Table Of ContentMurray & Nadel’s
Textbook of
Respiratory Medicine
SEVENTH EDITION
Editor-in-Chief Lynn M. Schnapp, MD
V. Courtney Broaddus, MD George R. and Elaine Love Professor
Chair, Department of Medicine
Professor Emeritus of Medicine
School of Medicine and Public Health
University of California San Francisco
University of Wisconsin-Madison
Division of Pulmonary and Critical Care Medicine
Madison, Wisconsin
Zuckerberg San Francisco General Hospital
San Francisco, California Renee D. Stapleton, MD, PhD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Editors
University of Vermont Larner College of Medicine
Joel D. Ernst, MD Burlington, Vermont
Professor of Medicine
Chief, Division of Experimental Medicine
University of California San Francisco School of Medicine Thoracic Imaging Editor
San Francisco, California Michael B. Gotway, MD
Talmadge E. King Jr, MD Professor of Radiology
Department of Diagnostic Imaging
Dean, UCSF School of Medicine
Mayo Clinic
Vice Chancellor for Medical Affairs
Scottsdale, Arizona;
University of California San Francisco
Clinical Associate Professor
San Francisco, California
Departments of Diagnostic Radiology and Biomedical
Stephen C. Lazarus, MD, FCCP, FERS Imaging, and Pulmonary and Critical Care Medicine
Professor of Medicine University of California San Francisco
Division of Pulmonary and Critical Care Medicine San Francisco, California;
Senior Investigator, Cardiovascular Research Institute Clinical Professor
University of California San Francisco University of Arizona College of Medicine
San Francisco, California Phoenix, Arizona;
Adjunct Professor
Kathleen F. Sarmiento, MD, MPH
Department of Biomedical Informatics
Associate Professor of Medicine
Arizona State University
Division of Pulmonary, Critical Care, and Sleep Medicine
Tempe, Arizona
University of California San Francisco;
San Francisco VA Healthcare System
San Francisco, California
Elsevier
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MURRAY & NADEL’S TEXTBOOK OF RESPIRATORY MEDICINE, ED 7 ISBN: 978-0-323-65587-3
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Previous editions copyrighted © 2016, 2010, 2005 by Saunders, an imprint of Elsevier, Inc.
Cover images courtesy Michael B. Gotway, MD (images 1 and 4), and U.S. Centers for Disease Control and
Prevention/Alissa Eckert, MSMI; Dan Higgins, MAMS (image 2); https://phil.cdc.gov/Details.aspx?pid=23311.
Executive Content Strategist: Robin Carter
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Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
We dedicate this Textbook to Dr. John F. Murray. In 1988, Dr. Murray, together with Dr. Jay A. Nadel,
published the first edition of this Textbook. Motivated by his love of teaching, he aimed to create a
comprehensive, clear, authoritative, thoroughly annotated compendium of respiratory medicine, always
integrated with scientific principles. Over the subsequent years and six more editions, he inspired us to
continue his work and to maintain his high standards.
Of all his contributions to respiratory medicine, he was perhaps most proud of the Textbook.
John F. Murray, MD
(1927-2020)
Dedication
To my husband, Chuck, who has been the bedrock. For my parents, to whom I owe all I have, and to my
To the rest of our wonderful family, Chris and Clay, Mary loving wife and daughter, Mary Pat and Allison, for all
the support and inspiration they provide.
and Lydia, and the grandboys Charlie and Rory.
Michael B. Gotway, MD
To my mentors, colleagues and fellow editors for their
inspiration and support of my career and of this project.
