Pulmonology
Encyclopedia
In medicine
, pulmonology (aka pneumology) is the specialty that deals with disease
s of the respiratory tract
and respiratory disease
. 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
(aka critical care medicine) when dealing with patients requiring mechanical ventilation
. 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
.
of the respiratory tract is generally performed by specialists in cardiothoracic surgery
(or thoracic surgery
), though minor procedures may be performed by pulmonologists. As mentioned above, pulmonology is closely related to critical care medicine when dealing with patients that require mechanical ventilation. As a result, many pulmonologists are certified to practice critical care medicine in addition to pulmonary medicine. There are fellowship programs that allow physicians to become board certified in pulmonary and critical care medicine simultaneously. Interventional pulmonology is a relatively new field within pulmonary medicine that deals with the use of procedures such as bronchoscopy
to treat several pulmonary diseases. Interventional pulmonology is not its own specialty.
. Originally, it was thought that blood
reaching the right side of the heart
passed through small 'pores' in the septum
into the left side to be oxygenated, as theorized by Galen
; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the second century. Thirteenth century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no 'direct' passage between the two sides (ventricles) of the heart. He believed that the blood must have passed through the pulmonary artery
, through the lungs, and back into the heart to be pumped
around the body. This is believed by many to be the first scientific description of pulmonary circulation.
Although pulmonary medicine only began to evolve as a medical specialty in the 1950's, William Welch
and William Osler
founded the 'parent' organization of the American Thoracic Society
, the National Association for the Study and Prevention of Tuberculosis
. When the specialty did begin to evolve, several discoveries were being made linking the respiratory system and the measurement of arterial blood gases, attracting more and more physicians and researchers to the developing field.
Physical diagnostics are as important as in the other fields of medicine
.
As many heart diseases
can give pulmonary signs, a thorough cardiac investigation is usually included.
Other tools include:
treatment is 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 (bronchodilator
s and steroid
s) or in oral form (antibiotic
s, leukotriene antagonist
s). A common example being the usage of inhalers in the treatment of inflammatory lung conditions such as Asthma
or Chronic obstructive pulmonary disease
. Oxygen therapy
is often necessary in severe respiratory disease (emphysema
and pulmonary fibrosis
). When this is insufficient, the patient might require mechanical ventilation
.
Pulmonary rehabilitation or respiratory therapy
may be initiated as a treatment after all or most other treatments do little to help the patient. Pulmonary rehabilitation is for patients whose respiratory function has decreased or improved very little, even with extensive medical treatment. Pulmonary rehabilitation is intended to educate the patient, the family, and improve the overall quality of life and prognosis
for the patient. Although a pulmonologist may refer a patient to therapy, the therapy is generally practiced by respiratory therapists.
, 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. After satisfactorily completing a fellowship in pulmonary medicine, he or she is permitted to take the board certification examination in pulmonary medicine. After passing this exam, he or she is now board certified. 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.
Usually, respiratory problems can be managed by a specialist in internal medicine
; however, some cases require the attention of a pulmonologist. Usually, a pulmonologist will be required in advanced cases of many respiratory disease
s.
, ranging from the anatomy of the respiratory epithelium
to the most effective treatment of pulmonary hypertension
(a disease notoriously resistant to therapy). Scientific research also takes place to look for causes and possible treatment in diseases such as pulmonary tuberculosis and lung cancer
. Several societies are dedicated to expanding the field of pulmonary medicine, some of which are listed below:
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, pulmonology (aka pneumology) is the specialty that deals with disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
s of the respiratory tract
Respiratory tract
In humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...
and respiratory disease
Respiratory disease
Respiratory disease is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange possible in higher organisms, and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, and the...
. It is called chest medicine and respiratory medicine in some countries and areas. Pulmonology is generally considered a branch of internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
, although it is closely related to intensive care medicine
Intensive care medicine
Intensive-care medicine or critical-care medicine is a branch of medicine concerned with the diagnosis and management of life threatening conditions requiring sophisticated organ support and invasive monitoring.- Overview :...
(aka critical care medicine) when dealing with patients requiring mechanical ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
. 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
Thoracic surgery
Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax . Generally treatment of conditions of the lungs, chest wall, and diaphragm....
, and intensive care medicine
Intensive care medicine
Intensive-care medicine or critical-care medicine is a branch of medicine concerned with the diagnosis and management of life threatening conditions requiring sophisticated organ support and invasive monitoring.- Overview :...
.
Background
In the United Kingdom, Ireland, South Africa and Australia the term "respiratory physician" is used rather than pulmonologist to distinguish a physician that practices pulmonology. In Canada, respirology and respirologist are used. SurgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
of the respiratory tract is generally performed by specialists in cardiothoracic surgery
Cardiothoracic Surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax —generally treatment of conditions of the heart and lungs .-Cardiac / Thoracic:...
