A pulmonologist is a doctor who diagnose and treat medical conditions involving the respiratory system.
A primary care doctor can refer someone to a pulmonologist if they show signs of a respiratory condition. Infections such as pneumonia and chronic diseases such as chronic obstructive pulmonary disease (COPD) and asthma include these.
This article addresses what pulmonologists are doing, what conditions they are treating and more.
What is a pulmonologist?
A pulmonologist is a physician who is trained in the respiratory system. The system includes all tissues, airways, and muscles that carry oxygen out of the body and extract carbon dioxide.
The respiratory system is specifically composed of:
- nasal cavity
- mouth
- throat, or pharynx
- voice box, or larynx
- trachea
- lungs
- bronchi
- bronchioles
- alveoli
Pulmonologists treat and diagnose respiratory problems that result from:
- infections
- inflammation
- structural irregularities
- tumors
- autoimmune conditions
Other respiratory conditions can also affect the cardiovascular system including COPD and interstitial lung disease. Symptoms such as chest pain and breathing difficulties occur in both cardiovascular and respiratory conditions.
Because of this, pulmonologists also work closely with cardiologists when they diagnose and treat certain conditions.
Pulmonologists also coordinate treatment plans for patients with interdisciplinary health care teams that include physicians, nurses, pathologists, and respiratory therapists.
Types of pulmonologist
Pulmonology is a subspecialty of internal medicine or pediatrics dedicated specifically to the study of the respiratory system and the management of breathing disorders.
Pulmonologists may further specialize in their practice by treating only specific conditions or by concentrating on certain groups of patients.
Pulmonology Subspecialties include:
- critical care medicine
- sleep-disordered breathing
- interstitial lung disease
- obstructive lung disease
- interventional pulmonology
- neuromuscular disease
- lung transplantation
What do pulmonologists do?
In order to diagnose and monitor a number of respiratory conditions, pulmonologists perform various tests and procedures. These procedures cover:
Imaging tests
Pulmonologists use imaging techniques to analyze the different lung and chest structures. Such tests can identify any structural abnormalities that cause respiratory symptoms in a person.
Pulmonologists, for example, might use the following imaging tests:
- Chest X-rays. These take images of the lungs. Pulmonologists use chest X-rays to monitor overall lung health, looking for infections such as pneumonia or lung masses such as cancer.
- Chest CT scans. These provide more detailed X-ray images of the chest and lungs. Pulmonologists can detect signs of emphysema, lung cancer, and pleural effusion using chest CT scans. Pulmonologists also use the scan results to plan their next steps.
- Chest ultrasound. These use soundwaves to produce images of the structures inside the chest and the pleural space, which is the area between the lungs and the chest wall.
Pulmonary function tests
Pulmonary function tests measure various aspects of respiratory health including volume of the lungs, absorption of oxygen and inflammation in the lungs. The findings of these tests are used by pulmonologists to help them identify respiratory problems and control current treatment effects.
Several measures of the pulmonary functions include:
- Spirometry. This is the most common type of pulmonary function test. It measures lung capacity and the rate for airflow in and out of the lungs.
- Lung volume tests. These measure the volume of air in the lungs when a person inhales and exhales.
- Pulse oximetry. This measures oxygen levels in the blood.
- Arterial blood gas test. This estimates the levels of oxygen and carbon dioxide in the blood.
- Fractional exhaled nitric oxide test. This measures the nitric oxide content in a person’s breath. Having high nitric oxide levels usually indicates asthmatic inflammation in the lungs.
Sleep studies
In order to diagnose obstructive sleep apnea, pulmonologists who specialize in sleep-disordered breathing conditions may perform sleep studies.
A sleep test, or polysomnogram, tracks the brain and muscle activity of a person as they sleep, as well as their eye movement, heart rate, and respiration rate.
Biopsies
A pulmonologist may conduct a biopsy to extract a sample of lung or pleura tissue, which is the membrane that surrounds the lungs. Lung and pleura biopsies may show signs of inflammation, infection or cancer.
What conditions do they treat?
Pulmonologists can view a wide array of medical conditions affecting the respiratory system. They range from diseases and chronic immune conditions to cancer and advanced deficiencies.
Pulmonologists sometimes treat these as follows:
- Asthma. This is a chronic condition in which airways are limited by inflammation, causing wheezing, shortness of breath, and coughing.
- Bronchitis. This applies to inflammation and swelling of the bronchial tubes due to viral or bacterial infections and irritant contact, such as dust, chemical contaminants, or smoke from cigarettes.
- COPD. This includes progressive conditions such as emphysema and chronic bronchitis, which damage or block the airways and air sacs in the lungs. Although smoking is the leading cause of COPD, up to 25% of people with this condition do not have a history of smoking, according to the National Heart, Lung, and Blood Institute.
- Cystic fibrosis. This is an inherited condition wherein the body produces thick, sticky mucus that can clog the lungs, airways, and pancreas. People with cystic fibrosis have a higher risk of developing persistent lung infections.
- Emphysema. This is a part of COPD. This condition damages the walls of the air sacs in the lungs, which can cause the air sacs to collapse or stretch beyond their normal capacity.
- Interstitial lung disease. This refers to a group of conditions that cause scarring, or fibrosis, of the lungs. Fibrosis makes the lungs less elastic, which makes it difficult to breathe.
- Obstructive sleep apnea. This occurs when a person repeatedly stops breathing for at least 10 seconds during the night. People with sleep apnea may also experience chronic snoring, daytime fatigue, and difficulty concentrating. It can also lead to other complications, such as depression, high blood pressure, or heart attack.
- Occupational lung disease. This refers to several respiratory issues that occur as a result of long-term exposure to irritating or toxic substances in a work environment. Substances that can cause occupational lung disease include asbestos, crystalline silica, mold, and chemical fumes.
- Pulmonary hypertension. This condition causes abnormally high blood pressure in the arteries that supply the lungs. Pulmonary hypertension typically develops as a result of other underlying conditions, such as blood clots in the lungs, emphysema, heart failure, or liver disease.
- Tuberculosis (TB). This occurs when Mycobacterium tuberculosis bacteria get into the lungs. TB can cause persistent coughing, chest pain, and coughing up bloody phlegm. Although infection rates are relatively low in most developed countries, TB is one of the top 10 causes of death worldwide, according to the World Health Organization (WHO).
Education and qualifications
Pulmonologists must meet the following instructional requirements:
- a 4-year undergraduate degree
- a 4-year medical school degree
- a 3-year residency in internal medicine
- a 2- or 3-year fellowship in pulmonology
- specialized training in critical care or sleep medicine
Upon completing their fellowship and any additional training, pulmonologists must pass Board certification exams. When they earn their certifications they will officially begin their work.
Summary
A pulmonologist is a medical doctor specialized in the diagnosis and treatment of respiratory problems including, but not limited to, emphysema, bronchitis and TB.
A primary care doctor may refer someone to a pulmonologist if they have recurrent or worsening respiratory symptoms such as breathing difficulties, chest pain, or a cough that lasts longer than 3 weeks.