V. Courtney Broaddus, MD
To Vicki, Kristina, and Genevieve, who make everything To my wife, Mozelle D. King
worthwhile. To my children, Consuelo King and Malaika King Kattke
Joel Ernst, MD
To my grandchildren, Madison and Siena Kattke
To the memories of my mother and father, Almetta and
Talmadge King
Talmadge E. King Jr, MD
Dedication vii
To my wife, Gail, who makes everything possible, and In loving memory of my parents, who were
better; to my daughter, Hillary, and her husband, an unwavering source of support and encouragement
Andrew, who continue to ask about what I do, and for everything that I did. They may not have
encourage it; to my grandchildren Lola and Axel, who understood why I ran, but they were always at the finish
give me hope for the future and joy in the present; and line to cheer me on.
to the many colleagues, students, and trainees, who Lynn M. Schnapp, MD
made my first 49 years at UCSF so enjoyable.
Stephen C. Lazarus, MD, FCCP, FERS
To my parents, Barbara and Barry Brennan, who taught To my husband Jonathan; our children Walker,
by example the value of hard work, perseverance, Emmerson, and Orion; my parents Myrna and Ted;
and compassion. and my mentors, colleagues, patients, and trainees for a
Kathleen F. Sarmiento, MD, MPH lifetime of pushing me to learn, grow, and change.
Renee D. Stapleton, MD, PhD
Contributors
Lewis Adams, PhD Christopher I. Amos, PhD
Professor of Physiology Professor of Medicine
School of Allied Health Sciences Director, Institute for Clinical and Translational
Griffith University Research Medicine
Gold Coast, Queensland, Australia Associate Director of Quantitative Science
Chapter 36: Dyspnea Dan L. Duncan Comprehensive Cancer Center
Baylor College of Medicine
Rosemary Adamson, MB, BS Houston, Texas
Associate Professor of Medicine Chapter 74: Lung Cancer: Epidemiology
Division of Pulmonary, Critical Care, and Sleep Medicine
University of Washington School of Medicine Douglas A. Arenberg, MD, FACCP
Veterans Affairs Puget Sound Healthcare System Professor of Medicine
Seattle, Washington Division of Pulmonary and Critical Care Medicine
Chapter 23: Ultrasonography: Principles and Basic University of Michigan Medical School
Ann Arbor, Michigan
Thoracic and Vascular Imaging
Chapter 79: Metastatic Malignant Tumors
Dan E. Adler, MD Chapter 80: Benign Lung Tumors
Professor of Pulmonary Medicine
A. Christine Argento, MD, FCCP
Division of Pneumology
University Hospital of Geneva Assistant Professor of Medicine
Geneva, Switzerland Division of Pulmonary and Critical Care Medicine
Northwestern University Feinberg School of Medicine
Chapter 136: Noninvasive Support of Ventilation
Chicago, Illinois;
Professor of Medicine
Evangelia Akoumianaki, MD, PhD
Division of Pulmonary and Critical Care Medicine
Consultant
Johns Hopkins University School of Medicine
Intensive Care Unit
Baltimore, Maryland
University Hospital of Heraklion
Chapter 27: Diagnostic Bronchoscopy: Advanced
Heraklion, Crete, Greece
Techniques (EBUS and Navigational)
Chapter 136: Noninvasive Support of Ventilation
Shaikh M. Atif, PhD
Tyler J. Albert, MD
Instructor of Medicine
Assistant Professor of Medicine
Division of Clinical Immunology
Department of Medicine
University of Colorado Anschutz Medical Campus
Division of General Internal Medicine
Aurora, Colorado
University of Washington School of Medicine
Chapter 16: Adaptive Immunity
Veterans Affairs Puget Sound Health Care System
Seattle, Washington
Najib T. Ayas, MD, MPH
Chapter 12: Acid- Base Balance
Associate Professor of Medicine
University of British Columbia Faculty of Medicine
Kurt H. Albertine, PhD, FAAAS, FAAA
Vancouver, British Columbia, Canada