(or thoracic surgery
Thoracic surgery
Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax . Generally treatment of conditions of the lungs, chest wall, and diaphragm....
), though minor procedures may be performed by pulmonologists. As mentioned above, pulmonology is closely related to critical care medicine when dealing with patients that require mechanical ventilation. As a result, many pulmonologists are certified to practice critical care medicine in addition to pulmonary medicine. There are fellowship programs that allow physicians to become board certified in pulmonary and critical care medicine simultaneously. Interventional pulmonology is a relatively new field within pulmonary medicine that deals with the use of procedures such as bronchoscopy
Bronchoscopy
Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
to treat several pulmonary diseases. Interventional pulmonology is not its own specialty.
History of pulmonology
One of the first major discoveries relevant to the field of pulmonology was the discovery of pulmonary circulationPulmonary circulation
Pulmonary circulation is the half portion of the cardiovascular system which carries Oxygen-depleted Blood away from the heart, to the Lungs, and returns oxygenated blood back to the heart. Encyclopedic description and discovery of the pulmonary circulation is widely attributed to Doctor Ibn...
. Originally, it was thought that blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
reaching the right side of the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
passed through small 'pores' in the septum
Interventricular septum
Interventricular septum , abbreviated IVS, is the stout wall separating the lower chambers of the heart from one another....
into the left side to be oxygenated, as theorized by Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the second century. Thirteenth century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no 'direct' passage between the two sides (ventricles) of the heart. He believed that the blood must have passed through the pulmonary artery
Pulmonary artery
The pulmonary arteries carry deoxygenated blood from the heart to the lungs. They are the only arteries that carry deoxygenated blood....
, through the lungs, and back into the heart to be pumped
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
around the body. This is believed by many to be the first scientific description of pulmonary circulation.
Although pulmonary medicine only began to evolve as a medical specialty in the 1950's, William Welch
William H. Welch
William Henry Welch, M.D. was an American physician, pathologist, and medical school administrator. He was one of the "Big Four" founding professors at Johns Hopkins Hospital. William Henry Welch, M.D. (April 8, 1850 - April 30, 1934) was an American physician, pathologist, and medical school...
and William Osler
William Osler
Sir William Osler, 1st Baronet was a physician. He was one of the "Big Four" founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there. Sir William Osler, 1st Baronet (July 12, 1849 – December 29, 1919) was a physician. He was...
founded the 'parent' organization of the American Thoracic Society
American Thoracic Society
American Thoracic Society , established in 1905, is an independently incorporated, international, educational and scientific society, serving its 18,000 members worldwide who are dedicated in respiratory and critical care medicine...
, the National Association for the Study and Prevention of Tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
. When the specialty did begin to evolve, several discoveries were being made linking the respiratory system and the measurement of arterial blood gases, attracting more and more physicians and researchers to the developing field.
Diagnosis
The pulmonologist begins the diagnostic process with a general review focusing on:- hereditary diseases affecting the lungs (cystic fibrosisCystic fibrosisCystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
, alpha 1-antitrypsin deficiencyAlpha 1-antitrypsin deficiencyAlpha 1-antitrypsin deficiency is an autosomal recessive genetic disorder caused by defective production of alpha 1-antitrypsin , leading to decreased A1AT activity in the blood and lungs, and deposition of excessive abnormal A1AT protein in liver cells...
) - exposure to toxinToxinA toxin is a poisonous substance produced within living cells or organisms; man-made substances created by artificial processes are thus excluded...
s (tobacco smokeTobacco smokingTobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
, asbestosAsbestosAsbestos is a set of six naturally occurring silicate minerals used commercially for their desirable physical properties. They all have in common their eponymous, asbestiform habit: long, thin fibrous crystals...
, exhaust fumesExhaust gasExhaust gas or flue gas is emitted as a result of the combustion of fuels such as natural gas, gasoline/petrol, diesel fuel, fuel oil or coal. According to the type of engine, it is discharged into the atmosphere through an exhaust pipe, flue gas stack or propelling nozzle.It often disperses...
, coal miningCoal miningThe goal of coal mining is to obtain coal from the ground. Coal is valued for its energy content, and since the 1880s has been widely used to generate electricity. Steel and cement industries use coal as a fuel for extraction of iron from iron ore and for cement production. In the United States,...
fumes) - exposure to infectious agentsInfectious diseaseInfectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
(certain types of birdBirdBirds are feathered, winged, bipedal, endothermic , egg-laying, vertebrate animals. Around 10,000 living species and 188 families makes them the most speciose class of tetrapod vertebrates. They inhabit ecosystems across the globe, from the Arctic to the Antarctic. Extant birds range in size from...
s, malt processing) - an autoimmune diathesisAutoimmunityAutoimmunity is the failure of an organism to recognize its own constituent parts as self, which allows an immune response against its own cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease...
that might predispose to certain conditions (pulmonary fibrosisPulmonary fibrosisPulmonary fibrosis is the formation or development of excess fibrous connective tissue in the lungs. It is also described as "scarring of the lung".-Symptoms:Symptoms of pulmonary fibrosis are mainly:...
