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PRINCIPLES
OF PULMONARY
MEDICINE
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PRINCIPLES
OF PULMONARY
MEDICINE
Seventh Edition
STEVEN E. WEINBERGER, MD, MACP, FRCP
Executive Vice President and Chief Executive Offcer Emeritus
American College of Physicians
Adjunct Professor of Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania;
Senior Lecturer on Medicine
Harvard Medical School
Boston, Massachusetts
BARBARA A. COCKRILL, MD
Harold Amos Associate Professor of Medicine
Harvard Medical School
Pulmonary Vascular Disease and Lung Centers
Brigham and Women’s Hospital
Boston, Massachusetts
JESS MANDEL, MD, FACP
Professor of Medicine
University of California San Diego School of Medicine
La Jolla, California
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
Principles of Pulmonary Medicine, Seventh Edition ISBN: 978-0-323-52371-4
Copyright © 2019 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this feld are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identifed, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2014, 2008, 2004, 1998, 1992, 1986 by Saunders, an imprint of Elsevier, Inc.
ISBN: 978-0-323-52371-4
Library of Congress Cataloging-in-Publication Data
Names: Weinberger, Steven E., author. | Cockrill, Barbara A., author. |
Mandel, Jess, author.
Title: Principles of pulmonary medicine / Steven E. Weinberger, Barbara A.
Cockrill, Jess Mandel.
Description: Seventh edition. | Philadelphia, PA : Elsevier, [2019] |
Includes bibliographical references and index.
Identifers: LCCN 2017029947 | ISBN 9780323523714 (pbk. : alk. paper)
Subjects: | MESH: Lung Diseases | Respiration Disorders
Classifcation: LCC RC756 | NLM WF 600 | DDC 616.2/4–dc23 LC record available at
https://lccn.loc.gov/2017029947
Content Strategist: Robin Carter
Senior Content Development Specialist: Marybeth Thiel
Publishing Services Manager: Patricia Tannian
Project Manager: Stephanie Turza
Design Direction: Bridget Hoette
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To Janet, Eric, and Mark
Steven E. Weinberger
To my parents, Fred and Shirley Cockrill
Barbara A. Cockrill
To my parents, Martha and Gerald Mandel
Jess Mandel
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Introduction to the
Seventh Edition
Principles of Pulmonary Medicine was frst published in 1986 as a “concise, core reference
[that] emphasizes pathophysiology and diagnosis as the basis for optimal management
of respiratory disorders. Physiologic, radiologic, and pathologic features of diseases
are correlated with clinical fndings providing an integrated, comprehensive approach.”
Much has changed over seven editions of the book and the more than 30 years that
have elapsed since the frst edition. Our understanding of many disease processes has
improved, particularly at a molecular level; our diagnostic tests have become more
sophisticated; and our therapeutic armamentarium has been expanded and improved.
The single author of the frst four editions, Steven E. Weinberger, MD, MACP, FRCP,
has been joined by two additional authors, Barbara A. Cockrill, MD, and Jess Mandel,
MD, FACP, since the ffth edition; their knowledge, experience, and perspectives have
clearly enhanced the quality of the book. Since the ffth edition, we have expanded the
number of supplementary images and self-assessment questions accessible on the
internet, recognizing the importance of learners being able to assess their knowledge
and their understanding of concepts that can at times be daunting to grasp.
At the same time, however, much remains unchanged since the frst edition. Although
the primary audience has always been the medical student taking a respiratory patho-
physiology course, the book has also been extensively used by residents and practicing
physicians as well as by other healthcare professionals who care for patients with
pulmonary disease. A persistent goal throughout all editions of the book has been to
present physiologic concepts, pathogenetic and pathophysiologic mechanisms, and
radiologic and pathologic correlates of disease in a clear fashion that can be easily
understood even by the beginning student of pulmonary medicine. We have also
continued to include margin notes throughout the text, which summarize the major
points and concepts and allow the reader to quickly review the material. Finally, starting
with the second edition, we have included three appendixes that provide simplifed
methods for interpreting pulmonary function tests and arterial blood gases, while also
presenting sample problems that test the reader’s ability to use respiratory equations,
assess pulmonary function abnormalities, and interpret arterial blood gases.
We have been most gratifed by the popularity of the textbook, which has been used
extensively not only in the United States and Canada but also in other countries
throughout the world. Various editions have been translated into Spanish, Portuguese,
Italian, Japanese, Chinese, and Polish. Although there may be some differences in
diagnostic and therapeutic approaches to pulmonary diseases in different countries,
the conceptual underpinnings of physiology, pathophysiology, and disease mechanisms
that we are trying to convey in a readable fashion are universal.
viii n Principles of Pulmonary Medicine
It has been a pleasure to work with the editorial staff at Elsevier in development of
this edition, just as it has been for past editions. We particularly want to express our
appreciation to Stephanie Turza, Marybeth Thiel, and Robin Carter, who have been
most supportive throughout the development and production process. Finally, we are
most grateful to our spouses and children for their support and understanding as we
had to sacrifce time with them to prepare this new edition of the book.
Steven E. Weinberger, MD, MACP, FRCP
Barbara A. Cockrill, MD
Jess Mandel, MD, FACP