Edward B. Clark Endowed Chair IV in Pediatrics
Chapter 11: Respiratory System Mechanics and Energetics
Adjunct Professor of Medicine and Neurobiology and
Anatomy
Jennifer M. Babik, MD, PhD
University of Utah School of Medicine
Associate Clinical Professor of Medicine
Editor- in- Chief, The Anatomical Record
Division of Infectious Diseases
Salt Lake City, Utah
University of California San Francisco School of Medicine
Chapter 1: Anatomy
San Francisco, California
Chapter 46a: COVID- 19
Barbara D. Alexander, MD, MHS
Professor of Medicine and Pathology Jessica B. Badlam, MD
Division of Infectious Diseases Assistant Professor of Medicine
Duke University Medical Center Division of Pulmonary Disease and Critical Care Medicine
Durham, North Carolina University of Vermont Larner College of Medicine
Chapter 57: Fungal Infections: Opportunistic Burlington, Vermont
viii Chapter 39: Wheezing and Stridor
Contributors ix
John Randolph Balmes, MD Joshua O. Benditt, MD
Professor of Medicine Professor of Medicine
Division of Occupational and Environmental Medicine Division of Pulmonary and Critical Care Medicine
University of California San Francisco University of Washington School of Medicine
Division of Pulmonary and Critical Care Medicine Director, Respiratory Care Services
Zuckerberg San Francisco General Hospital University of Washington Medical Center
San Francisco, California; Seattle, Washington
Professor of Environmental Health Sciences Chapter 130: The Respiratory System and Neuromuscu-
University of California Berkeley School of Public Health lar Diseases
Berkeley, California
Chapter 102: Indoor and Outdoor Air Pollution Neal L. Benowitz, MD
Emeritus Professor of Medicine
Niaz Banaei, MD University of California San Francisco;
Professor Attending Physician
Departments of Pathology and Medicine (Infectious Departments of Medicine and Biopharmaceutical Sciences
Diseases) Program in Clinical Pharmacology
Stanford University School of Medicine Division of Cardiology
Stanford, California; Zuckerberg San Francisco General Hospital
Medical Director, Clinical Microbiology Laboratory San Francisco, California
Stanford University Medical Center Chapter 65: Smoking Hazards: Cigarettes, Vaping, Marijuana
Palo Alto, California
Chapter 19: Microbiologic Diagnosis of Lung Infection Nirav R. Bhakta, MD, PhD
Associate Professor of Medicine
Christopher F. Barnett, MD, MPH Division of Pulmonary, Critical Care, Allergy, and Sleep
Director, Pulmonary Hypertension Program Medicine
Director, Medical Cardiovascular Intensive Care Unit Director of Education and Associate Director, Adult Pulmo-
Department of Cardiology nary Function Laboratory
Medstar Washington Hospital Center University of California San Francisco
Washington, DC San Francisco, California
Chapter 24: Ultrasonography: Advanced Applications and Chapter 31: Pulmonary Function Testing: Physiologic
Procedures and Technical Principles
Chapter 85: Pulmonary Hypertension Due to Lung Chapter 32: Pulmonary Function Testing: Interpretation
Disease: Group 3 and Applications
Chapter 60: Asthma: Pathogenesis and Phenotypes
Sonja D. Bartolome, MD
Professor of Medicine Rahul Bhatnagar, MBChB, PhD
Division of Pulmonary and Critical Care Medicine Honorary Lecturer
University of Texas Southwestern Medical Center Academic Respiratory Unit
Dallas, Texas University of Bristol
Chapter 84: Pulmonary Arterial Hypertension: Bristol, United Kingdom
Group 1 Chapter 112: Pleural Fibrosis and Unexpandable Lung
Robert P. Baughman, MD Surya P. Bhatt, MD, MSPH
Professor of Medicine Associate Professor of Medicine
Department of Internal Medicine Division of Pulmonary, Allergy, and Critical Care Medicine
