CP Page and WJ Metzger; eds. 621 pages. New York: Raven; 1994. $125.00. ISBN 0-7817-0135-X. Order phone 212-930-9500.
The internist's primary therapeutic weapons are drugs. The proliferation of pharmacologic agents attests to this and has generated many animal studies and human clinical trials designed to show efficacy and safety. Pharmacology texts and reference books detail the general pharmacology of medications; Drugs and the Lung focuses on pulmonary medicine and extends basic pharmacologic information into a compilation of hundreds of clinical and animal investigations involving drugs used to manage lung diseases, which are a "considerable burden to health systems and economies around the world."
The book's 16 chapters have an average of 184 references each. In some instances, a study is simply noted, but often the results of the research are detailed. This litany is burdensome at times. In one 22-line, two-paragraph discussion of the effect of inhaled steroids on the early and late asthmatic responses, 13 references are cited. Some chapters contain tables organizing references and results for individual classes of drugs. Material that can be used in teaching is plentiful.
Most of the chapters deal with the pharmacotherapy of asthma and airways disease. The first part of the book is devoted to standard therapies and the second to "novel drugs" in the treatment of pulmonary diseases. The detail in the discussions is impressive. All five muscarinic receptors, the two kinin receptors, the two tachykinin receptors, and the five families of phosphodiesterase isoenzymes, for example, are described and examined.
The authors presume that the reader has a strong foundation in pharmacology. Nomenclature can be overwhelming. While learning that it takes 3 years for full hypothalamic-pituitary-adrenal axis recovery when changing from high-dose oral to inhalational steroid therapy, one reads that nedocromil is a salt of pyranoquinoline tricyclic dicarboxylic acid.
Current and future pharmaceutical agents are and will continue to be part of ongoing clinical and experimental research. Page and Metzger have provided a substantial head start for the clinician or investigator interested in lung-drug interaction.
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