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Oxford American Handbook of Pulmonary Medicine 1st
Edition Kevin Brown Digital Instant Download
Author(s): Kevin Brown, Teofilo Lee-Chiong
ISBN(s): 9780195329568, 0195329562
Edition: 1
File Details: PDF, 4.05 MB
Year: 2009
Language: english
About the Oxford American Handbooks in Medicine
The Oxford American Handbooks are flexi-covered pocket clinical
books, providing practical guidance in quick reference, note form. Titles
cover major medical specialties or cross-specialty topics and are aimed at
students, residents, internists, family physicians, and practicing physicians
within specific disciplines.
Their reputation is built on including the best clinical information, com-
plemented by hints, tips, and advice from the authors. Each one is carefully
reviewed by senior subject experts, residents, and students to ensure that
content reflects the reality of day-to-day medical practice.
Key series features
- Written in short chunks, each topic is covered in a two-page spread to
enable readers to find information quickly. They are also perfect for
test preparation and gaining a quick overview of a subject without
scanning through unnecessary pages.
- Content is evidence based and complemented by the expertise and
judgment of experienced authors.
- The Handbooks provide a humanistic approach to medicine— it’s
morethan just treatment by numbers.
- A “friend in your pocket,” the Handbooks offer honest, reliable
guidance about the difficulties of practicing medicine and provide
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- For quick reference, useful “everyday” information is included on the
inside covers.
- Made with hard-wearing plastic covers, tough paper, and built-in
ribbon bookmarks, the Handbooks stand up to heavy usage.
This page intentionally left blank
TRACHEA
Apical Apical
APICAL
CARINA
POSTERIOR IN
LE UPPER
FT DIVISION Anterior Posterior
MA
Posterior UP
PER MA
Anterior IN
HT
R LI
SUPERIOR
UPPE NGUL
RIG
ANTERIOR AR
Superior Apical
Apical
Lateral INFERIOR
MIDDLE
LO
LATERAL
W
LATERAL APICAL APICAL
ER
LOWER BASAL Inferior
BASAL LOWER
Posterior
Anterior MEDIAL
Medial Basal
Basal BASAL
ANTERIOR BASAL
Lateral ANTERIOR Lateral
[WITH MEDIAL
Basal BASAL BRANCH] Basal
Posterior POSTERIOR POSTERIOR Anterior
Basal BASAL BASAL Basal
Lateral view right lung Lateral view left lung

Index to emergency topics
Acute massive pulmonary embolus 455

Acute exacerbation of COPD 156
Acute severe asthma 118–19
Alveolar hemorrhage 64–5
Anaphylaxis 592–3
Carbon monoxide poisoning 654–5
Cricothyroidotomy 760–1
Hemoptysis (massive) 31
Hypercalcemia 188
Inappropriate ADH secretion 189
Spinal cord compression 190
Superior vena cava obstruction (SVCO) 186
Tension pneumothorax 324
Toxic inhaled substances 650–3
Upper airways obstruction 590–1
Preface A
i
Oxford American Handbook of

Pulmonary
Medicine
ii 1
Published and forthcoming Oxford American Handbooks
Oxford American Handbook of Clinical Medicine

Oxford American Handbook of Anesthesiology
Oxford American Handbook of Clinical Dentistry
Oxford American Handbook of Critical Care
Oxford American Handbook of Emergency Medicine
Oxford American Handbook of Nephrology and Hypertension
Oxford American Handbook of Obstetrics and Gynecology
Oxford American Handbook of Oncology
Oxford American Handbook of Otolaryngology
Oxford American Handbook of Pediatrics
Oxford American Handbook of Psychiatry
Oxford American Handbook of Pulmonary Medicine
Oxford American Handbook of Rheumatology
Oxford American Handbook of Surgery
1 iii
Oxford American
Handbook of
Pulmonary
Medicine
Kevin K. Brown, MD
Professor and Vice Chairman
Department of Medicine
National Jewish Health
Denver, Colorado
Teofilo Lee-Chiong, MD
Professor of Medicine
Head, Division of Sleep Medicine
Department of Medicine
University of Colorado
Denver School of Medicine
Denver, Colorado
with
Stephen Chapman
Grace Robinson
John Stradling
Sophie West
iv 1
Oxford University Press, Inc., publishes works that further

Oxford University’s objective of excellence
in research, scholarship, and education.
Oxford New York

Auckland Cape Town Dar es Salaam Hong Kong Karachi
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With offices in
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Copyright © 2009 by Oxford University Press, Inc.
Published by Oxford University Press, Inc.

198 Madison Avenue, New York, New York 10016
www.oup.com
Oxford is a registered trademark of Oxford University Press

All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data
Oxford American handbook of pulmonary medicine/edited by Kevin K. Brown,

Teofilo Lee-Chiong.
p. ; cm.—(Oxford American handbooks)
Based on: Oxford handbook of respiratory medicine/Stephen Chapman ... [et al.]. 2005.
ISBN 978–0–19–532956–8 (alk. paper)
1. Respiratory organs—Diseases—Handbooks, manuals, etc.
[DNLM: 1. Respiratory Tract Diseases—diagnosis—Handbooks.
2. Respiratory Tract Diseases—therapy—Handbooks. WF 39 O978 2008]
I. Title: Handbook of pulmonary medicine. II. Brown, Kevin K. III. Lee-Chiong, Teofilo
L., 1960. IV. Oxford handbook of pulmonary medicine. V. Series.
RC732.O95 2008
616.2—dc22 2007044658
10 9 8 7 6 5 4 3 2 1
Printed in China
on acid-free paper
1 v
This material is not intended to be, and should not be considered, a

substitute for medical or other professional advice. Treatment for the
conditions described in this material is highly dependent on the individual
circumstances. And, while this material is designed to offer accurate
information with respect to the subject matter covered and to be current
as of the time it was written, research and knowledge about medical and
health issues is constantly evolving and dose schedules for medications are
being revised continually, with new side effects recognized and accounted
for regularly. Readers must therefore always check the product information
and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most
recent codes of conduct and safety regulation. Oxford University Press
and the authors make no representations or warranties to readers, express
or implied, as to the accuracy or completeness of this material, including
without limitation that they make no representation or warranties as to
the accuracy or efficacy of the drug dosages mentioned in the material.
The authors and the publishers do not accept, and expressly disclaim, any
responsibility for any liability, loss, or risk that may be claimed or
incurred as a consequence of the use and/or application of any of the
contents of this material.
vi 1
Preface
This handbook is designed to meet the needs of its various readers, from
the pulmonary subspecialist who yearns to know “more about less,” the
pulmonary generalist who is required to know “something about every-
thing,” and the pulmonary trainee who wants to understand it all. To the
busy clinician, this concise book can serve as an independent portable
manual for the day-to-day management of patients with respiratory
disorders as well as a complement to larger textbooks in the field. This
book can be brought to the outpatient clinic, inpatient hospital ward, or
intensive care unit, wherever patients are cared for.
We wish to express our sincere gratitude to the many contributors
and colleagues, all of whom are major authorities on contemporary
respiratory medicine, for the expert submissions and counsel they have
generously provided us. We also thank the editorial board at Oxford
University Press for their patience and unwavering enthusiasm for this
project. We are especially indebted to Amy Hall at National Jewish
Health, who almost single-handedly kept all the authors on schedule.
Finally, we must gratefully acknowledge the support and encouragement
given us by our families. To them we dedicate this book:
Kathleen A. Doyle, MD, MPH, Lily Clare Brown, and Mei Linn Brown
Dolores Grace Zamudio and Zoë Lee-Chiong.
Kevin K. Brown, MD
Teofilo Lee-Chiong, MD
1 vii
Contents
Detailed contents xi
Contributors xxix
Symbols and abbreviations xxxv
Part I Clinical presentations—approaches

to problems
1 Dyspnea 3
2 Chronic cough and normal chest X-ray 9
3 Chest pain 21
4 Hemoptysis 27
5 Unexplained respiratory failure 33
6 Pleural effusion 41
7 Diffuse parenchymal lung disease 53
8 Diffuse alveolar hemorrhage 63
9 Pulmonary infiltrates in the
immunocompromised host (non-HIV) 67
10 Pulmonary infiltrates in the
immunocompromised host (HIV) 79
11 The respiratory sleep patient 87
12 The breathless, pregnant patient 93
13 Preoperative assessment of
the pulmonary patient 99
14 Postoperative breathlessness 103
viii 1CONTENTS
Part II Clinical conditions

15 Asthma 109
16 Chronic obstructive pulmonary disease (COPD) 143
17 Lung cancer 161
18 Mediastinal abnormalities 199
19 Bacterial respiratory infection 207
20 Viral respiratory infection 247
21 Mycobacterial respiratory infection 269
22 Fungal respiratory diseases 285
23 Parasitic lung disease 311
24 Pneumothorax 315
25 Pleural effusions 327
26 Asbestos and the lung 345
27 Sleep-related respiratory disorders 357
28 Bronchiectasis 371
29 Adult cystic fibrosis (CF) 381
30 Lung transplantation 405
31 Pulmonary hypertension 421
32 Pulmonary thromboembolic disease 437
33 Sarcoidosis 465
34 Idiopathic interstitial pneumonias 481
35 Hypersensitivity pneumonitis 499
36 Bronchiolitis and related disorders 507
CONTENTS1 ix
37 Eosinophilic lung disease 515

38 Pneumoconioses 523
39 Connective tissue disease and the lung 541
40 Vasculitis and the lung 559
41 Gastrointestinal disease and the lung 573
42 Acute respiratory distress syndrome (ARDS) 585
43 Upper airway diseases 589
44 Hyperventilation syndrome 599
45 Unusual conditions 603
46 Flying, diving, and altitude 633
47 Toxic agents 641
48 Pediatric lung disorders pertinent
to adult practice 657
Part III Supportive care
49 Noninvasive ventilation 665
50 Indications for intensive care unit admission 677
51 Ethical issues 681
52 Tracheostomy 685
53 Inhalers and nebulizers 689
54 Immunosuppressive therapy 697
55 Long-term oxygen therapy 727
x 1CONTENTS
56 Pulmonary rehabilitation 731

57 Smoking cessation 737
58 Palliative care of the chest patient 745
Part IV Practical procedures
59 Airway management 751
60 Cricothyroidotomy 759
61 Bronchoscopy 763
62 Thoracentesis 769
63 Aspiration of pneumothorax 773
64 Abrams pleural biopsy 775
65 Chest drains 779
66 Chemical pleurodesis 785
67 Medical thoracoscopy 789
68 Some diagnostic tests 793
Appendices
1 Lung function testing 799
2 Blood gases and acid–base balance 809
3 CT anatomy of the thorax 821
4 CT patterns of lung disease 829
5 BMI calculator and height converter 833
Index 837
1 xi
Detailed contents
Part I Clinical presentations: approaches to problems