University of Cincinnati College of Medicine Medical Director, Pulmonary Function and Exercise
Cincinnati, Ohio Physiology Laboratory
Chapter 93: Sarcoidosis University of Alabama at Birmingham
Birmingham, Alabama
Michael F. Beers, MD Chapter 32: Pulmonary Function Testing: Interpretation
Robert L. Mayock and David A. Cooper Professor of and Applications
Medicine
Department of Medicine Anna C. Bibby, MBChB, BSC, MRCP
Division of Pulmonary and Critical Care Academic Respiratory Unit
Perelman School of Medicine at the University of Translational Health Sciences
Pennsylvania University of Bristol Medical School;
Philadelphia, Pennsylvania Respiratory Department
Chapter 3: Alveolar Compartment North Bristol NHS Trust
Bristol, United Kingdom
Chapter 109: Pleural Infections
x Contributors
Alexandra Binnie, MD, DPhil, FRCP(C) Steven L. Brody, MD
Invited Assistant Professor Dorothy R. and Hubert C. Moog Professor of Pulmonary
University of Algarve Medicine
Faro, Portugal; Washington University School of Medicine in St. Louis
Critical Care Physician St. Louis, Missouri
William Osler Health System Chapter 4: Airway Biology
Toronto, Canada
Chapter 134: Acute Respiratory Distress Syndrome Kevin K. Brown, MD
Professor and Chair
Paul D. Blanc, MD, MSPH Department of Medicine
Professor of Medicine National Jewish Health
Endowed Chair in Occupational and Environmental Denver, Colorado;
Medicine Professor of Medicine
University of California San Francisco Division of Pulmonary Sciences and Critical Care Medicine
Chief, Division of Occupational and Environmental University of Colorado School of Medicine
Medicine Aurora, Colorado
UCSF Medical Center Chapter 87: Pulmonary Vasculitis
San Francisco, California
Chapter 103: Acute Responses to Toxic Exposures Paul G. Brunetta, MD
Adjunct Associate Professor of Medicine
Zea Borok, MB, ChB Division of Pulmonary and Critical Care Medicine
Professor of Medicine and Biochemistry and Molecular University of California San Francisco;
Medicine Fontana Tobacco Treatment Center
Division of Pulmonary, Critical Care, and Sleep Medicine Mt. Zion Medical Center
Keck School of Medicine San Francisco, California
University of Southern California Chapter 66: Smoking Cessation
Los Angeles, California
Chapter 3: Alveolar Compartment Jacques Cadranel, MD, PhD
Professor of Respiratory Medicine
T. Douglas Bradley, MD, FRCPC Service de Pneumologie
Professor of Medicine Hôpital Tenon, Assistance Publique Hôpitaux de Paris
Director, Division of Respirology Paris, France
Centre for Sleep Medicine and Circadian Biology Chapter 78: Rare Primary Lung Tumors
University of Toronto Faculty of Medicine;
Director, Sleep Medicine Laboratory Shamus R. Carr, MD
University Health Network Associate Research Physician
Toronto Rehabilitation Institute Thoracic Surgery Branch
Toronto General Hospital Center for Cancer Research
Toronto, Ontario, Canada National Cancer Institute
Chapter 121: Central Sleep Apnea Bethesda, Maryland
Chapter 30: Thoracic Surgery
V. Courtney Broaddus, MD
Professor Emeritus of Medicine Tara F. Carr, MD
University of California San Francisco Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine College of Medicine, Tucson
Zuckerberg San Francisco General Hospital Asthma and Airway Disease Research Center
San Francisco, California University of Arizona Health Sciences
Chapter 14: Pleural Physiology and Pathophysiology Tucson, Arizona
Chapter 44: Hypoxemia Chapter 62: Asthma: Diagnosis and Management
Chapter 108: Pleural Effusion
Adithya Cattamanchi, MD, MAS
Laurent J. Brochard, MD Professor of Medicine and Epidemiology
