Beneath whose awful hand we hold
Dominion over palm and pine—
Lord God of Hosts, be with us yet,
Lest we forget—lest we forget!

The tumult and the shouting dies—

The captains and the kings depart,
Still stands Thine ancient Sacrifice,
An humble and a contrite heart—
Lord God of Hosts, be with us yet,
Lest we forget—lest we forget!
Far-called, our navies melt away—
On dune and headland sinks the fire;
Lo! all our pomp of yesterday
Is one with Nineveh and Tyre!
Judge of the Nations, spare us yet,
Lest we forget—lest we forget!

If drunk with sight of power, we loose

Wild tongues that have not Thee in awe—
Such boastings as the Gentiles use,
Or lesser breeds, without the law—
Lord God of Hosts, be with us yet,
Lest we forget—lest we forget!

For heathen heart that puts its trust

In reeking tube, and iron shard—
All valiant dust, that builds on dust,
And guarding call not Thee to guard—
For frantic boast and foolish word,
Thy mercy on Thy people, Lord!

MY COUNTRY
By Robert Whitaker

My country is the world; I count

No son of man my foe,
Whether the warm life-currents mount
And mantle brows like snow
Or red or yellow, brown or black,
The face that into mine looks back.

My native land is Mother Earth,

And all men are my kin,
Whether of rude or gentle birth,
However steeped in sin;
Or rich, or poor, or great, or small,
I count them brothers, one and all.

My birthplace is no spot apart,

I claim no town nor State;
Love hath a shrine in every heart,
And wheresoe’er men mate
To do the right and say the truth,
Love evermore renews her youth.

My flag is the star-spangled sky,

Woven without a seam,
Where dawn and sunset colors lie,
Fair as an angel’s dream;
The flag that still, unstained, untorn,
Floats over all of mortal born.

My party is all human-kind,

My platform brotherhood;
I count all men of honest mind
Who work for human good,
And for the hope that gleams afar,
My comrades in this holy war.

My heroes are the great and good

Of every age and clime,
Too often mocked, misunderstood,
And murdered in their time;
But spite of ignorance and hate
Known and exalted soon or late.

My country is the world; I scorn

No lesser love than mine,
But calmly wait that happy morn
When all shall own this sign,
And love of country as of clan,
Shall yield to world-wide love of man.
 SOMEWHERE ADOWN THE YEARS
By Robert Whitaker

Somewhere adown the years there waits a man

Who shall give wings to what my soul has said:
Shall speak for me when I am mute and dead;
And shall perfect the work I but began.

What matter, therefore, if my word to-day

Falls on unwilling ears, finds few to praise?
Since some mere child, in his incipient days,
That word may win to walk a prophet’s way?

And he, of greater gift, more favored state,

Shall speak to thousands where I speak to one:
Shall do the work that I would fain have done;
Helped to that fortune at my lonely gate.

Perchance some Saul of Tarsus, hating me,

And hating mine while yet misunderstood,
Stung by my word shall some day find it good,
And bear it broadcast over land and sea.

Or some Saint Augustine, of careless mien,

Giving himself to sensuous pleasures now,
Shall catch the glory from his mother’s brow
That in some word of mine her soul hath seen.

Nay, but I claim no honor as my own

That is not equally the goal for all
Who run with truth, and care not though it fall
That they must sometimes run with her alone.

God will not suffer any word to fail

That is not uttered for the hour’s success:
No word that has in it the power to bless
Shall lack the means to make it of avail.
Who speaks the people’s weal shall some day find
Voices to bear it to the people’s will.
However potent be the present ill
They who assail it are to-morrow’s kind.

And that to-morrow shall uphold their cause

Who fell not for the plaudits of to-day:
Those who are reckoned rebels in their day
Are always makers of to-morrow’s laws.

Our present skeptics voice to-morrow’s faith;

To-day’s disturbers bring to-morrow’s peace:
’Tis they who dare to die who win release
For all their fellows from the fear of death.

SERENADE
By Henry Wadsworth Longfellow

Stars of the summer night!

Far in your azure deeps,
Hide, hide your golden light!
She sleeps!
My lady sleeps!
Sleeps!

Moon of the summer night!

Far down yon western steeps,
Sink, sink in silver light!
She sleeps!
My lady sleeps!
Sleeps!

Wind of the summer night!

Where yonder woodbine creeps,
Fold, fold thy pinions light!
She sleeps!
My lady sleeps!
 Sleeps!

Dreams of the summer night!

Tell her, her lover keeps
Watch, while in slumbers light
She sleeps!
My lady sleeps!
Sleeps!

THE BROOKSIDE
By Richard Monckton Milnes

I wandered by the brookside,

I wandered by the mill;
I could not hear the brook flow,—
The noisy wheel was still.
There was no burr of grasshopper,
No chirp of any bird,
But the beating of my own heart
Was all the sound I heard.

I sat beneath the elm-tree:

I watched the long, long shade,
And, as it grew longer,
I did not feel afraid;
For I listened for a footfall,
I listened for a word,—
But the beating of my own heart
Was all the sound I heard.