, pulmonary hypertensionPulmonary hypertensionIn medicine, pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion...
)
Physical diagnostics are as important as in the other fields of medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
.
- Inspection of the hands for signs of cyanosisCyanosisCyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...
or clubbing, chest wall, and respiratory rate. - Palpation of the cervical lymph nodesCervical lymph nodesCervical lymph nodes are lymph nodes found in the neck.-Classification:There are approximately 300 lymph nodes in the neck, and they can be classified in many different ways.Henri Rouvière produced an influential classification in 1938...
, tracheaVertebrate tracheaIn tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
and chest wall movement. - Percussion of the lung fields for dullness or hyperresonance.
- AuscultationAuscultationAuscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
(with a stethoscopeStethoscopeThe stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...
) of the lung fields for diminished or unusual breath soundsBreath soundsRespiratory sounds refer to the specific sounds identified through auscultation of the respiratory system with a stethoscope....
.- RalesRalesCrackles, crepitations, or rales are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation. They are often heard only with a stethoscope...
or RhonchiRhonchiRhonchi is the coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways. Rhonchi is the plural form of the singular word rhonchus.-Description:...
heard over lung fields with a stethoscopeStethoscopeThe stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...
.
- Rales
As many heart diseases
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
can give pulmonary signs, a thorough cardiac investigation is usually included.
Other tools include:
- LaboratoryLaboratoryA laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurement may be performed. The title of laboratory is also used for certain other facilities where the processes or equipment used are similar to those in scientific laboratories...
investigation of bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
(blood testBlood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s). Sometimes arterial blood gasArterial blood gasAn arterial blood gas is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. The most common puncture site is the radial artery at the wrist, but sometimes the femoral artery in the groin or...
measurements are also required. - SpirometrySpirometrySpirometry is the most common of the pulmonary function tests , measuring lung function, specifically the measurement of the amount and/or speed of air that can be inhaled and exhaled...
(the determination of lung volumesLung volumesLung volumes and lung capacities refer to the volume of air associated with different phases of the respiratory cycle. Lung volumes are directly measured...
in time by breathing into a dedicated machine; response to bronchodilatators and diffusionDiffusionMolecular diffusion, often called simply diffusion, is the thermal motion of all particles at temperatures above absolute zero. The rate of this movement is a function of temperature, viscosity of the fluid and the size of the particles...
of carbon monoxideCarbon monoxideCarbon monoxide , also called carbonous oxide, is a colorless, odorless, and tasteless gas that is slightly lighter than air. It is highly toxic to humans and animals in higher quantities, although it is also produced in normal animal metabolism in low quantities, and is thought to have some normal...
) - BronchoscopyBronchoscopyBronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
with bronchoalveolar lavageBronchoalveolar lavageBronchoalveolar lavage is a medical procedure in which a bronchoscope is passed through the mouth or nose into the lungs and fluid is squirted into a small part of the lung and then recollected for examination. BAL is typically performed to diagnose lung disease...
(BAL), endobronchial and transbronchial biopsyBiopsyA biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
and epithelialEpitheliumEpithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
brushing - Chest X-rays
- CT scanningComputed tomographyX-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
(MRI scanningMagnetic resonance imagingMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
is rarely used) - ScintigraphyScintigraphyScintigraphy is a form of diagnostic test used in nuclear medicine, wherein radioisotopes are taken internally, and the emitted radiation is captured by external detectors to form two-dimensional images...
and other methods of nuclear medicineNuclear medicineIn nuclear medicine procedures, elemental radionuclides are combined with other elements to form chemical compounds, or else combined with existing pharmaceutical compounds, to form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs... - Positron emission tomographyPositron emission tomographyPositron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
(especially in lung cancerLung cancerLung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
) - PolysomnographyPolysomnographyPolysomnography , also known as a sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG...
(sleep studies) commonly used for the diagnosis of Sleep apneaSleep apneaSleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
Treatment
SurgicalSurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
treatment is generally performed by the (cardio)thoracic surgeon
Thoracic surgery
Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax . Generally treatment of conditions of the lungs, chest wall, and diaphragm....