Interdepartmental Division Director for Critical Care Division of Pulmonary and Critical Care Medicine
University of Toronto Faculty of Medicine University of California San Francisco Center for
Full Professor and Clinician Scientist Tuberculosis
Department of Medicine University of California San Francisco School of Medicine
Division of Critical Care San Francisco, California
Saint Michael’s Hospital Chapter 53: Tuberculosis: Clinical Manifestations and
Keenan Research Center for Biomedical Science Diagnosis
Toronto, Ontario, Canada
Chapter 136: Noninvasive Support of Ventilation
Contributors xi
Lara Chalabreysse, MD Michael H. Cho, MD, MPH
Département de Pathologie Associate Professor of Medicine
Groupement Hospitalier Est Hospices Civils de Lyon Channing Division of Network Medicine and Division of
Lyon, France Pulmonary and Critical Care Medicine
Chapter 78: Rare Primary Lung Tumors Brigham and Women’s Hospital
Harvard Medical School
Edward D. Chan, MD Boston, Massachusetts
Professor of Medicine Chapter 9: Genetics of Lung Disease
University of Colorado Anschutz Medical Campus Chapter 63: COPD: Pathogenesis and Natural History
Staff Physician
Department of Medicine David C. Christiani, MD
Rocky Mountain Regional Veterans Affairs Medical Center Professor of Medicine
Aurora, Colorado; Harvard Medical School
Staff Physician Elkan Blout Professor of Environmental Genetics
Department of Academic Affairs Department of Environmental Health
National Jewish Health Harvard School of Public Health;
Denver, Colorado Physician
Chapter 69: Bronchiectasis Division of Pulmonary and Critical Care
Massachusetts General Hospital
Ken K.P. Chan, MBChB, MRCP (UK), FHKCP, FHKAM Boston, Massachusetts
Clinical Assistant Professor (Honorary) Chapter 74: Lung Cancer: Epidemiology
Department of Medicine & Therapeutics
Chinese University of Hong Kong; Kian Fan Chung, MD, DSc, FRCP
Associate Consultant Professor of Respiratory Medicine
Department of Medicine & Therapeutics Head of Experimental Studies
Prince of Wales Hospital National Heart & Lung Institute
Hong Kong Imperial College London;
Chapter 111: Chylothorax Consultant Physician
Royal Brompton and Harefield NHS Trust
Jean Chastre, MD London, United Kingdom
Professor Chapter 37: Cough
Service de Réanimation Médicale
Institut de Cardiologie, Groupe Hospitalier Pitié- Salpêtrière Amelia O. Clive, MBBS, PhD
Paris, France Consultant in Thoracic Medicine
Chapter 49: Ventilator- Associated Pneumonia North Bristol Lung Centre
Southmead Hospital
Guang- Shing Cheng, MD Bristol, United Kingdom
Associate Professor, Clinical Research Division Chapter 112: Pleural Fibrosis and Unexpandable Lung
Fred Hutchinson Cancer Research Center;
Associate Professor of Medicine Robert A. Cohen, MD
Division of Pulmonary, Critical Care, and Sleep Medicine Professor of Medicine
University of Washington School of Medicine Northwestern University Feinberg School of Medicine
Seattle, Washington Clinical Professor of Environmental and Occupational
Chapter 115: Mediastinal Tumors and Cysts Health Sciences
Chapter 125: Pulmonary Complications of Stem Cell and University of Illinois at Chicago School of Public Health
Solid Organ Transplantation Chicago, Illinois
Chapter 101: Pneumoconioses
Kelly M. Chin, MD, MSCS
Associate Professor of Medicine Thomas V. Colby, MD
Division of Pulmonary and Critical Care Medicine Professor Emeritus
Director, Pulmonary Hypertension Program Department of Laboratory Medicine and Pathology
University of Texas Southwestern Medical Center Mayo Clinic Alix College of Medicine
Dallas, Texas Scottsdale, Arizona
Chapter 84: Pulmonary Arterial Hypertension: Group 1 Chapter 89: Idiopathic Pulmonary Fibrosis
