Pulmonology

In medicine, pulmonology (aka pneumology) is the specialty that deals with diseases of the lungs and the respiratory tract. It is called chest medicine and respiratory medicine in some countries and areas. Pulmonology is generally considered a branch of internal medicine, although it is closely related to intensive care medicine when dealing with patients requiring mechanical ventilation. Surgery of the respiratory tract is generally performed by specialists in cardiothoracic surgery (or thoracic surgery). Chest medicine is not a specialty in itself but is an inclusive term which pertains to the treatment of diseases of the chest and contains the fields of pulmonology, thoracic surgery, and intensive care medicine. Pulmonology is concerned with the diagnosis and treatment of lung diseases, as well as secondary prevention (tuberculosis). Physicians specializing in this area are called pulmonologists.

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Diagnosis

In medicine, 50% of all diagnoses can be made by a thorough medical history, and lung diseases are no different. The pulmonologist will conduct a general review and focus on:

• hereditary diseases affecting the lungs (cystic fibrosis, alpha 1-antitrypsin deficiency)
• exposure to toxins (tobacco smoke, asbestos, exhaust fumes, coal mining fumes)
• exposure to infectious agents (certain types of birds, malt processing)
• an autoimmune diathesis that might predispose to certain conditions (pulmonary fibrosis, pulmonary hypertension)

Physical diagnostics are as important as in the other fields of medicine.

• Inspection of the hands for signs of cyanosis or clubbing, chest wall, and respiratory rate.
• Palpation of the cervical lymph nodes, trachea and chest wall movement.
• Percussion of the lung fields for dullness or hyperresonance.
• Auscultation (with a stethoscope) of the lung fields for diminished or unusual breath sounds.

As many heart diseases can give pulmonary signs, a thorough cardiac investigation is usually included.

Other tools include:

• Laboratory investigation of blood (blood tests). Sometimes arterial blood gas measurements are also required.
• Spirometry (the determination of lung volumes in time by breathing into a dedicated machine; response to bronchodilatators and diffusion of carbon monoxide)
• Bronchoscopy with bronchoalveolar lavage (BAL), endobronchial and transbronchial biopsy and epithelial brushing
• Chest X-rays
• CT scanning (MRI scanning is rarely used)
• Scintigraphy and other methods of nuclear medicine
• Positron emission tomography (especially in lung cancer)

Treatment

Surgical treatment in generally performed by the (cardio)thoracic surgeon, generally after primary evaluation by a pulmonologist.

Medication is the most important treatment of most diseases of pulmonology, either by inhalation (bronchodilators and steroids) or in oral form (antibiotics, leukotriene antagonists).

Oxygen therapy is often necessary in severe respiratory disease (emphysema and pulmonary fibrosis). When this is insufficient, the patient might require mechanical ventilation.

Training

In the United States, pulmonologists are physicians who, after receiving a medical degree MD or DO, complete residency training in internal medicine (3 years), followed by at least 2 additional years of subspeciality fellowship training in pulmonology. Most pulmonologists complete 3 years of combined subspecialty fellowship training in pulmonary medicine and critical care medicine.

In the United States, pediatric pulmonologists are physicians who, after receiving a medical degree MD or DO, complete residency training in pediatrics (3 years), followed by at least 3 additional years of subspeciality fellowship training in pulmonology.

Diseases managed by the pulmonologist

• Allergic bronchopulmonary aspergillosis
• Asthma
• Chronic obstructive pulmonary disease: -
  • Chronic bronchitis
  • Emphysema
• Cystic fibrosis (in adults; pediatricians may be involved in the care of children with the disease)
• Lung cancer diagnosis
• Pneumoconiosis
• Pneumonia
• Pneumothorax
• Psittacosis
• Pulmonary embolism
• Pulmonary fibrosis
• Pulmonary hypertension
• Pulmonary sequestration
• Sarcoidosis
• Sleep apnea
• Tuberculosis

Scientific research

Pulmonologists are involved in both clinical and basic research of the respiratory system, ranging from the anatomy of the bronchial epithelium to the most effective treatment of pulmonary hypertension (a disease notoriously resistant to therapy).