1 Dyspnea 3
Clinical assessment and causes 4
Specific situations 8
2 Chronic cough and normal chest X-ray 9

Etiology, clinical assessment, and treatment 10
Causes of chronic cough: UACS 13
Causes of chronic cough: asthma, NAEB 14
Causes of chronic cough: GERD 16
Causes of chronic cough: chronic bronchitis,
bronchiectasis, ACE inhibitors 18
Causes of chronic cough: miscellaneous 20
Further information 20
3 Chest pain 21
Chest pain: overview 22
Acute chest pain 24
Chronic chest pain 25
4 Hemoptysis 27
Clinical assessment and causes 28
Investigations 30
Management of massive hemoptysis 31
5 Unexplained respiratory failure 33

Causes 34
Clinical assessment and management 38
xii 1DETAILED CONTENTS
6 Pleural effusion 41
Clinical assessment 42
Diagnostic algorithm for the patient with a
pleural effusion 44
Transudative pleural effusions 45
Exudative pleural effusions 46
Pleural fluid analysis 1 48
Pleural fluid analysis 2 50
7 Diffuse parenchymal lung disease 53

Causes 54
Clinical assessment and imaging 56
HRCT diagnosis 58
Further investigations 60
8 Diffuse alveolar hemorrhage 63
9 Pulmonary infiltrates in the immunocompromised 67

host (non-HIV)
Clinical assessment 68
Further investigations 70
Causes 72
Treatment 76
10 Pulmonary infiltrates in the immunocompromised 79

host (HIV)
Introduction 80
Causes of respiratory disease in HIV infection 84
11 The respiratory sleep patient 87

History 88
Examination and investigations 90
DETAILED CONTENTS1 xiii
12 The breathless, pregnant patient 93

Causes 94
Investigations 96
13 Preoperative assessment of the pulmonary patient 99
14 Postoperative breathlessness 103
Part II Clinical conditions

15 Asthma 109
Definition, epidemiology, pathophysiology, etiology 110
Diagnosis 112
Investigations 114
Asthma exacerbations 116
Acute severe or life-threatening asthma 118
Treatment of acute asthma 120
Chronic asthma: management 126
Nonpharmacological therapies 131
“Difficult/refractory” asthma 132
Asthma in pregnancy 134
Occupational asthma 136
Management of occupational asthma 138
Vocal cord dysfunction 139
Allergic rhinitis (hay fever) 140
16 Chronic obstructive pulmonary disease (COPD) 143

Definition, etiology, pathology, and clinical features 144
Investigations 148
Nonpharmacological management of stable COPD 150
Pharmacological management of stable COPD 152
Management of exacerbations 154
xiv 1DETAILED CONTENTS
Summary of approaches to medical treatment 156

Surgical treatment 158
17 Lung cancer 161

Epidemiology and types 162
Clinical features 164
Investigations 166
Diagnostic procedures 168
Staging 170
Non-small cell lung cancer (NSCLC): surgery 174
NSCLC: chemotherapy 178
NSCLC: radiotherapy 180
Small cell lung cancer: treatment 182
Superior vena caval obstruction (SVCO): etiology
and clinical assessment 184
SVCO: management 186
Hypercalcemia 188
Syndrome of inappropriate ADH secretion
(SIADH) 189
Spinal cord compression 190
Pulmonary carcinoid tumors 192
Pulmonary nodules 194
Lung cancer screening 198
18 Mediastinal abnormalities 199

Anatomy 200
Mediastinal abnormalities 202
19 Bacterial respiratory infection 207

Community-acquired pneumonia (CAP) 208
CAP: clinical features 210
DETAILED CONTENTS1 xv
CAP: severity assessment 212

CAP: investigations 214
CAP: management 216
CAP: antibiotics 218
CAP: treatment failure 220
CAP: follow-up 222
Hospital-acquired pneumonia: clinical features 224
Hospital-acquired pneumonia: management 226
Ventilator-acquired pneumonia (VAP) 228
Aspiration pneumonia 230
Aspiration pneumonia: clinical features 232
Lung abscess: clinical features 234
Lung abscess: diagnosis 236
Lung abscess: management 238
Nocardiosis 240
Actinomycosis 242
Anthrax 244
20 Viral respiratory infection 247

Viral pneumonia: overview 248
Influenza 250
Respiratory syncytial virus 252
Parainfluenza 254
Adenovirus 255
Cytomegalovirus 256
Herpes simplex virus 258
Varicella zoster virus 260
Measles 262
Epstein–Barr virus 263
Hantavirus 264
Severe acute respiratory syndrome 266
xvi 1DETAILED CONTENTS
21 Mycobacterial respiratory infection 269

Tuberculosis (TB): epidemiology
and pathophysiology 270
TB: clinical manifestations 272
Extrapulmonary tuberculosis (XPTB) 273
TB: diagnostics studies 274
TB: treatment 276
Isolation of TB suspects and patients 280
Nontuberculous (environmental) mycobacterial (NTM)
lung disease 282
22 Fungal respiratory diseases 285

Aspergillus lung disease: classification 286
1. Atopic allergy to fungal spores 287
2. Allergic bronchopulmonary aspergillosis 288
3. Invasive aspergillosis 292
4. Chronic necrotizing aspergillosis 295
5. Aspergilloma/mycetoma 296
Pneumocystis pneumonia (PCP) 298
PCP: treatment 300
Endemic mycoses 302
Histoplasmosis 304
Blastomycosis 306
Coccidioidomycosis 308
Paracoccidioidomycosis 308
Cryptococcosis 309
Candida 310
23 Parasitic lung disease 311

Hyadatidosis 312
Amebiasis 312
DETAILED CONTENTS1 xvii
Ascariasis 313
Strongyloidiasis 313
Toxocara canis 313
Dirofilariasis 313
Schistosomiasis 314
Paragonimiasis 314
Tropical pulmonary eosinophilia 314
24 Pneumothorax 315
Clinical features and investigations 316
Initial management 318
Further management 320
Treatment algorithm for primary pneumothorax 322
Treatment algorithm for secondary pneumothorax 323
Specific situations 324
25 Pleural effusions 327

Clinical features and imaging 328
Malignant pleural effusion: causes and investigations 330
Malignant pleural effusion: management 332
Parapneumonic effusion and empyema: definition
and clinical features 334
Parapneumonic effusion and empyema: bacteriology
and investigations 336
Parapneumonic effusion and empyema: management
and outcome 338
Tuberculous pleural effusion 340
Other causes 342
26 Asbestos and the lung 345

Asbestos 346
Benign asbestos-related pleural disease 348
Asbestosis 350
xviii 1DETAILED CONTENTS
Mesothelioma: diagnosis 352

Mesothelioma: treatment and outcome 354
Asbestos-related lung cancer 356
27 Sleep-related respiratory disorders 357

Introduction 358
Obstructive sleep apnea: clinical features,
pathophysiology, and consequences 360
Obstructive sleep apnea: evaluation 362
Obstructive sleep apnea: therapy 364
Central sleep apnea 366
Cheyne–Stokes respiration 367
Obesity hypoventilation syndrome 368
Chronic alveolar hypoventilation syndromes 369
Further reading 369
28 Bronchiectasis 371
Epidemiology, pathophysiology, and causes 372
Clinical features and diagnosis 374
General management 376
Further management 378
29 Adult cystic fibrosis (CF) 381

General principles 382
Principles of disease management 384
Management of CF lung disease 386
Other pulmonary disease 390
Nonpulmonary disease 392
CF pulmonary exacerbation: etiology 398
CF pulmonary exacerbation: antibiotics 400
Management of an exacerbation 402
Seeing the patient with CF in the clinic 404
DETAILED CONTENTS1 xix
30 Lung transplantation 405

Background and current status 406
Indications and patient selection 408
Timing of referral and listing 410
Surgical approaches 412
Organ allocation and donor–recipient matching 413
Routine post-transplant care 414
Outcomes 415
Complications 416
31 Pulmonary hypertension 421

Classification 422
Idiopathic pulmonary arterial hypertension (IPAH) 424
IPAH: clinical features 426
IPAH: general management 427
IPAH: vasodilator therapy 428
IPAH: surgical treatments, end-of-life care, and future
developments 430
Associated pulmonary hypertension (APH): causes 432
Associated pulmonary hypertension: management 434
Further information 435
32 Pulmonary thromboembolic disease 437

Epidemiology and pathophysiology 438
Etiology 440
Clinical features 444
Diagnosis of acute pulmonary embolism 446
Diagnostic studies 450
Management 454
Special considerations 460
xx 1DETAILED CONTENTS
Rare causes of embolic disease 462

Future developments 464
33 Sarcoidosis 465
Etiology and pathology 466
Chest disease: clinical features 468
Chest disease: management 470
General management 472
Extrathoracic disease 476
34 Idiopathic interstitial pneumonias 481

Overview 482
Idiopathic pulmonary fibrosis (IPF): diagnosis 484
IPF: management 488
Nonspecific interstitial pneumonia (NSIP) 490
Cryptogenic organizing pneumonia (COP) 492
Acute interstitial pneumonia (AIP) 494
Respiratory bronchiolitis-associated interstitial lung
disease (RB-ILD) 496
Desquamative interstitial pneumonia (DIP) 497
Lymphoid interstitial pneumonia (LIP) 498
35 Hypersensitivity pneumonitis 499

Causes 500
Diagnosis 502
Management 505
36 Bronchiolitis and related disorders 507

Pathophysiology and causes 508
Management 512
DETAILED CONTENTS1 xxi
37 Eosinophilic lung disease 515

Introduction 516
Eosinophilic lung disease: secondary disorders 518
Eosinophilic lung disease: primary disorders,
lung-limited 520
Eosinophilic lung disease: primary disorders,
systemic 521
38 Pneumoconioses 523
Overview and causative mineral dusts 524
Coal-workers’ pneumoconiosis 528
Silicosis 532
Berylliosis 536
39 Connective tissue disease and the lung 541

Differential diagnosis and standard tests
to consider 542
Rheumatoid arthritis (RA) 546
Systemic lupus erythematosus (SLE) 548
Polymyositis and dermatomyositis 552
Systemic sclerosis 554
Sjögren’s syndrome 556
Ankylosing spondylitis 557
40 Vasculitis and the lung 559

Classification 560
Wegener’s granulomatosis: presentation
and diagnosis 562
Wegener’s granulomatosis: management 564
Microscopic polyangiitis 566
Goodpasture’s disease 568
xxii 1DETAILED CONTENTS
Churg–Strauss syndrome 570

Rare pulmonary vasculitic diseases 572
41 Gastrointestinal disease and the lung 573

Hepatic hydrothorax 574
Hepatopulmonary syndrome 576
Portopulmonary hypertension (POPH) 578
Inflammatory bowel disease, celiac disease,
and pancreatitis 582
42 Acute respiratory distress syndrome (ARDS) 585

Pathophysiology and diagnosis 586
Management and complications 588
43 Upper airway diseases 589

Acute upper airway obstruction 590
Anaphylaxis 592
Upper respiratory tract infections 1 594
Upper respiratory tract infections 2 596
44 Hyperventilation syndrome 599
45 Unusual conditions 603

