TENTH EDITION West’s RespiRatoRy physiology The essenTials FM.indd 1 8/19/2015 7:56:02 PM FM.indd 2 8/19/2015 7:56:03 PM TENTH EDITION West’s RespiRatoRy physiology The essenTials John B. West, M.D., Ph.D., D.sc. Professor of Medicine and Physiology University of California, San Diego School of Medicine La Jolla, California andrew M. luks, M.D. Associate Professor of Medicine University of Washington School of Medicine Seattle, Washington FM.indd 3 8/19/2015 7:56:03 PM Acquisitions Editor: Crystal Taylor Product Development Editor: Amy Weintraub Editorial Assistant: Joshua Haffner Marketing Manager: Joy Fisher-Williams Production Project Manager: Priscilla Crater Design Coordinator: Steve Druding Art Director: Jen Clements Manufacturing Coordinator: Margie Orzech Prepress Vendor: SPi Global 10th edition Copyright © 2016 Wolters Kluwer. Copyright © 2012, 2008 Lippincott Williams & Wilkins, a Wolters Kluwer business. Copyright © 2004, 2003, 1998 by Lippincott Williams & Wilkins. Copyright © 1992, 1987, 1982, 1974 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic cop- ies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China (or the United States of America) Library of Congress Cataloging-in-Publication Data West, John B. (John Burnard), author. [Respiratory physiology] West’s respiratory physiology : the essentials / John B. West, Andrew M. Luks. — Tenth edition. p. ; cm. Preceded by Respiratory physiology : the essentials / John B. West. 9th ed. c2012. Includes bibliographical references and index. ISBN 978-1-4963-1011-8 (alk. paper) I. Luks, Andrew, author. II. Title. [DNLM: 1. Respiratory Physiological Phenomena. WF 102] QP121 612.2—dc23 2015017652 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examina- tion of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verifica- tion of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com FM.indd 4 8/19/2015 7:56:03 PM To P.H.W.—John B. West To P.A.K., R.W.G. and E.R.S.—Andrew M. Luks FM.indd 5 8/19/2015 7:56:03 PM FM.indd 6 8/19/2015 7:56:03 PM pReface T his book was first published 40 years ago and has served several genera- tions of students. It has been translated into 15 languages. This new 10th edition incorporates a number of innovations—the most important is that Andrew Luks, M.D., has come on board as a coauthor. Dr. Luks is a felici- tous choice. He obtained his M.D. at the University of California San Diego (UCSD) School of Medicine and therefore took the course for which the book was originally written. In fact, he still has his extensively underlined fifth edition of the book! He has a strong interest in teaching medical students at the University of Washington School of Medicine, and so he is well poised to look after the coming generations. Another innovation of this new edition are clinical vignettes for each of the first nine chapters of the book. The purpose of these is to emphasize how the physiology that is described in the main text can be used in a clinical situation. Also 26 new multiple-choice questions have been added. Some of these require more reasoning than the traditional questions that rely heav- ily on factual recall. Another new development has been the production of fourteen 50-minute lectures closely based on the material in the book. These are freely available on YouTube and have proved to be popular with students. For example, the first lecture on Structure and Function of the Lung has had over 100,000 visits. The URL is http://meded.ucsd.edu/ifp/jwest/resp_phys/ index.html. Finally, there has been a change in the title of the book consistent with its coming of age. In spite of these new features, the objectives of the book have not changed. First, the book is intended as an introductory text for medical students and allied health students. As such, it will normally be used in conjunction with a course of lectures, and this is the case at UCSD. Indeed, the first edition was written because I believed that there was no appropriate textbook at that time to accompany the first-year physiology course. Second, the book is written as a review for residents and fellows in such areas as pulmonary medicine, anesthesiology, and internal medicine, particu- larly to help them prepare for licensing and other examinations. Here, the requirements are somewhat different. The reader is familiar with the general area but needs to have his or her memory jogged on various points, and the many didactic diagrams are particularly important. vii FM.indd 7 8/19/2015 7:56:03 PM viii PREFACE It might be useful to add a word or two about how the book meshes with the lectures to the first-year medical students at UCSD. We are limited to about twelve 50-minute lectures on respiratory physiology supplemented by two laboratory demonstrations, three small discussion groups, and a review session with the whole class present. The lectures follow the individual chap- ters of the book closely, with most chapters corresponding to a single lec- ture. The exceptions are that Chapter 5 has two lectures (one on normal gas exchange, hypoventilation, and shunt; another on the difficult topic of venti- lation-perfusion relationships); Chapter 6 has two lectures (one on blood-gas transport and another on acid-base balance); Chapter 7 has two lectures (on statics and dynamics). There is no lecture on Chapter 10, “Tests of Pulmonary Function,” because this is not part of the core course. It is included partly for interest and partly because of its importance to people who work in pulmo- nary function laboratories. The present edition has been updated in many areas including blood flow and metabolism, gas transport by the blood, and the physiology of high alti- tude. Appendix B contains discussions of the answers to the questions includ- ing the new questions appended to the clinical vignettes. There are several animations expanding sections of the text, and these are indicated by the sym- bol . Great efforts have been made to keep the book lean in spite of enor- mous temptations to fatten it. Occasionally, medical students wonder if the book is too superficial. Not so. If pulmonary fellows beginning their training in intensive care units fully understood all the material on gas exchange and mechanics, the world would be a better place. Many students and teachers have written to query statements in the book or to make suggestions for improvements. We respond personally to every point that is raised and much appreciate the input. John B. West [email protected] Andrew M. Luks [email protected] FM.indd 8 8/19/2015 7:56:03 PM