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What is Pulmonology: An Overview

Definition & Overview

Pulmonology is a branch of medicine and a subspecialty of internal medicine. It specialises in the treatment of diseases that affect the respiratory system. It deals with all disorders of the lungs, upper airways, thoracic cavity, and the chest wall. It also deals with all problems that involve the nose, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli.

Pulmonology is also part of intensive care medicine because it involves providing life support and mechanical ventilation to patients who need them. It is also known as pneumology and respiratory medicine. Its subspecialties include:

  • Interstitial lung disease, which focuses on lung diseases caused by lung inflammation and scarring
  • Interventional pulmonology, which deals with airway disorders, lung cancer, and pleural diseases
  • Neuromuscular disease, which focuses on lung disorders caused by respiratory muscle failure
  • Obstructive lung disease, which focuses on conditions caused by the narrowing or obstruction of the airways
  • Lung transplantation
  • Sleep-related breathing problems
  • Paediatric pulmonology


Doctors who specialise in pulmonology are called pulmonologists. Those who specialise in treating young patients are called paediatric pulmonologists. In addition, those who perform lung surgery for the treatment of lung diseases are called thoracic surgeons.

Most respiratory problems can be treated by general physicians, doctors specialising in internal medicine, and paediatricians. The expertise of pulmonologists become necessary if the patient has an unknown and undiagnosed disorder. Their services are also required in the management of unusual and complicated respiratory diseases.

In the course of their work, pulmonologists deal with several different types of lung disorders, including:

  • Structural disorders
  • Inflammatory diseases
  • Infectious disorders
  • Neoplastic disorders
  • Pulmonary vascular disorders


In some cases, respiratory diseases affect the cardiovascular system. Thus, pulmonologists are usually part of a multi-disciplinary team of doctors working together to manage a patient’s condition.

Pulmonologists use a variety of tests and procedures to diagnose pulmonary diseases. These include:

  • Laboratory blood tests
  • Arterial blood gas measurement
  • Chest x-rays
  • Computed tomography (CT) scans
  • Positron emission tomography (PET)


Some tests are used specifically for diagnosing lung disorders. These include:

  • Spirometry - A common test used to assess how well the lungs work and detect breathing disorders
  • Pulmonary function tests - A group of tests that measure how well the lungs work
  • Bronchoscopy - A procedure wherein a flexible scope is passed through the upper airways down into the lungs for a visual examination
  • Pleural biopsy - A procedure that takes tissue sample from the pleura (the thin membrane that surrounds the lungs)
  • Endobronchial biopsy - Refers to the sampling of a lesion in the lungs usually to diagnose suspected sarcoidosis
  • Transbronchial biopsy - A procedure used to diagnose lung diseases as an alternative to open lung biopsy
  • Polysomnography - A sleep study used to measure a person’s oxygen levels and breathing during sleep to diagnose sleep disorders
  • Pulse oximetry test - It determines the blood’s oxygen saturation level


In treating diagnosed patients, pulmonologists use:

  • Medications
  • Oxygen therapy
  • Mechanical ventilation
  • Surgery
  • Lobectomy, which removes one of the lobes of the lung
  • Lung transplant, which removes a damaged lung and replaces it with a healthy lung from a donor
  • Thoracentesis, which removes air or fluid from the lungs or around it


These techniques make up a pulmonary rehabilitation plan, which is carried out by a rehabilitation team as well as the patient’s family. The plan may also involve exercise, emotional support, and other necessary actions to help patients have a good quality of life.

When Should You See a Pulmonologist?

Patients should see a pulmonologist if they:

  • Are diagnosed with lung disease
  • Suffer from symptoms of lung disease
  • Are at risk of lung disease
  • Have a hereditary condition that affects the lungs


The following symptoms should also prompt patients to see a pulmonologist:

  • Chronic cough
  • Shortness of breath
  • Chronic chest pain
  • Chronic mucus production
  • Wheezing
  • Coughing up blood
  • Breathing problems


Patients who meet the following risk factors should also see a pulmonologist:

  • Exposed to harmful toxins
  • Exposed to infectious agents
  • Have hereditary diseases that affect the lungs, such as cystic fibrosis and alpha 1 antitrypsin deficiency


Most patients also do so upon the referral of their primary care physician when serious pulmonary disease is suspected.

Some examples of respiratory and lung diseases are:

  • Acute respiratory distress syndrome
  • Asthma
  • Bronchiectasis
  • Chest infections
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Emphysema
  • Interstitial lung disease, including sarcoidosis and idiopathic pulmonary fibrosis
  • Lung cancer
  • Mesothelioma
  • Obesity hyperventilation syndrome
  • Pleural effusion
  • Pneumoconiosis
  • Pneumonia
  • Pneumothorax
  • Pulmonary hypertension
  • Pulmonary oedema
  • Sleep apnoea (also known as sleep-disordered breathing)
  • Tuberculosis


Some of these diseases are called occupational lung disease because they occur due to the nature of the patient’s work. Some types of jobs put patients at risk of lung problems due to the inhalation of dust, chemicals, and proteins.

Some diseases are also chronic disorders that may affect a person throughout his life. These diseases require continuous pulmonary management to prevent potential complications from arising.

References:

  • Martinez FD. “Early-Life Origins of Chronic Obstructive Pulmonary Disease.” N Engl J Med 2016; 375:871-878. http://www.nejm.org/pulmonary

  • Talbot FB. “Asthma in children: Its relation to anaphylaxis.” Boston Med Surg J. 1916;175:191-195. http://www.nejm.org/doi/full/10.1056/NEJM191608101750602?query=featured_pulmonary

  • Price DB, Yawn BP, Jones RCM. “Improving the differential diagnosis of chronic obstructive pulmonary disease in primary care.” Mayo Clin Proc. 2010 Dec; 85(12): 1122-1129. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996146/