Alveolar microlithiasis 604
Pulmonary alveolar proteinosis (PAP): pathophysiology
and clinical features 606
PAP: diagnosis and treatment 608
Amyloidosis: pathophysiology and classification 610
Amyloidosis: lung involvement 612
Idiopathic pulmonary hemosiderosis 616
Pulmonary Langerhans cell histiocytosis (PLCH) 618
DETAILED CONTENTS1 xxiii
Lymphangioleiomyomatosis (LAM): clinical features 620

LAM: diagnosis and management 622
Recurrent respiratory papillomatosis 624
Pulmonary arteriovenous malformations
(PAVMs): etiology and diagnosis 626
PAVMs: management and complications 628
Hereditary hemorrhagic telangiectasia 629
Primary ciliary dyskinesia (PCD) 630
46 Flying, diving, and altitude 633

Lung disease and flying 634
Diving 636
Altitude sickness 638
47 Toxic agents 641

Drug-induced lung disease: clinical presentations 642
Drug-induced lung disease: examples 644
Paraquat poisoning 649
Inhalational lung injury 650
Carbon monoxide poisoning 654
48 Pediatric lung disorders pertinent to adult practice 657

Chronic lung disease of prematurity and viral
wheeze 658
Congenital abnormalities 660
Part III Supportive care

49 Noninvasive ventilation 665
Terminology 666
Indications 668
Contraindications 670
xxiv 1DETAILED CONTENTS
NIV in acute respiratory failure 672

NIV in chronic respiratory failure 674
50 Indications for intensive care unit admission 677
51 Ethical issues 681

Background and COPD 682
Lung cancer and neurological disease 684
52 Tracheostomy 685
53 Inhalers and nebulizers 689

Background 690
Different inhaler types and instructions for their use 692
54 Immunosuppressive therapy 697

Introduction 698
Glucocorticoids 700
Azathioprine 706
Hydroxychloroquine 708
Methotrexate 710
Cyclophosphamide 714
Mycophenolate mofetil 716
Infliximab 718
Rituximab 720
Cyclosporine 722
Sirolimus 724
55 Long-term oxygen therapy 727
56 Pulmonary rehabilitation 731

Definition 732
Aims and evidence 732
DETAILED CONTENTS1 xxv
Patient selection 733

Program 734
57 Smoking cessation 737
Aims and nicotine replacement therapy 738
Non-nicotine replacement therapy 742
58 Palliative care of the chest patient 745

Pain and dyspnea 746
Other symptoms 748
Part IV Practical procedures

59 Airway management 751
60 Cricothyroidotomy 759
61 Bronchoscopy 763
62 Thoracentesis 769
Diagnostic thoracentesis 770
Therapeutic thoracentesis 771
63 Aspiration of pneumothorax 773
64 Abrams pleural biopsy 775
65 Chest drains 779

Indications, drain types, and complications 780
Insertion technique 782
Drain management 784
66 Chemical pleurodesis 785

xxvi 1DETAILED CONTENTS
67 Medical thoracoscopy 789
68 Some diagnostic tests 793

Skin-prick tests 794
Technique of induced sputum 795
Methacholine challenge testing 796
Appendices
1 Lung function testing 799
Flow–volume loop 800
Spirometry, peak flow measurements, and CO
transfer 804
Respiratory muscle function, body plethysmography,
and lung volumes 806
2 Blood gases and acid–base balance 809

Introduction 810
Interpretation of arterial blood gases: 1. Hypoxia 811
Interpretation of arterial blood gases: 2. Acid–base
disorders 812
Cases 819
3 CT anatomy of the thorax 821

Mediastinal window 822
Level of head and neck vessels
Level of aortic arch
Level of left main pulmonary artery
Level of right main pulmonary artery
Level of right ventricular outflow tract
Level of aortic valve
Level of coronary sinus
Lung window 826
DETAILED CONTENTS1 xxvii
Level of trachea
Level of carina
Level of bifurcation of right upper lobe bronchus
Level of lingular bronchus
Level of right middle lobe bronchus
Level of basal segmental bronchi
4 CT patterns of lung disease 829
5 BMI calculator and height converter 833
Index 837
This page intentionally left blank
1 xxix
Contributors
Contributors
John David Armstrong II, Darren Boe, MD

MD, MA [Phil] Fellow
Professor, Institute for Advanced Division of Pulmonary Sciences
BioMedical Imaging and Critical Care Medicine,
National Jewish Health University of Colorado Denver
Professor, Diagnostic School of Medicine
Imaging and Division of Denver, Colorado
Pulmonary Sciences &
Critical Care Medicine Kevin K. Brown, MD
Faculty Associate, Center for Professor and Vice Chairman
Bioethics & Humanities Department of Medicine
University of Colorado Denver National Jewish Health
School of Medicine Denver, Colorado
Denver, Colorado Todd M. Bull, MD
David A. Badesch, MD Associate Professor of Medicine
Professor of Medicine Pulmonary Hypertension Center
Division of Pulmonary Sciences, Division of Pulmonary Sciences
Critical Care Medicine and Critical Care Medicine
and Cardiology University of Colorado Denver
Clinical Director, Pulmonary School of Medicine
Hypertension Center Denver, Colorado
University of Colorado Denver Brendan J. Clark, MD
School of Medicine
Denver, Colorado Fellow, Pulmonary and Critical
Care Medicine
Ronald Carlisle Balkissoon University of Colorado Denver
Associate Professor of Medicine School of Medicine
National Jewish Health Denver, Colorado
Denver, Colorado
Samay Dalal, MD
Robert Phillip Baughman, MD Instructor
Professor of Medicine Division of Pulmonary Sciences
University of Cincinnati and Critical Care Medicine
Medical Center University of Colorado Denver
Cincinnati, Ohio School of Medicine
Denver, Colorado
David A. Beuther, MD
Assistant Professor Charles S. Dela Cruz,
Department of Medicine MD, PhD
Director of Medical Informatics Senior Research Fellow
National Jewish Health Pulmonary and Critical Care Medicine
University of Colorado Denver Yale University School of Medicine
School of Medicine New Haven, Connecticut
Denver, Colorado
xxx 1CONTRIBUTORS
Maxine E. Dexter, MD Mary Gilmartin, RN, RRT,

University of Colorado Denver AE-C
School of Medicine Principal Coordinator, NETT
Denver, Colorado Coordinator, COPD CRN
Nurse Specialist
Peter Doelken, MD National Jewish Health
Associate Professor of Medicine Denver, Colorado
Director, Interventional Pleural Unit
Division of Pulmonary, Critical E. Brigitte Gottschall, MD,
Care, Allergy and Sleep Medicine MSPH
Medical University of South Assistant Professor of Medicine
Carolina Charleston, National Jewish Health
South Carolina Denver, Colorado
Lior Dolgonos, MD Brian Barkley Graham, MD
Fellow, Pulmonary and Critical Fellow, Division of Pulmonary
Care Medicine Sciences and Critical Care Medicine
University of Colorado Denver University of Colorado Denver
School of Medicine School of Medicine
Denver, Colorado Denver, Colorado
James H. Ellis, Jr. MD
John J. Harrington, MD, MPH
Clinical Professor of Medicine
and Pulmonary Disease Assistant Professor
National Jewish Health National Jewish Health
University of Colorado Denver Denver, Colorado
School of Medicine Kristin B. Highland, MD,
Denver, Colorado
MSCR
Stephen K. Frankel, MD, Associate Professor of Medicine
FCCP Director, Pulmonary Hypertension
Associate Professor of Medicine, Program
Section Head, Critical Care & Division of Pulmonary, Critical Care,
Hospital Medicine Allergy and Sleep Medicine
National Jewish Health Division of Rheumatology and
Associate Professor of Medicine, Immunology
Division of Pulmonary Sciences Medical University of South Carolina
and Critical Care Medicine Charleston, South Carolina
University of Colorado Denver
School of Medicine Stella E. Hines, MD
Denver, Colorado Fellow, Pulmonary Sciences and
Critical Care Medicine
Adam L. Friedlander, MD Resident, Occupational and
Instructor of Medicine Environmental Medicine
Division of Pulmonary Sciences University of Colorado Denver
and Critical Care Medicine School of Medicine
University of Colorado Denver Division of Environmental
School of Medicine and Occupational Health Sciences
National Jewish Health National Jewish Health
Denver, CO Denver, Colorado
CONTRIBUTORS1 xxxi
Katherine Hodgin, MD Jeffrey S. Klein, MD

Fellow Soule and Tampas Green and Gold
Division of Pulmonary Sciences Professor of Radiology
and Critical Care Medicine University of Vermont
University of Colorado Denver College of Medicine
School of Medicine Fletcher Allen Health Care
Denver, Colorado Burlington, Vermont
Tristan J, Huie, MD Robert M. Kotloff, MD
Fellow, Division of Pulmonary Professor of Medicine
Sciences and Critical Care Chief, Section of Advanced Lung
Medicine Disease and Lung Transplantation
University of Colorado Denver Hospital of the University
School of Medicine of Pennsylvania
Denver, Colorado Philadelphia, Pennsylvania
Richard Stephen Irwin, MD Heather R. LaChance, PhD
Professor of Medicine Assistant Professor of Medicine
University of Massachusetts National Jewish Health
Medical School Denver, Colorado
Worcester, Massachusetts Esther L. Langmack, MD
Michael D. Iseman, MD Associate Professor of Medicine
Professor of Medicine National Jewish Health
Divisions of Pulmonary Sciences Pyng Lee, MD, FCCP
and Critical Care Medicine and Senior Consultant
Infectious Diseases Department of Respiratory
University of Colorado Denver and Critical Care Medicine
School of Medicine Singapore General Hospital
Denver, Colorado Singapore
David A. Kaminsky, MD Teofilo Lee-Chiong, MD
Associate Professor of Medicine Professor of Medicine
Division of Pulmonary and Critical Head, Division of Sleep Medicine
Care Medicine National Jewish Health
University of Vermont College of University of Colorado
Medicine Denver School of Medicine
Burlington, Vermont Denver, Colorado
Mark Kearns, MD Mark E. Lund, MD, FCCP
Fellow, Division of Pulmonary Assistant Professor of Medicine
Sciences and Critical Care Drexel University College of Medicine
Medicine Philadelphia, Pennsylvania
School of Medicine J. Mark Madison, MD
Denver, Colorado Professor of Medicine and Physiology
Chief, Division of Pulmonary,
Ghulam Khaleeq, MD Allergy and Critical Care Medicine
Albert Einstein Medical Center University of Massachusetts Medical
Philadelphia, Pennsylvania School, Worcester, Massachusetts
xxxii 1CONTRIBUTORS
Barry Make, MD Thomas L. Petty, MD