, generally after primary evaluation by a pulmonologist. Medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
is the most important treatment of most diseases of pulmonology, either by inhalation (bronchodilator
Bronchodilator
A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. Bronchodilators may be endogenous , or they may be medications administered for the treatment of breathing difficulties...
s and steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s) or in oral form (antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s, leukotriene antagonist
Leukotriene antagonist
A leukotriene antagonist is a drug that inhibits leukotrienes, which are fatty compounds produced by the immune system that cause inflammation in asthma and bronchitis, and constrict airways....
s). A common example being the usage of inhalers in the treatment of inflammatory lung conditions such as Asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
or Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
. Oxygen therapy
Oxygen therapy
Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care...
is often necessary in severe respiratory disease (emphysema
Emphysema
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary...
and pulmonary fibrosis
Pulmonary fibrosis
Pulmonary fibrosis is the formation or development of excess fibrous connective tissue in the lungs. It is also described as "scarring of the lung".-Symptoms:Symptoms of pulmonary fibrosis are mainly:...
). When this is insufficient, the patient might require mechanical ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
.
Pulmonary rehabilitation or respiratory therapy
Respiratory therapy
Respiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic respiratory problems. These specialists are termed Respiratory Therapists in most places internationally but may also be referred to as Respiratory Scientists or...
may be initiated as a treatment after all or most other treatments do little to help the patient. Pulmonary rehabilitation is for patients whose respiratory function has decreased or improved very little, even with extensive medical treatment. Pulmonary rehabilitation is intended to educate the patient, the family, and improve the overall quality of life and prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
for the patient. Although a pulmonologist may refer a patient to therapy, the therapy is generally practiced by respiratory therapists.
Pulmonology as a career
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, pulmonologists are physicians who, after receiving a medical degree (MD
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
or DO
DO
DO may refer to:* Directorate of Operations, former name of the National Clandestine Service* Doctor of Osteopathic Medicine, a degree held by physicians in the United States* Dominican Republic, ISO country code: do...
), complete residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
training in internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
(3 years), followed by at least 2 additional years of subspeciality fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...
training in pulmonology. After satisfactorily completing a fellowship in pulmonary medicine, he or she is permitted to take the board certification examination in pulmonary medicine. After passing this exam, he or she is now board certified. Most pulmonologists complete 3 years of combined subspecialty fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...
training in pulmonary medicine and critical care medicine.
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, pediatric pulmonologists are physicians who, after receiving a medical degree (MD
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
or DO
DO
DO may refer to:* Directorate of Operations, former name of the National Clandestine Service* Doctor of Osteopathic Medicine, a degree held by physicians in the United States* Dominican Republic, ISO country code: do...
), complete residency training in pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
(3 years), followed by at least 3 additional years of subspeciality fellowship training in pulmonology.
Usually, respiratory problems can be managed by a specialist in internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
; however, some cases require the attention of a pulmonologist. Usually, a pulmonologist will be required in advanced cases of many respiratory disease
Respiratory disease
Respiratory disease is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange possible in higher organisms, and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, and the...
s.
Scientific research
Pulmonologists are involved in both clinical and basic research of the respiratory systemRespiratory system
The respiratory system is the anatomical system of an organism that introduces respiratory gases to the interior and performs gas exchange. In humans and other mammals, the anatomical features of the respiratory system include airways, lungs, and the respiratory muscles...
, ranging from the anatomy of the respiratory epithelium
Respiratory epithelium
Respiratory epithelium is a type of epithelium found lining the respiratory tract, where it serves to moisten and protect the airways. It also functions as a barrier to potential pathogens and foreign particles, preventing infection and tissue injury by action of the mucociliary escalator.-...
to the most effective treatment of pulmonary hypertension
Pulmonary hypertension
In medicine, pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion...
(a disease notoriously resistant to therapy). Scientific research also takes place to look for causes and possible treatment in diseases such as pulmonary tuberculosis and lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
. Several societies are dedicated to expanding the field of pulmonary medicine, some of which are listed below:
- American College of Chest PhysiciansAmerican College of Chest PhysiciansThe American College of Chest Physicians is a medical organization in the United States consisting of physicians and non-physician specialists in the field of chest medicine, which includes pulmonology, thoracic surgery, and critical care medicine....
- American Lung AssociationAmerican Lung AssociationThe American Lung Association is a voluntary health organization whose mission is to save lives by improving lung health and preventing lung disease.-History:...
- American Thoracic SocietyAmerican Thoracic SocietyAmerican Thoracic Society , established in 1905, is an independently incorporated, international, educational and scientific society, serving its 18,000 members worldwide who are dedicated in respiratory and critical care medicine...
- British Thoracic SocietyBritish Thoracic SocietyThe British Thoracic Society was formed in 1982 by the amalgamation of the British Thoracic Association and the Thoracic Society. It is a registered charity and a company limited by guarantee.-Function:...
- European Respiratory SocietyEuropean Respiratory SocietyThe European Respiratory Society, or ERS, is a non-profit organization based in Switzerland founded in 1990 in the field of respiratory medicine. The organization was formed with the merger of the Societas Europaea Physiologiae Clinicae Respoiratoriae and the European Society of Pneumology...