He came not,—no, he came not,—

The night came on alone,—
The little stars sat one by one,
Each on his golden throne;
The evening wind passed by my cheek,
The leaves above were stirred,—
But the beating of my own heart
Was all the sound I heard.

Fast, silent tears were flowing,

When something stood behind:
A hand was on my shoulder,—
I knew its touch was kind:
It drew me nearer—nearer—
We did not speak one word,
For the beating of our own hearts
Was all the sound we heard.

THE SPINNING-WHEEL SONG

By John Francis Waller

Mellow the moonlight to shine is beginning;

Close by the window young Eileen is spinning;
Bent o’er the fire, her blind grandmother, sitting,
Is groaning, and moaning, and drowsily knitting,—
“Eileen, achora, I hear some one tapping.”
“’Tis the ivy, dear mother, against the glass flapping.”
“Eileen, I surely hear somebody sighing.”
“’Tis the sound, mother dear, of the summer wind dying.”
Merrily, cheerily, noisily whirring,
Swings the wheel, spins the reel, while the foot’s stirring;
Sprightly, and lightly, and airily ringing,
Thrills the sweet voice of the young maiden singing.

“What’s that noise that I hear at the window, I wonder?”

“’Tis the little birds chirping the holly-bush under.”
“What makes you be shoving and moving your stool in,
And singing all wrong that old song of ‘The Coolin’?’”
There’s a form at the casement,—the form of her true love,—
And he whispers, with face bent, “I’m waiting for you, love;
Get up on the stool, through the lattice step lightly,
We’ll rove in the grove while the moon’s shining brightly.”
Merrily, cheerily, noisily whirring,
Swings the wheel, spins the reel, while the foot’s stirring;
Sprightly, and lightly, and airily ringing,
Thrills the sweet voice of the young maiden singing.

The maid shakes her head, on her lip lays her fingers,
Steals up from her seat,—longs to go, and yet lingers;
A frightened glance turns to her drowsy grandmother,
Puts one foot on the stool, and spins the wheel with the other.
Lazily, easily, swings now the wheel round;
Slowly and lowly is heard now the reel’s sound;
Noiseless and light to the lattice above her
The maid steps,—then leaps to the arms of her lover.
Slower—and slower—and slower the wheel swings;
Lower—and lower—and lower the reel rings;
Ere the reel and the wheel stop their ringing and moving,
Through the grove the young lovers by moonlight are roving.

DOWN THE LANE

By Clinton Scollard

Down the lane, as I went humming, humming,

Who should I see coming
But May Marjory!
“What was that I heard you humming, humming,
As you saw me coming?
Prithee, tell!” said she.

“Oh,” I smiled, “I was just humming, humming,

As I saw you coming
Where boughs met above,—
And the crickets kept on thrumming, thrumming,
As I saw you coming,—
Something about love!”
Ah, her blush it was becoming—coming,
As I kept on humming
 While we walked along,
And the crickets still were strumming, strumming,
As I kept on humming
That low strain of song.

Drooped her eyes as I continued humming;

Ah, ’twas so becoming
To May Marjory!
Then she raised them, and my heart went thrumming,
Though I kept on humming;
“You’re a dear!” said she.

—From Judge.

THE MOUNTAIN MIST

By Hesper Le Gallienne

I am the mist and the lover of mountains,

I, like a scarf, waft and wave in the breeze;
I am the sister of streams and of fountains,
Born ’neath the roots of the flowers and the trees.
Wayward and free
Listen to me—
I am the Now and the Never-to-Be!

Slowly I rise in the cool of the gloaming,

Softly I creep through the grass and the leaves,
Over the river, on past the men homing,
Men living lives midst the fruit and the sheaves,
Airy and light,
Filmy and white,
I come when Daytime is kissing the Night.

I am the Question, so luring, so cunning,

Yet, when you answer, the Answer is—none!
For, when you watch me skipping and running
Yet, when you catch me, you find I am—gone!
 Catch if you can!
Never there ran
Any so fast, be they maiden or man.

THE LOOM OF LIFE

Anonymous

All day, all night, I can hear the jar

Of the loom of life; and near and far
It thrills with its deep and muffled sound,
As the tireless wheels go always round.
Busily, ceaselessly goes the loom
In the light of day and the midnight’s gloom.
The wheels are turning early and late,
And the woof is wound in the warp of fate.
Click! Clack! there’s a thread of love wove in!
Click! Clack! and another of wrong and sin!

What a checkered thing this life will be,

When we see it unrolled in eternity!
Time, with a face like a mystery,
And hands as busy as hands can be,
Sits at the loom with its warp outspread,
To catch in its meshes each glancing thread.
When shall this wonderful web be done?
In a thousand years, perhaps, or one,
Or to-morrow, who knoweth? Not you nor I,
But the wheels turn on, and the shuttles fly.

Ah, sad-eyed weaver, the years are slow,

But each one is nearer the end, I know.
And some day the last thread shall be wove in,
God grant it be love instead of sin.
Are we spinners of woof for this life web, say?
Do we furnish the weavers a thread each day?
It were better then, O my friend, to spin