Professor of Medicine Professor of Medicine
Co-Director, COPD Program University of Colorado Denver
Director, Pulmonary School of Medicine
Rehabilitation and Denver, Colorado
Respiratory Care Rush Presbyterian St. Luke’s
National Jewish Health Chicago, Illinois
Denver, Colorado Professor Emeritus
Richard A. Matthay, MD Denver, Colorado
Boehringer Ingelheim Professor of
Medicine Jason Phan, MD
Associate Director, Pulmonary and Department of Radiology
Critical Care Medicine Section University of Vermont College of
Department of Medicine Medicine
Yale University School of Medicine Fletcher Allen Healthcare
New Haven, Connecticut Burlington, Vermont
Marc Moss, MD Michael Risbano, MD, MA
Roger S. Mitchell Professor of Fellow, Division of Pulmonary
Medicine Sciences & Critical Care Medicine
Head of Critical Care University of Colorado Denver
Division of Pulmonary School of Medicine
Sciences and Critical Care Denver, Colorado
School of Medicine Jay H. Ryu, MD
Denver, Colorado Professor of Medicine
Mayo Clinic College of Medicine
Ali I. Musani, MD, FCCP Consultant, Division of Pulmonary
Associate Professor of Medicine and Critical Care Medicine
Director, Director
Interventional Pulmonary Interstitial Lung Disease Clinic
Program Mayo Clinic
National Jewish Health Rochester, Minnesota
Pulmonary Sciences and Critical
Care Medicine Milene T. Saavedra, MD
University of Colorado Denver Assistant Professor of Medicine
School of Medicine National Jewish Health
Denver, Colorado Denver, Colorado
Jerry A. Nick, MD Steven A. Sahn, MD
Associate Professor of Medicine Professor of Medicine
Director, Adult Cystic Fibrosis Director, Division of Pulmonary,
Program Critical Care, Allergy and Sleep
National Jewish Health Medicine
Denver, Colorado Medical University of South Carolina
Charleston, South Carolina
CONTRIBUTORS1 xxxiii
George Samuel, MD, CM, MSc. David R. Theil, MD

Assistant Professor Medical Director,
Division of Environmental and Department of Anesthesiology
Occupational Health Sciences Rose Medical Center
Denver, Colorado
Gregory Tino, MD, FCCP,
Marvin I. Schwarz, MD FACP
The James C. Campbell Professor of Associate Professor of Medicine
Pulmonary Sciences and Critical Pulmonary, Allergy and Critical
Care Medicine Care Division
Director, Fellowship Program Chief, Pulmonary Clinical Service
University of Colorado Denver Hospital of the University of
School of Medicine Pennsylvania
Denver, Colorado University of Pennsylvania School
of Medicine
Amen Sergrew, MD Philadelphia, Pennsylvania
Fellow, Division of Pulmonary Frederick S. Wamboldt, MD
Sciences and Critical Care
Medicine Professor of Medicine
University of Colorado Denver Head, Division of Psychosocial
School of Medicine Medicine
Denver, Colorado National Jewish Health
Professor of Psychiatry
Om R. Sharma, MD, FRCP, University of Colorado Denver
Master FCCP School of Medicine
Denver, Colorado
Professor of Medicine
Keck School of Medicine Jennifer J. Weinberger, MS,
Los Angeles, California RN, ANP
Division of Cardiology
Daniel R. Smith, MD, FCCP Denver Health Medical Center
Assistant Professor of Medicine Denver, Colorado
Denver, Colorado Howard D. Weinberger,
MD, FACC, FACP
Jeff Swigris, DO, MS Professor of Medicine
Assistant Professor of Medicine Head, Division of Cardiology
Autoimmune Lung Center and National Jewish Health
Interstitial Lung Disease Program Division of Cardiology
National Jewish Health University of Colorado Denver
Denver, Colorado School of Medicine
Denver, Colorado
Masayoshi Takashima, MD
Program Director, Carl W. White, MD
Bobby R. Alford Department of Professor of Pediatrics
Otolaryngology, National Jewish Health
Head and Neck Surgery University of Colorado Denver
Baylor College of Medicine School of Medicine
Houston, Texas Denver, Colorado
xxxiv 1CONTRIBUTORS
Howard Yeong-Rung Li, MD Jose P. Zevallos, MD

Fellow, Bobby R. Alford Department of
Division of Pulmonary Sciences and Otolaryngology
Critical Care Medicine Baylor College of Medicine
University of Colorado Denver Houston, Texas
School of Medicine
Denver, Colorado
Robert L. Young, MD, PhD
Assistant Professor of Medicine
Denver, Colorado
1 xxxv
Symbols and abbreviations
A–a alveolar to arterial gradient

ABC airway, breathing, circulation
ABG arterial blood gas
ABPA allergic bronchopulmonary aspergillosis
ACCP American College of Chest Physicians
ACE angiotensin-converting enzyme
ACI acute lung injury
ACTH adrenocorticotrophic hormone
ADH antidiuretic hormone
AECC American–European Consensus Conference
AFB acid-fast bacillus
AFP A-fetoprotein
AG anion gap
AHI apnea–hypopnea index
AIA aspirin-induced asthma
AIDS acquired immune deficiency syndrome
AIP acute interstitial pneumonia
ALI acute lung injury
AML acute myeloid leukemia
AMS acute mountain sickness
ANA antinuclear antibody
ANCA antinuclear cytoplasmic antibody
ANP atrial natriuretic peptide
AP aortopulmonary
APACHE acute physiology and chronic health evaluation (score)
APAP automated positive airway pressure
APH associated pulmonary hypertension
APTT activated partial thromboplastin time
ARB angiotensin II receptor blocker
ARDS acute respiratory distress syndrome
ASV adaptive servo ventilation
ATN acute tubular necrosis
ATRA all-trans retinoic acid
ATS American Thoracic Society
xxxvi 1SYMBOLS AND ABBREVIATIONS
AVM arteriovenous malformation

BAC bronchoalveolar carcinoma
BAL bronchoalveolar lavage
BCG bacille Calmette–Guérin
B-hCG beta human chorionic gonadotrophin
bid twice a day
BHR bronchial hyperreactivity or hyperresponsiveness
BIPAP bilevel positive airways pressure
BMD bonemineral density
BMI body mass index (kg/meters2)
BMT bone marrow transplantation
BNP brain natriuretic peptide
BOOP bronchiolitis obliterans organizing pneumonia
BP blood pressure
BPAP bilevel positive airway pressure
BPD bronchopulmonary dysplasia
BTS British Thoracic Society
CABG coronary artery bypass graft
C-ANCA cytoplasmic pattern of ANCA
CAP community-acquired pneumonia
CBC complete blood count
CBD chronic beryllium disease
CCB calcium channel blocker
CCHS congenitally central hypoventilation syndrome
CF cystic fibrosis
CFA cryptogenic fibrosing alveolitis
CFRD cystic fibrosis–related diabetes
CFT complement fixation test
CFTR cystic fibrosis transmembrane conductance regulator
CFU colony-forming unit
CHART continuous hyperfractionated accelerated radiotherapy
CHF congestive heart failure
CI contraindication
CLL chronic lymphocytic leukemia
CMV cytomegalovirus
CNS central nervous system
CO carbon monoxide
CO2 carbon dioxide
COHb carboxyhemoglobin
SYMBOLS AND ABBREVIATIONS1 xxxvii
COP cryptogenic organizing pneumonia

COPD chronic obstructive pulmonary disease
CPAP continuous positive airway pressure
CPK creatine phosphokinase
CPT chest physiotherapy
CRP C-reactive protein
CRQ Chronic Respiratory Questionnaire
CSA central sleep apnea
CSF cerebrospinal fluid
CSR Cheyne–Stokes respiration
CT computerized tomography
CTD connective tissue disease
CTPA computerized tomographic pulmonary angiogram
CTV computed tomography venography
CURB confusion, urea, respiration rate, blood pressure (score)
CVA cardiovascular accident
CVD cardiovascular disease
CVP central venous pressure
CXR chest radiograph
DAD diffuse alveolar damage
DAH diffuse alveolar hemorrhage
DEXA dual energy X-ray absorptiometry
DFA direct fluorescent-antibody
DIC disseminated intravascular coagulation
DIF direct immunofluorescence (test)
DIOS distal intestinal obstructive syndrome
DIP desquamative interstitial pneumonitis
DLCO carbon monoxide diffusing capacity
DM dermatomyositis
DOT directly observed therapy
DPI dry powder inhaler
DPLD diffuse parenchymal lung disease
DPT diffuse pleural thickening
DSA digital subcutaneous angiography
dsDNA double-stranded DNA
DST drug susceptibility testing
DTH delayed-type hypersensitivity
DVT deep vein thrombosis
EBUS endobroncheal ultrasound
xxxviii 1SYMBOLS AND ABBREVIATIONS
EBV Epstein–Barr virus

ECG electrocardiogram
Echo echocardiogram
ECMO extracorporeal membrane oxygenation
ECOG Eastern Cooperative Oncology Group
ED emergency department
EEG electroencephalogram
EGFR epidermal growth factor receptor
EIA enzyme immunoassay
EIB exercise-induced bronchospasm
ELCAP Early Lung Cancer Action Project
ELISA enzyme-linked immunosorbent assay
EMG electromyogram
ENA extractable nuclear antigen
ENT ear, nose, and throat
EOG electrooculogram
EPAP expiratory positive airways pressure
ESR erythrocyte sedimentation rate
ESS Epworth sleepiness scale/score
ETT endotracheal tube
EUS esophageal ultrasound
FBC full blood count
FBG fasting blood glucose
FDG-18 fluorodeoxyglucose
FeNO inhaled nitric oxide
FEV1 forced expiratory volume in 1 second
FFP fresh frozen plasma
FiO2 fractional inspired oxygen
FNA fine needle aspirate
FOB fibre optic bronchoscopy
FPAH familial pulmonary arterial hypertension
FRC functional residual capacity
FVC forced vital capacity
g gram
GBM glomerular basement membrane
GERD gastroesophageal reflux disease
GI gastrointestinal
GM-CSF granulocyte macrophage colony-stimulating factor
GU genitourinary
H2 histamine receptors, type 2
SYMBOLS AND ABBREVIATIONS1 xxxix
HAART highly active antiretroviral therapy

HACE high-altitude cerebral edema
HADS Hospital Anxiety and Depression Score
HAPE high-altitude pulmonary edema
Hb haemoglobin
–
HCG human chorionic gonadotrophin
–
HCO 3 bicarbonate
HES hypereosinphilic syndrome
HHT hereditary hemorrhagic telangiectasia
HHV human herpes virus
HIT heparin-induced thrombocytopenia
HIV human immunodeficiency virus
HLA human leukocyte antigen
HP hypersensitivity pneumonitis
HPA hypothalamic–pituitary–adrenal (axis)
HPOA hypertrophic pulmonary osteoarthropathy
HPS hepatopulmonary syndrome
HRCT high-resolution computerized tomography
HRT hormone replacement therapy
HSV herpes simplex virus
IA invasive aspergillosis
IBD inflammatory bowel disease
IBW ideal body weight
ICS inhaled corticosteroids
ICU intensive care unit
IDSA Infectious Diseases Society of America
IFA indirect immunofluorescence assay
IgE immunoglobulin E
IgG immunoglobulin G
IgM immunoglobulin M
IGRA interferon-G release assay
IIP idiopathic interstitial pneumonia
ILD interstitial lung disease
IM intramuscular
INR international normalized ratio
IPAH idiopathic pulmonary arterial hypertension
IPAP inspiratory positive airways pressure
IPF idiopathic pulmonary fibrosis
IV intravenous
xl 1SYMBOLS AND ABBREVIATIONS
IVC inferior vena cava

