Definition and Overview
Pulmonology is a medical specialty that deals with the diseases of the pulmonary system, particularly those involving the upper respiratory tract, lungs, and bronchial tubes. It is sometimes referred to as “respiratory medicine” because it deals primarily with diseases affecting respiration and ventilation.
Doctors who specialize in this field are called pulmonologists. They are general internist with fellowship training in pulmonary medicine. They must pass a board examination before they are certified and allowed to practice as pulmonologists. Although they are trained to handle both common and complicated respiratory conditions, pulmonologists are typically consulted only when patients suffer from serious respiratory diseases.
Who Should Undergo and Expected Results
A pulmonology consultation is usually recommended for patients whose conditions are beyond the scope of a general internist. This means that either the condition has gotten worse and must be referred to a specialist or that it is a complex disease to begin with. Below is the list of respiratory conditions that may prompt a patient to consult a pulmonologist:
Asthma – Asthma is a no cure, long-term disease that affects children and adults. Its severity ranges from mild to severe attacks, with some asthma patients requiring hospitalizations. Since asthma cannot be cured, the only way to deal with it is through effective management, and this is where a pulmonologist consultation becomes helpful. The specialist can help identify what triggers the condition and provide an asthma management plan to keep the attacks to a bare minimum.
Tuberculosis (TB) – This is a potentially fatal infectious disease that affects the lungs caused by the bacteria called Mycobacterium tuberculosis. People with TB can infect other people through coughing or sneezing. Because TB is easily spread, a pulmonology consultation is necessary to immediately treat the disease and protect other people from getting infected.
Chronic Obstructive Pulmonary Disease (COPD) – This is a progressive disease that involves the obstruction of the air that goes in and out of the lungs. COPD is diagnosed if, (1) the airways and air sacs are no longer as elastic as they used to be; (2) the walls between many air sacs have disappeared resulting in fewer but larger air sacs; (3) the walls of the airways are swollen and inflamed; and, (4) the airways are clogged with severe amounts of mucus. There are two diseases that fall under COPD – emphysema and bronchitis. With emphysema, the first two conditions of COPD are observed – the air sacs are damaged and have become larger. With chronic bronchitis, the last two conditions of COPD apply – the lining of the airways is constantly inflamed, and thus, more mucus are produced and stuck in the airways, making it difficult to breathe.
Interstitial Lung Disease (ILD) – This is caused by the continuous scarring of the lungs that prevents the patient from taking a full breath. Common symptoms include shortness of breath, coughing, and eventual lung stiffness that affect the patient’s ability to breathe properly.
How Does the Procedure Work?
A pulmonology consultation starts with the discussion of the patient’s medical history. Ordinarily, a patient will only be referred to a pulmonologist if a general practitioner is unable to deal with the problem due to its complexity. Medical records must be brought to the consultation, so the pulmonologist will fully understand the patient’s condition. He will also need to know if the patient has been exposed to toxins like asbestos, exhaust fumes, mining fumes, and tobacco smoke, which may have caused the disease. He may also perform physical tests to ascertain the patient’s breathing condition and check his patient’s hands for signs of clubbing, which are symptoms of some lung diseases.
To gather additional information needed to accurately identify potential pulmonary diseases, the pulmonologist may request additional tests, such as:
Diagnostic imaging scans, such as chest X-rays and CT scans
Pulmonary function testing – This is used to measure the lungs’ performance in terms of movement of air through airways, lung volumes, respiratory pressure, and carbon monoxide's diffusing capacity. It can also include cardiopulmonary exercises to determine how strong or weak the lungs’ responses are.
Fiberoptic bronchoscopy – This is used to view the airway passages to search for abnormalities and gather lung tissue for a biopsy
Once the pulmonologist has a complete picture of the patient’s condition, he will be able to recommend a treatment plan, which may include medication, pulmonary rehabilitation, smoking cessation, dietary planning, and other therapeutic treatments.
Possible Complications and Risks
A pulmonology consultation is 100% safe. However, some complications and risks may arise if certain tests are performed. An example is bronchoscopy, which may result in bleeding or irritation of the airways.
- Mason, R. Murray and Nadel’s Textbook of Respiratory Medicine, 5th edition, Saunders, 2010.