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This, the fifth edition of Fishman's Pulmonary Diseases and Disorders, represents a substantial departure in content and style from the previous four editions. Notably, this is the first edition in which the founding editor, Alfred P. Fishman (1918–2010), is no longer at the helm. Dr. Fishman, a legend in pulmonary science and medicine, leaves a legacy based on a long and distinguished career. Incredibly, he served as sole editor of the first two editions of the textbook, which initially appeared in print in 1980. Subsequently, he enlisted a number of coeditors, including several from the current group. Those of us who had the opportunity to work with him on the prior two editions remain grateful for his leadership, editorial style, and unrelenting commitment to excellence. His memory inspired us in preparing the current volume. We can only hope that it measures up to his exacting standards.

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While many of the elements of the book have changed, one aspect remains firmly entrenched: The book represents a coupling of the body of knowledge of pulmonary and critical care medicine with the underlying basic and applied science upon which the clinical material is based. The book is designed to appeal both to clinicians and investigators who are interested in the science of medicine, including relevant respiratory biology and underlying cellular and molecular mechanisms. We hope that readers will find it authoritative, well referenced, and a suitable platform from which to launch additional inquiry.

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The body of knowledge and level of detail in the fifth edition have evolved substantially since the last edition, published in 2008. In virtually all areas of pulmonary medicine, notable advancements have been made, and each is discussed in detail. For example, tremendous progress has occurred in our understanding of the genetics of respiratory disease; indeed, the era of “personalized medicine” is upon us. A full chapter has been devoted to the genetics of pulmonary disease and another to personalized pulmonary medicine—additions from the previous edition. Similarly, growth in immunology and immunosuppressive management, along with technical advances in lung transplantation, has been amply documented in the literature over the last 5 years and is presented in detail. Advances in the science and treatment of pulmonary hypertension have been noteworthy. This area, which was one of great interest to Dr. Fishman, is discussed in a comprehensive chapter on the subject. In addition, the rapid evolution of cardiovascular and pulmonary imaging techniques has been dramatic, and multiple examples of such advanced imaging populate many of the chapters. Utilization of the technology and its attendant costs constitute the basis for considerable debate and ongoing studies regarding applicability in screening patients for underlying pulmonary disease (e.g., lung cancer screening using low-dose CT scanning in at-risk patients). Finally, as another example of noteworthy progress, developments in interventional bronchoscopic techniques continue to evolve and have become increasingly sophisticated over the last 5 years. They are discussed in two related chapters on diagnostic and interventional bronchoscopy.

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Within the realm of critical care medicine, significant advances have been reported in the early diagnosis and management of sepsis, multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), and the newly defined entity of “chronic critical illness.” These advances have translated into improved survival of patients with disorders that, at one time, were largely fatal. Patient survival, particularly in the setting of chronic and, sometimes, debilitating, organ dysfunction has generated debate on the appropriateness of application of the technology and affordability of the healthcare thereby engendered. Such considerations inform a discussion of the organization of intensive care units and long-term acute care facilities, topics which have been included in this edition.

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Not all of the news has been good. For example, challenges in the medical management of advanced interstitial lung disease, particularly idiopathic pulmonary fibrosis, have remained all too evident. Therapy has been disappointing. Notably, however, several recently completed clinical trials have improved prospects for management.

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Those responsible for generating the content of the fifth edition include 278 contributors. They are drawn from among the world's experts in the areas about which they have written. One hundred fifty-nine contributors are new from the last edition, including many from outside the United States, reflecting the vast array of expertise available globally in the areas of pulmonary science and medicine.

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Organization and content are not the only metrics that have changed with the fifth edition. Footnoted references are now incorporated extensively. Supplemental content and illustrations are made available by accessing QR codes embedded on the printed pages. Production constraints created by page limitations have been curtailed significantly. Notably, the fifth edition is being made available in an electronic version accessed via the World Wide Web.

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An additional technological advance over the prior edition is incorporation of a number of videos designed to complement and, at times, accentuate information contained within the text. Not surprisingly, most of the videos relate to procedures or imaging. They are designed to reflect common or unique findings drawn from “real life” clinical experiences. They, too, are accessible using a QR code reader.

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With all of the technological advances in play, at the end of the day, the compilation and synthesis of the information contained within this textbook are a reflection of the commitment, untiring effort, and professionalism of many contributing authors. The editors are enormously grateful for their willingness to “dig deep” and generate authoritative discussions of the complex and expanding fields of pulmonary and critical care medicine.

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These same, appreciative editors have, themselves, contributed enormous boluses of time in editing and authoring the chapters that comprise the book. Personally, I found the willingness of my colleagues to step up and orchestrate its preparation extraordinarily gratifying.

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Finally, on behalf of all of the editors, I wish to express our thanks for the commitment of key individuals in preparing the fifth edition, including Brian Belval, Executive Editor at McGraw-Hill; Peter Boyle, Sr Project Development Editor; Priscilla Beer, Sr Media Project Manager; and Sarah M. Granlund, Project Manager. Their ability to keep the train on the track was nothing short of exceptional.

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Michael A. Grippi, MD

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