IVIG intravenous immunoglobulin
JVP jugular venous pressure
kCO carbon monoxide transfer factor
L liter
LAM lymphangioleiomyomatosis
LCH Langerhans cell histiocytosis
LDH lactate dehydrogenase
LFTs liver function tests
LIP lymphocytic or lymphoid interstitial pneumonia
LMA laryngeal mask airway
LMWH low-molecular-weight heparin
LRI lower respiratory tract infection
LTOT long-term oxygen therapy
LV left ventricular
LVRS lung volume reduction surgery
MAC Mycobacterium avium complex
M, C, & S microscopy, culture, and sensitivity
MDI metered dose inhaler
MDR-TB multidrug-resistant TB
MDT multidisciplinary team
MEP maximum expiratory pressure
mg milligrams
MGUS monoclonal gammopathy of uncertain significance
MHC major histocompatibility complex
MI myocardial infarction
min minute
MIP maximum inhibitory pressure
MND motor neuron disease
MODS multiple organ dysfunction syndrome
MPO myeloperoxidase
MRA magnetic resonance angiography
MRC Medical Research Council
MRI magnetic resonance imaging
MRSA methicillin (or multiply) resistant Staphylococcus aureus
MTB Mycobacterium tuberculosis
NAC N-acetyl cysteine
NAEB nonasthmatic eosinophil bronchitis
ng nanograms
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doctrine and private instruction, to bring him hereto, and specially in
the doctrine of repentance, which, being neglected, the public place
of repentance is turned in a mocking.
“Dilapidation of benefices, dimitting of them for favour, or money,
that they become laick patronages, without advise of the Kirk, and
such like interchanging of benefices, by transaction and transporting
of themselves by that occasion, without the knowledge of the Kirk,
precisely to be punished. Such like, that setting of tacks without the
consent of the Assembly, be punished according to the acts: and
that the dimitters in favours for money, or otherwise to the effect
above writen; bee punished as the dilapidators.
“Corruptions in their persons and lives.
“That such as are light and wanton in their behaviour, as in

gorgeous and light apparell; in speech, in using light and prophane
companie, unlawfull gaming, as dancing, carding, dycing, and such
like, not beseeming the gravitie of a Pastour, bee sharply and gravely
reproved by the Presbyterie, according to the degree thereof: and
continuing therein after due admonition, that hee bee depryved, as
slanderous to the Gospel.
“That Ministers being found swearers, or banners, prophaners of
the Sabbath, drunkards, fighters, guiltie of all these or any of them,
be deposed simpliciter; and such like, lyars, detracters, flatterers,
breakers of promise, brawlers, and quarrellers, after admonition
continuing therein, incurre the same punishment.
“That Ministers given to unlawful and incompetent trades and
occupations for filthie gain, as holding of ostleries, taking of ocker
beside conscience and good lawes, and bearing worldly offices in
noblemen and gentlements houses, merchandise, and such like,
buying of victuals, and keeping to the dearth, and all such worldly
occupations, as may distract them from their charge, and may be
slanderous to the pastorall calling, be admonished and brought to
the acknowledging of their sins, and if they continue therein, to be
deposed.
“That Ministers not resident at their flocks, be deposed according
to the Acts of the generall Assembly, and lawes of the Realme:
otherwise the burthen to be laid on the Presbyteries, and they to be
censured therefore.
“That the Assembly command all their members, that none of
them await on the court and afairs thereof, without the advice and
allowance of their Presbyterie. Item, that they intend no action civill
without the said advice, except in small maters; and for remeding of
the necessitie, that some Ministers hath to enter in plea of law, that
remedie bee craved, that short processe bee devised, to bee used in
Ministers actions.
“That Ministers take speciall care in using godly exercises in their
families, in teaching of their wives, children, and servants, in using
ordinarie prayers and reading of Scriptures, in removing of offensive
persons out of their families, and such like other points of godly
conversation, and good example, & that they, at the visitation of
their Kirks, try the Ministers families in these points foresaid, and
such as are found negligent in these points after due admonition,
shall be adjudged unmeet to govern the house of God, according to
the rule of the Apostle.
“That Ministers in all companies strive to bee spirituall and
profitable, and to talke of things pertaining to godlinesse, as,
namely, of such as may strengthen us in Christ, instruct us in our
calling, of the means how to have Christs Kingdome better
established in our Congregations, and to know how the Gospel
flourisheth in our flocks, and such like others the hinderances, and
the remeeds that we finde, &c., wherein there is manifold
corruptions, both in our companying with our selves, and with
others: and that the contraveeners thereof be tryed, and sharply be
rebuked.
“That no Minister be found to contenance, procure, or assist a
publick offender challenged by his own Minister, for his publick
offence, or to bear with him, as though his Minister were too severe
upon him, under the pain of admonition and rebuking.
“Anent generall Assemblies.
“To urge the keeping of the Acts anent the keeping of the
Assembly, that it may have the own reverence and majestie.”
The Assembly having heard the whole act read, most
unanimously alloweth and approveth this article.
X. Anent the defraying of the expenses of the Commissioners to

the generall Assembly, referreth and recommendeth the same unto
the particular Presbyteries, and especially to the ruling Elders
therein, that they may take such courses whereby, according to
reason and former acts of Assemblies, the Commissioners expenses
to this Assembly, and to the subsequent, may be born by the
particular parochins of every Presbyterie, who sendeth them in their
name, and to their behalf, and for that effect, that all sort of persons
able in land or moneys proportionally, may bear a part of the
burthen, as they reap the benefit of their paines.
The Assembly referreth this unto the care of the particular
Presbyteries.
XI. Anent the repressing of poperie and superstition; It seemeth

expedient that the number and names of all the Papists in this
Kingdome be taken up at this Assembly, if it may be conveniently
done, and if not, that it be remitted to the next provincial
Assemblies, that it may appear what grouth poperie hath had, and
now hath through this Kingdome, what popish priests, and Iesuits
there born in the land; and that all persons of whatsoever state and
condition, be obliged to swear and subscribe the confession of Faith,
as it is now condescended upon by this generall Assembly, that they
frequent the word and Sacraments in the ordinar dyets and places,
otherwise to proceed against them with the censures of the Kirk,
and that children be not sent out of the countrey without licence of
the Presbyteries or provinciall Synods of the bounds where they
dwell.
The Assembly referreth this article to the severall
Presbyteries.
XII. Anent order to be taken that the Lords Supper be more

frequently administrat both in burgh and landward, then it hath been
in these years by-gone: It were expedient that the act at Edinburgh
December 25. 1562. Sess. 5. bee renewed, and some course bee
taken for furnishing of the elements, where the Minister of the Parish
hath allowance only for once in the year.
The Assembly referreth this to the consideration of
Presbyteries, and declareth that the charges be rather
payed out of that dayes collection, then that the
Congregation want the more frequent use of the
Sacrament.
XIII. Anent the entrie of Ministers to the ministrie: The Assembly

thinks expedient that the act holden at St. Andrews April 24. 1582.
Sess. 7. Touching the age of twenty five years be renewed, and none
to be admitted before that time, except such as for rare and singular
qualities, shall be judged by the generall or provinciall Assembly to
be meet and worthie thereof.
The Assembly approveth this article.
XIV. Anent mercats on Monday and Saturday within Burghs,

causing intollerable profanation of the Lords Day, by carying of
loads, bearing of Burthens; and other work of that kinde: It were
expedient for the redresse thereof, that the care for restraining of
this abuse be recommended by the Assembly unto the several
Burghs, and they to bee earnestly entreated to finde out some way
for the repressing of this evill, and changing of the day, and to
report their diligence there-anent to the next generall Assembly.
The Assembly referreth this article to the consideration of the
Burrows.
XV. Anent the profaination of the Sabbath-day in Landward,

especially for want of divine service in the afternoone: The Assembly
ordaineth the act of Assembly holden at Dundie, Iuly 12. 1580. Sess.
10. for keeping both dyets, to be put in execution.
The Assembly alloweth this article.
XVI. Anent frequenting with excommunicat persons: The Assembly

ordaineth that the act at Edinburgh, March 5. 1569. Sess. 10. to wit,
“That these who will not forbear the companie of excommunicat
persons after due admonition, be excommunicat themselves except
they forbear,” to be put in execution.
XVII. Whereas the confession of the Faith of this Kirk, concerning

both Doctrine and Discipline, so often called in question by the
corrupt judgment and tyrannous authoritie of the pretended Prelats,
in now clearly explained, and by this whole Kirk represented by this
generall Assembly concluded, ordained also to bee subscribed by all
sorts of persons within the said Kirk and Kingdome: The Assembly
constitutes, and ordaines, that from henceforth no sort of person, of
whatsoever quality and degree, be permitted to speak, or write
against the said Confession, this Assembly, or any act of this
Assembly, and that under the paine of incurring the censures of this
Kirk.
XVIII. Anent voicing in Kirk Sessions: It is thought expedient that

no Minister moderating his Session, shall usurpe a negative voice
over the members of his Session, and where there is two or moe
Ministers in one Congregation, that they have equall power in
voicing, that one of them hinder not the reasoning or voicing of any
thing, whereunto the other Minister or Ministers, with a great part of
the Session inclineth, being agreeable to the acts and practise of the
Kirk, and that one of the Ministers without advice of his colleague
appoint not dyets of Communion nor examination, neither hinder his
colleague from catechising and using other religious exercises as oft
as he pleaseth.
The Assembly referreth this article to the care of the
Presbyteries.
XIX. Since the office of Diocesane, or lordly Bishop, is all-uterly

abjured, and removed? out of this Kirk: It is thought fit that all titles
of dignitie, savouring more of poperie than of Christian libertie, as
Chapters with their elections and consecrations, Abbots, Pryors,
Deans, Arch-deacons, Preaching-deacons, Chanters, Subchanters,
and others having the like title, flowing from the Pope and canon law
only, as testifieth the second book of Discipline, bee also banished
out of this reformed Kirk, and not to bee usurped or used hereafter
under ecclesiasticall censure.
The Assembly alloweth this Article.
XX. Anent the presenting either of Pastours or Readers and

School-masters, to particular Congregations, that there be a respect
had to the Congregation, and that no person be intruded in any
office of the Kirke, contrare to the will of the congregation to which
they are appointed.
XXI. Anent Marriage without proclamation of bans, which being in

use these years by-gone hath produced many dangerous effects:
The Assembly would discharge the same, conforme to the former
acts, except the Presbyterie in some necessarie exigents dispense
therewith.
XXII. Anent the buriall in Kirks, the Assembly would be pleased to

consider anent the act of Assembly at Edinburgh 1588. Sess. 5. if it
shall be put in execution, and to discharge funerall sermons, as
savouring of superstition.
The Assembly referreth the former part of this article anent
buriall in Kirks to the care of Presbyteries, and dischargeth
all funerall sermons.
XXIII. Anent the tryall of Expectants before their entrie to the

ministrie, it being notour that they have subscribed the confession of
Faith now declared in this Assembly, and that they have exercised
often privatly, and publickly, with approbation of the Presbyterie,
they shall first adde and make the exercise publicly, and make a
discourse of some common head in Latine, and give propositions
thereupon for dispute, and thereafter be questioned by the
Presbyterie upon questions of controversie, and chronologie, anent
particular texts of Scripture how they may be interpreted according
to the analogie of Faith, and reconciled, and that they be examined
upon their skill of the Greek and Hebrew, that they bring a testificat
of their life and conversation from either Colledge or Presbyterie,
where they reside.
XXIV. The Assembly having considered the order of the provincial

Assemblies, given in by the most ancient of the Ministrie within
every Province, as the ancient plateforme thereof, ordained the
same to be observed conforme to the roll, registrat in the books of
Assembly, whereof the tennour followeth.
The order of the Provincial Assemblies in Scotland, according to the
Presbyteries therein contained.
1. The Provinciall Assembly of Mers and Tividaill.

The Presbyteries of The bounds.
Dunce. Mers.
Chirnside. Tividail.
Kelso. The Forrest.
Erstiltoun. Lauderdail.
Jedburgh.
Melros.
To meet the first time at Jedburgh, the third Twesday of April.
2. The Provinciall of Louthian.

Dumbar. e. Louthian.
Hadingtoun. w. Louthian.
Dalkeeth. Tweeddaill.
Edinburgh.
Peebles.
Linlithgow.
To meet the first time at Edinburgh the third Twesday of April.
3. The Provinciall of Perth.

Perth. The Shyrefdome of Perth and of Striviling
Dunkel. Shire.
Aughterardor.
Striviling.
Dumblane.
To meet the first time at Perth, the second Twesday of April.
4. The Province of Drumfrees.
Dumfrees. Niddisdaill.
Penpont. Annandaill.
Lochmabane. Ewsdaill.
Middilbee. Eskdaill.
Wachopdaill & a part of Galloway.
To meet the first time at Drumfrees, the second Twesday of April.
5. The Provinciall of Galloway.

Wigtoun. The Shyrefdome of Wigtoun, and Stewartie
Kirkubright. of Kirkubright.
Stranraver.
To meet the first time at Wigtoun, third Twesday of April.
The Provinciall Synod of Aire or Irwing.

Aire. The Shyrefdome of Aire
Irwing.
To meet with the Provincial Synod of Glasgow pro hac vice, the first
Twesday of April.
6. The Provinciall Synod of Glasgow.

Pasley. The Shyr. of Lennox, the Barrony of Renfrow,
Dumbartane. the Shy. of Clydsdail over and nether.
Glasgow.
Hamiltoun.
Lanerik.
To meet with the Provincial Synod of Aire and Irwing at Glasgow,
pro hac vice.
7. The Provinciall Synod of Argyl, desired to bee erected in several

Presbyteries, according to the note given in.
Dunnune. The Shyrifdomes of Argil & Boot, with a part
Kinloch. of Lochabar.
Inneraray.
Kilmoir.
Skye.
To meet the first time at Innereray, the 4 Twesday of April.
8. The Provinciall Synod of Fife.

St Andrews. The Shyrefdome of Fife.
Cowper.
Kirkadie.
Dunferling.
To meet the first time at Cowper in Fife the first Twesday of April.
9. The Provinciall Synod of Angus and Merns.

Meegle. The Shyrefdomes of Forfair and Merns.
Dundie.
Arbroth.
Forfair.
Brechen.
Merns.
To meet the first time at Dundie, the third Twesday of April.
10. The Provinciall Synod of Aberdene.
Aberdene. The Shyrefdomes of Aberdene and Bamfe.
Kincairdin.
All-foord.
Gairloch.
Ellan Deer.
Turreffe.
Fordyce.
To meet the first time at new Aberdene, the 3 Twesday of April.
11. The Provinciall Synod of Murray.

Innernes. The Shyrefdomes of Innernes in part, Nairn
Forresse. in part, Murray, Bamf in part, Aberden in
Elgin. part.
Strabogie.
Abernethie.
Aberlower.
To meet the first time at Forresse, the last Twesday of April.
12. The Provinciall Synod of Rosse.

Chanrie. The Shyrefdome of Innernes in part.
Taine.
Dingwall.
To meet the first time at Chanrie, the 2 Twesday of April.
13. The Provinciall Synod of Cathnes.

Dornoch. Cathnes.
Weeke or Thurso. Sutherland.
To meet the first time at Dornoch, the third Twesday of April.
14. The Provinciall Synod of Orkney and Zetland.

Kirkwall. The Shrefdome of Orkney and Zetland.
Scalloway.
To meet the first time at Kirkwall, the second Twesday of April.
15. The Provinciall Synod of the Isles.

All the Kirks of the North west Isles, viz. Sky, Lewes, and the rest
of the Isles, which were lyable to the Diocie of the Isles, except the
South-west isles which are joyned to the Presbyteries of Argyll, To
meet the first time at Skye the second Twesday of May.
That the Minister of the place where the Synodall Assembly meets
shall preach the first day of their meeting, and give timouse
advertisement to the rest of the Presbyteries.
It is remembered that of old the Synodall Assemblies that were
nearest to others, had correspondence among themselves, by
sending one or two Commissioners mutually from one to another,
which course is thought fit to be keeped in time comming: viz. The
Provincials of Louthian, and Mers, &c. The Provincials of Drumfries,
Galloway, Glasgow, and Argyll, The Provincials of Perth, Fyfe, and
Angus, &c. The Provincials of Aberdein and Murray. The Provincials
of Rosse, Caithnes, and Orknay. The Commissioners for
correspondence amongst the Synodals to be a Minister and a ruling
Elder.
The Assembly recommendeth to the severall Presbyteries the
execution of the old acts of Assemblies, against the break of the
Sabbath-day, by the going of Milles, Salt-pans, Salmond-fishing, or
any such-like labour, and to this end revives and renews the act of
the Assembly, holden at Halyrudehouse 1602. Sess. 5. whereof the
tennour followeth.
“The Assemblie considering that the conventions of the people,
specially on the Sabbath-day, are verie rare in manie places, by
distraction of labour, not only in Harvest and Seed-time, but also
every Sabbath by fishing both of white fish and Salmond fishing, and
in going of Milles: Therefore the Assemblie, dischargeth and
inhibiteth, all such labour of fishing as-well whyte fish as Salmond-
fish, and going of Miles of all sorts upon the Sabbath-day, under the
paine of incurring the censures of the Kirk. And ordains the
Commissioners of this Assemblie to meane the same to his Majestie,
and to desire that a pecuniall paine may be injoyned upon the
contraveeners of this present act.”
Act Sess. 24. December 18. 1638.
T
HE Assembly considering the great necessity of purging this land
from bygone corruptions, and of preserving her from the like in
time coming, ordaineth the Presbyteries to proceed with the
censures of the Kirk, to excommunication, against those Ministers
who being deposed by this Assembly acquiesces not to their
sentences, but exercise some part of their Ministeriall function,
refuseth themselves, and with-draw others from the obedience of
the acts of the Assembly.
Against the civill places and power of Kirk-men.
T
HE generall Assembly, remembering that among other clauses of
the application of the confession of Faith to the present time,
which was subscribed in Februarie 1638. The clause touching the
civill places and power of Kirk-men, was referred unto the tryall of
this Assembly; entered into a serious search thereof, especially of
their sitting on the bench, as Iustices of peace, their sitting in
Session and Councell, their ryding and voting in Parlament: and
considering how this vote in Parlament, was not at first sought nor
requyred by this Kirke, or worthy men of the Ministerie, but being
obtruded upon them, was disallowed for such reasons as could not
well be answered (as appeareth by the conference, holden at
Halyrude-house 1599. which with the reasons therein contained was
read in the face of the Assembly) & by plurality of voices not being
able to resist that enforced favour, they foreseeing the dangerous
consequences thereof, in the Assembly at Montrose did limitate the
same by many necessare cautions: Considering also the protestation
made in the Parliament 1606. by Commissioners from Presbyteries,
and provinciall Assemblies, against this restitution of Bishops to vote
in Parlament, and against all civill offices in the persons of Pastors,
separate unto the Gospel, as incompatible with their spirituall
function; with the manifold reasons of that Protestation from the
word of God, ancient Councels, ancient and moderne Divines, from
the Doctrine, discipline, and Confession of Faith of the Kirk of
Scotland, which are extant in print, and were read in the audience of
the Assembly: Considering also from their own experience the bad
fruits and great evils, which have been the inseparable consequents
of these offices, and that power in the persons of Pastors separate
to the Gospel, to the great prejudice of the freedome and libertie of
the Kirk, the jurisdiction of her Assemblies, and the powerfull fruits
of their spirituall Ministerie; The Assembly most unanimously in one
voice, with the hesitation of two allanerly, declared, that as on the
one part the Kirk and the Ministers thereof are oblidged to give their
advise and good counsell in matters concerning the Kirk or the
Conscience of any whatsomever, to his Majestie, to the Parlament to
the Councell, or to any member thereof, for their resolutions from
the word of God, So on the other part, that it is both inexpedient,
and unlawful in this Kirk, for Pastors separate unto the Gospel to
brook civil places, and offices, as to be Iustices of peace; sit and
decerne in Councell, Session, or Exchecker; to ryde or vote in
Parlament, to be Iudges or Assessors in any Civill Judicatorie: and
therefore rescinds and annuls, all contrarie acts of Assembly, namely
of the Assembly holden at Montrose 1600. which being prest by
authority, did rather for an interim tolerat the same, and that limitate
by many cautions, for the breach whereof the Prelats have been
justly censured, then in freedome of judgement allow thereof, and
ordaineth the Presbyteries to proceed with the Censures of the Kirk,
against such as shall transgresse herein in time comming.
T
HE Assembly considering the great prejudice which God’s Kirk in
this land, hath sustained these years bypast, by the unwarranted
printing of lybels, pamphlets, and polemicks, to the disgrace of
Religion, slander of the Gospel, infecting and disquyeting the mindes
of God’s people, and disturbance of the peace of the Kirk, and
remembring the former acts, and custome of this Kirk, as of all other
Kirks, made for restraining these and the like abuses, and that
nothing be printed concerning the Kirk, and Religion, except it be
allowed by these whom the Kirk intrusts with that charge: The
Assembly unanimously, by vertue of their ecclesiastical authority,
dischargeth and inhibiteth all printers within this Kingdome, to print
any act of the former Assemblies, any of the acts or proceedings, of
this Assembly, any confession of Faith, any Protestations, any
reasons pro or contra, anent the present divisions and controversies
of this time, or any other treatise whatsoever which may concerne
the Kirk of Scotland, or God’s cause in hand, without warrand
subscribed by Mr Archibald Iohnston, as Clerk to the Assembly, and
Advocate for the Kirk; or to reprint without his warrand, any acts or
treatises foresaids, which he hath caused any other to print, under
the paine of Ecclesiasticall censures to be execute against the
transgressours by the several Presbyteries, and in case of their
refusal, by the several Commissiones from this Assembly: Whereunto
also we are confident, the honourable Iudges of this land will
contribute their civill authority: and this to be intimat publickly in
pulpit, with the other generall acts of this Assembly.
T
HE generall Assembly ordaineth all Presbyteries and Provinciall
Assemblies to conveen before them, such as are scandalous and
malicious, and will not acknowledge this Assembly, nor acquiesce
unto the acts thereof: And to censure them according to their malice
and contempt, and acts of this Kirk; and where Presbyteries are
refractarie, granteth power unto the several Commissions to
summond them to compear before the next generall Assembly to be
holden at Edinburgh, the third Wedinsday of Iulie, to abide their
tryall and censure.
Act. Sess. 26. December 20. 1638.
T
HE Assembly considering the acts and practise of this Kirk in her
purest times, that the Commissioners of every Presbyterie,
Burgh, and Universitie, were both ordained to take, and really did
take from the Clerk the whole generall acts of the Assembly,
subscribed by the Clerk: Whereby they might rule and conforme
their judicatorie themselves, and all persons within their
jurisdictions, unto the obedience thereof: Considering the great
prejudices we have lately felt out of ignorance of the acts of
Assembly, Considering also the great necessity in this time of
reformation, beyond any other ordinarie time, to have an extract
thereof: The Assembly ordaineth be this present act, that all
Commissioners from Presbyteries, Burghs, and Universities,
presently get under the Clerks hand an Index of the acts, till the acts
themselves be extracted, and thereafter to get the full extract of the
whole generall acts, to be insert in their Presbyterie books, whereby
all their proceedings may be regulate in time coming. Likeas the
Assembly recommendeth unto every Kirk Session, for the
preservation of their particular Paroch from the reentrie of the
corruptions now discharged, and for their continuance in the
Covenant, anent doctrine, worship, and discipline now declared, to
obtain an extract of these acts: especially if they be printed: Seeing
their pryce will no wayes then be considerable: as the benefite both
of the particular Parish, and the interest of the whole Kirk, in the
preservation thereof from defection is undenyable: seeing
Presbyteries are composed of sundry parochins, and so must be
affected, or infected as they are, as Provinciall and generall
Assemblies, are composed of Presbyteries, and so must be disposed
as they are.
Act Sess. 26. December 20.
In the Assembly at Glasgow 1638. concerning the
confession of Faith renewed in Februar, 1638.
T
HE Assembly considering that for the purging and preservation of
religion, for the Kings Majesties honour, and for the publick peace
of the Kirk and Kingdome, the renewing of that nationall Covenant
and oath of this Kirk and Kingdome, in Februar 1638. was most
necessare, likeas the Lord hath blessed the same from Heaven with
a wonderfull successe for the good of religion, that the said
Covenant suspendeth the practise of novations already introduced,
and the approbation of the corruptions of the present governement
of the Kirk, with the civill places, and power of Kirkmen, till they be
tryed in a free generall Assembly, and that now after long and
serious examination, it is found that by the confession of Faith, the
five articles of Perth, and Episcopall governement are abjured and to
be removed out of this Kirk, and the civill places and power of Kirk-
men are declared to be unlawfull; The Assembly alloweth and
approveth the same in all the heads and articles thereof, And
ordaineth that all Ministers, Masters of Universities, Colledges, and
Schooles and all others who have not already subscribed the said
Confession and Covenant, shall subscribe the same with these words
prefixed, to the subscription, viz. The article of this Covenant which
was at the first subscription referred to the determination of the
general Assembly being now determined at Glasgow, in December
1638. and thereby the five articles of Perth, and the governement of
the Kirk by Bishops, being declared to be abjured and removed, the
civill places and power of Kirk-men declared to be unlawfull; We
subscrive according to the determination, of the said free and lawfull
generall Assembly holden at Glasgow; and ordaineth, ad perpetuam
rei memoriam, the said Covenant with this declaration to be insert in
the registers of the Assemblies of this Kirk; generall, Provinciall and
Presbyteriall.
Concerning the subscribing the confession of Faithe
lately subscribed by his Majesties Commissioner, and
urged to be subscribed by others.
S
EEING the generall Assembly, to whom belongeth properly the
publick and judiciall interpretation of the confession of Faith, hath
now after accurat tryall, and mature deliberation clearly found, that
the five articles of Perth, and the governement of the Kirk by
Bishops, are abjured by the confession of Faith, as the same was
professed in the year 1580. and was renewed in this instant year
1638. And that the Marques of Hammiltoun his Majesties
Commissioner hath caused print a Declaration, hearing that his
Majesties intention and his own, in causing subscribe the confession
of Faith, is no wayes to abjure, but to defend Episcopall
governement, and that by the oath and explanation set down in the
act of Councel, it neither was nor possibly could be abjured,
requiring that none take the said oath, or any other oath in any
sense, which may not consist with Episcopall governement: which is
directly repugnant to the genuine and true meaning of the foresaid
Confession as it was professed in the year 1580. as is clearly now
found and declared by the generall Assembly: Therefore the generall
Assembly: Doth humbly supplicate, that his Majestie may be
graciously pleased, to acknowledge and approve the foresaid true
interpretation, and meaning of the generall Assembly, by his Royall
warrand to his Majesties Commissioner, Councell, and Subjects, to
be put in record for that effect, whereof we are confident, after his
Majesty, hath received true information from this Kirk, honoured with
his Majesties birth and baptisme, which will be a royall testimonie of
his Majesties piety and justice, and a powerfull meane to procure the
heartie affection and obedience of all his Majesties loyall Subjects:
And in the meane time, least any should fall under the danger of a
contradictorie oath, and bring the wrath of God upon themselves
and the land, for the abuse of his Name and Covenant; The
Assembly by their Ecclesiasticall authority, prohibiteth and
dischargeth, that no member of this Kirk swear or subscribe the said
Confession, so far wreasted to a contrare meaning, under paine of
all Ecclesiasticall censure: but that they subscribe the confession of
Faith, renewed in Februar, with the Declaration of the Assembly set
down in the former Act.
Concerning yearly generall Assemblies.
T
HE Assembly having considered the reasons lately printed for
holding of generall Assemblies, which are taken from the light of
nature, the promise of Iesus Christ, the practise of the holy Apostles,
the doctrine and custome of other reformed Kirks, and the liberty of
this nationall Kirk, as it is expressed in the book of Policie, and
acknowledged in the act of Parlament 1592, and from recent and
present experience, comparing the lamentable prejudices done to
religion, through the former want of free and lawfull Assemblies, and
the great benefite arysing to the Kirk, from this one free and lawfull
Assembly; finde it necessary to declare, and hereby declares, that by
Divine, Ecclesiasticall, and Civill warrands, this national Kirk hath
power and liberty to assemble and conveen in her yearly generall
Assemblies, and oftner pro re nata, as occasion and necessity shall
require. Appointeth the next Generall Assembly to sit at Edinburgh,
the third Weddinsday of Iulie 1639. And warneth all Presbyteries,
Universities, and Burghes, to send their Commissioners for keeping
the same. Giving power also to the Presbiterie of Edinburgh, pro re
nata: and upon any urgent and extraordinarie necessity (if any shall
happen before the diet appointed in Iulie) to give advertisement to
all the Presbyteries, Universities, and Burghes, to send their
Commissioners for holding an occasionall Assembly. And if in the
meane time it shall please the Kings Majestie to indict a generall
Assembly, ordaineth all Presbyteries, Universities, and Burghes, to
send their Commissioners for keeping the time and place which shall
be appointed by his Majesties Proclamation.
Act Sess. 26. December 20.
Ordaining an humble supplication to be sent to the
King’s Majestie.
T
HE Assembly, from the sense of his Majesties pietie and justice,
manifested in the publick indiction of their solemne meeting, for
the purging and preservation of Religion, in so great an exigent of
the extreame danger of both, from their fears arising out of
experience of the craftie and malicious dealing of their adversaries in
giving sinistrous informations against the most religious and loyall
designes and doings of his Majesties good Subjects, and from their
earnest desire to have his Majestie truely informed of their intentions
and proceedings, from themselves, who know them best, (which
they are confident, will be better beleeved, and finde more credite
with his Majestie, than any secret surmise or private suggestion to
the contrarie) that they may gaine his Majesties princely approbation
and ratification in the ensuing Parliament to their constitutions: Hath
thought meet and ordaineth, that an humble supplication be directed
to his Majestie, testifying their most heartie thankfullnesse for so
Royall a favour, as at this time hath refreshed the whole Kirk and
Kingdome, stopping the way of calumnie, and humbly supplicating
for the approbation, and ratification foresaid: That truth and peace
may dwell together in this Land, to the increase of his Majesties
glorie, and the comfort and quietnesse of his Majesties good People:
This the Assembly hath committed, according to the Articles
foresaid, to be subscribed by their Moderatour and Clerk, in their
name. The tennour whereof followeth.
To the Kings Most Excellent Maiestie:

The humble Supplication of the generall Assembly of the Kirk of
Scotland, conveened at Glasgow, November 21. 1638.
Most gracious Soveraigne,
We your Majesties most humble and loyall Subjects, The
Commissioners from all the parts of this your Majesties ancient and
native Kingdome, and members of the National Assembly,
conveened at Glasgow, by your Majesties special indiction,
considering the great happinesse which ariseth both to Kirk and
Common-wealth, by the mutual embracements of Religion and
Iustice, of truth and peace, when it pleaseth the Supreame
Providence so to dispose, that princely power and ecclesiasticall
authoritie joyne in one, do with all thankfulnesse of heart
acknowledge, with our mouthes doe confesse, and not only with our
pennes, but with all our power are readie to witnesse unto the
world, to your Majesties never dying glorie, how much the whole
Kingdome is affected and not only refreshed, but revived, with the
comfortable sense of your Majesties pietie, justice, and goodnesse,
in hearing our humble supplications, for a full and free generall
Assembly: and remembring that for the present, a more true and
real testimonie of our unfained acknowledgement, could not proceed
from us your Majesties duetyfull Subjects, then to walke worthie of
so royall a favour: It hath been our greatest care and most serious
endevour, next unto the will of IESUS CHRIST, the great King of his
Kirk redeemed by his own bloud, in all our proceedings, joyned with
our hearty prayers to GOD, for a blessing from heaven upon your
Majesties Person and government, from the first houre of our
meeting, to carie our selves in such moderation, order and loyaltie,
as beseemed the subjects of so just and gracious a King, lacking
nothing so much as your Majesties personall presence; With which
had we been honoured and made happie, we were confident to have
gained your Majesties Royall approbation to our ecclesiastick
constitutions, and conclusions, knowing that a truly Christian minde
and royall heart inclined from above, to religion and piety, will at the
first discern, and discerning be deeply possessed with the love of the
ravishing beautie, and heavenly order of the house of God; they
both proceeding from the same Spirit. But as the joy was
unspeakable, and the hopes lively, which from the fountaines of your
Majesties favour did fill our hearts, so were we not a little troubled,
when wee did perceive that your Majesties Commissioner, as before
our meeting, he did endevour a prelimitation of the Assembly in the
necessarie Members thereof, and the matters to bee treated therein,
contrarie to the intention of your Majesties Proclamation indicting a
free Assembly according to the order of this Kirk, and laws of the
Kingdome: So from the first beginnings of our sitting (as if his
Lordship had come rather to crosse, nor to countenance our lawfull
proceedings, or as we had intended any prejudice to the good of
Religion, or to your Majesties honour (which GOD knoweth was far
from our thoughts) did suffer nothing, although most necessarie,
most ordinarie, and most undenyable, to passe without some
censure, contradiction, or protestation: And after some dayes
debating of this kinde, farre against our expectation, and to our
great griefe, did arise himself, commanded us, who had laboured in
everything to approve ourselves to GOD, and to his Lordship, as
representing your Majesties Person, to arise also, and prohibited our
further meeting by such a proclamation, as will bee found to have
proceeded, rather from an unwillingnesse that we should any longer
sit, than from any ground or reason, which may endure the tryall
either of your Majesties Parliament, or of your own royall
Iudgement, unto which if (being conveened by indiction from your
Majestie, and sitting now in a constitute Assembly) we should have
given place, This Kirk and Kingdome, contrare to your Majesties
most laudable intentions manifested in former proclamations, and
contrarie to the desires and expectation of all your Majesties good
people had been in an instant precipitate in such a world of
confusions, and such depths of miserie, as afterward could not easily
have been cured. In this extreamitie we made choise rather of that
course which was most agreeable to your Majesties will revealed
unto us, after so many fervent supplications, and did most conduce
for the good of Religion, your Majesties honour, and the well of your
Majesties kingdome; then to give way to any sudden motion,
tending to the ruine of all; wherein wee are so far from fearing the
light, least our deeds should be reproved, that the more accuracy
that we are tryed, and the more impartially our using of that power,
which God Almighty, and your sacred Majestie, his Vicegerent had
put in our hands, for so good and necessarie ends, is examined, we
have the greater confidence, of your Majesties allowance and
ratihabition: and so much the rather, that being in a manner
inhibited to proceed in so good a work, we doubled our diligence,
and endevoured more carefully then before, when your Majesties
Commissioner was present, in every point, falling under our
consideration, to walke circumspectly, and without offence, as in the
sight of God, and as if your Majesties eyes had been looking upon
us, labouring to proceed according to the word of God, our
confession of Faith, and nationall oath, and the laudable
constitutions of the lawfull Assemblies of this Kirk; and studying
rather to renew, and revive old acts made for the reformation of
Religion, in the time of your Majesties father, of happie memorie,
and extant in the records of the Kirk, which divine providence hath
preserved, and at this time brought to our hands; then either to
allow of such novations, as the avarice and ambition of men,
abusing authoritie for their own ends, had without order introduced;
or to appoint any new order, which had not been formerly received,
and sworn to bee reteined, in this Kirk. In all which the members of
the Assembly, found so clear and convincing light, to their full
satisfaction, against all their doubts and difficulties, that the
harmonie and unanimitie was rare and wonderfull, and that we could
not have agreed upon other constitutions, except wee would have
been found fighting against GOD. Your Majesties wise and princely
minde knowethe, that nothing is more ordinary then for men, when
they doe well, to bee evil spoken of, and that the best actions of
men are many times mis-construed, and mis-reported. Balaam,
although a false Prophet, was wronged: for in place of that which
hee said, The Lord refuseth to give me leave to go with you: the
princes of Moab reported unto Balack, that Balaam refused to goe
with them. But our comfort is, That Truth is the daughter of time,
and although calumnie often starteth first, and runneth before, yet
Veritie followeth her at the heels, and possesseth her self in noble
and royall hearts: where base calumnie cannot long finde place. And
our confidence is, that your Majestie with that worthie King, will
keep one eare shut against all the obloquies of men; and with that
more wise King, who, when he gave a proofe that the wisedome of
GOD was in him to doe judgment, would have both parties to stand
before him at once: that hearing them equally, they might speed
best, and go out most chearfully from his Majesties face, who had
the best cause. When your Majesties wisedome hath searched all
the secrets of this Assembly, let us be reputed the worst of all men
according to the aspersions which partialitie would put upon us, let
us be the most miserable of all men, to the full satisfaction of the
vindictive malice of our adversaries, let us by the whole world bee
judged of all men the most unworthie to breath any more in this
your Majesties Kingdome, if the cause that we maintaine, and have
been prosecuting, shall be found any other, but that we desire that
the Majestie of GOD, who is our fear and our dread, be served, and
his house ruled, according to his owne will; if we have not carried
along with us in all the Sessions of our Assemblie, a most humble
and loyall respect to your Majesties honour, which next unto the
honour of the living GOD, lyeth nearest our hearts; if we have not
keeped our selves within the limits of our reformation, without
debording or reflecting upon the constitution of other reformed
Kirks, unto which wee heartily wish all truth and peace, and by
whose sound judgement and Christian affection we certainly look to
be approven; if we have not failed rather by lenitie then by rigour in
censuring of delinquents, never exceeding the rules and lines
prescribed, and observed by this Kirk; and if (whatsoever men
minding themselves, suggest to the contrary) the government and
discipline of this Kirk, subscribed and sworn before, and now
acknowledged by the unanimous consent of this Assembly, shall not
bee found to serve for the advancement of the Kingdome of CHRIST,
for procuring all duetifull obedience to your Majestie, in this your
Kingdome, and great riches and glorie to your Crown, for peace to
us, your Majesties loyall subjects, and for terrour to all the enemies
of your Majesties honour and our happinesse: and if any act hath
proceeded from us, so farre as our understanding could reach, and
humane infirmitie would suffer, which being duely examined
according to the grounds laid by your Majesties Father, of everlasting
memory, and our religious Progenitours, and which religion did
forbid us to infringe, shall merit the anger and indignation,
wherewith wee are so often threatened: But on the contrare, having
sincerely sought the glorie of GOD, the good of Religion, your
Majesties honour, the censure of impietie, and of men who had sold
themselves to wickednesse, and the re-establishment of the right
constitution and government of this Kirk, farre from the smallest
appearance of wronging any other reformed Kirk, we humbly beg,
and certainly expect, that from the bright beames of your Majesties
countenance shining on this your Majesties own Kingdome and
people, all our stormes shall bee changed in a comfortable calme,
and sweet Sunshine, and that your Majesties ratification in the
ensuing Parliament, graciously indicted by your Majesties
Proclamation to bee keeped in May, shall setle us in such a
firmnesse, and stabilitie in our Religion, as shall adde a further lustre
unto your Majesties glorious Diademe, and make us a blessed
people under your Majesties long and prosperous reigne: which we
beseech him who hath directed us in our affaires, and by whom
Kings reigne, to grant unto your Majestie, to the admiration of all the
world, the astonishment of your enemies, and comfort of the godly.
FINIS.
Collected, visied, and extracted forth of the Register of the acts of

the Assembly by me Mr. A. Ihonston, Clerk thereto, under my signe
and subscription manuall.—Edinburgh the 12 of Jan. 1639.
A Breife Collection of the Passages of the Assembly
holden at Glasgow, in Scotland, November last,
1638; with the Deposicon of Divers B.p.p. Their
Offences for which they were sentenced; and an
Index of all the Acts made at the said Assembly.
Upon Wednesday the vijᵗʰ day of November, a generall ffast was

kept throughout all Scotland, for calling upon God for his blessing
upon their Assembly, and praying for Gods gracious assistance that
their meeting might take good effect to Gods glorie and their owne
good.
21.—Upon the 21ˢᵗ day of November, their Assembly begun,
where (after calling upon the name of the Lord) their Nobilitie and
Commissioners were called and desired to bring in their
Commissions.
22.—The 22ᵈ day, the Commissioners Letters, and Commissions
were produced; and the Commissioners for every Presbyterie
produced their Commission.
23.—The 23ᵈ day, Mr Alexʳ. Henrison (after long contestacon) was
chosen Moderator for the Assembly.
24.—The 24ᵗʰ day the Assembly proceeded to the election of their
Clerke out of 4 Clarks, then nomynated:—(viz.)—Mr Thomas
Sandilands, Mr Archibald Johnston, Mr John Nicholls, and Mr Alexʳ
Blair.
The Marquesse (as his Majesties Commissioner) desired that the
votes of his Assessors might be admitted for choosing the Clerke,
and in all other things, which the whole Assembly refused, for many
reasons then given.

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Lateral view right lung Lateral view left lung

Acute massive pulmonary embolus 455

Oxford American Handbook of

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Library of Congress Cataloging-in-Publication Data

Oxford American handbook of pulmonary medicine/edited by Kevin K. Brown,

This material is not intended to be, and should not be considered, a

Part I Clinical presentations—approaches

Part II Clinical conditions

37 Eosinophilic lung disease 515

56 Pulmonary rehabilitation 731

Part I Clinical presentations: approaches to problems

2 Chronic cough and normal chest X-ray 9

5 Unexplained respiratory failure 33

7 Diffuse parenchymal lung disease 53

8 Diffuse alveolar hemorrhage 63

9 Pulmonary infiltrates in the immunocompromised 67

10 Pulmonary infiltrates in the immunocompromised 79

11 The respiratory sleep patient 87

12 The breathless, pregnant patient 93

13 Preoperative assessment of the pulmonary patient 99

14 Postoperative breathlessness 103

Part II Clinical conditions

16 Chronic obstructive pulmonary disease (COPD) 143

Summary of approaches to medical treatment 156

17 Lung cancer 161

18 Mediastinal abnormalities 199

19 Bacterial respiratory infection 207

CAP: severity assessment 212

20 Viral respiratory infection 247

21 Mycobacterial respiratory infection 269

22 Fungal respiratory diseases 285

23 Parasitic lung disease 311

25 Pleural effusions 327

26 Asbestos and the lung 345

Mesothelioma: diagnosis 352

27 Sleep-related respiratory disorders 357

29 Adult cystic fibrosis (CF) 381

30 Lung transplantation 405

31 Pulmonary hypertension 421

32 Pulmonary thromboembolic disease 437

Rare causes of embolic disease 462

34 Idiopathic interstitial pneumonias 481