A pulmonologist diagnoses and treats conditions that affect the respiratory system.
Pulmonologists treat everything from asthma to tuberculosis. They have expertise in the following types of respiratory disorders:
- neoplastic, which means having to do with a tumor
In some instances, their expertise extends to the cardiovascular system. Certain conditions, such as pulmonary vascular disease, can first affect the respiratory system but go on to affect other areas of the body.
A pulmonologist may work in their own office or as part of a multidisciplinary practice. They can also work in hospital settings, particularly intensive care units.
Pulmonology is the field of medicine that focuses specifically on the respiratory system. The respiratory system includes the organs that help you breathe.
The respiratory system
The three major parts of this system are the airway, lungs, and respiratory muscles.
The airway includes the:
- throat, which is also known as the pharynx
- voice box, which is also known as the larynx
- windpipe, which is also known as the trachea
- bronchi, or passageways in the lungs
- bronchioles, or even smaller passageways in the lungs
- alveoli, or air sacs in the lungs
You use several muscles during respiration. The most notable is the diaphragm. The other muscles are categorized in groups, including the:
- Intercostal muscles. These are many different groups of muscles that run between the ribs and help form and move the chest wall. The intercostal muscles aid in the mechanical aspects of breathing by helping expand and shrink the size of the chest.
- Accessory muscles. Accessory muscles assist but do not play a primary role in breathing. Using these muscles while at rest is often interpreted as a sign of respiratory distress.
Exhalation is a passive process because of the elastic properties of the lungs. During forced exhalation, the expiratory muscles are used, which include those of the abdominal wall and some of the rib cage.
Subspecialties of pulmonology include:
- interstitial lung disease, which is a group of conditions that affect the space and tissue within the lungs
- interventional pulmonology, which uses multidisciplinary care to treat airway disorders, lung cancer, and pleural diseases (which affect the pleura, the membrane that surrounds your lungs)
- lung transplantation as well as management before and after surgery
- neuromuscular disorders, which refers to conditions that result in respiratory muscle failure
- obstructive lung disease, which involves airway narrowing or obstruction
- sleep-disordered breathing
Conditions pulmonologists commonly treat include:
- bronchiectasis, a condition that involves inflammation and excess mucus
- acute and chronic bronchitis, which occur when you have inflamed lower airways
- chronic obstructive pulmonary disease (COPD), including emphysema, which occurs when the alveoli in your lungs are damaged
- interstitial lung diseases, which are marked by persistent inflammation and scarring
- occupational lung disease, which can occur due to inhaling dusts, chemicals, or proteins
- obstructive sleep apnea, which causes your breathing to slow or stop entirely when you’re sleeping
- tuberculosis, an infectious disease that mostly affects the lungs
To become a pulmonologist, you must earn a four-year college degree. From there, you must complete a four-year medical school program. You must then complete a three-year training program, or residency, in internal medicine.
After you complete your residency, you must complete a two- to three-year fellowship. This allows you to get additional specialized training in pulmonology. After you complete your fellowship, you must pass a certification exam by a specialty board.
Pulmonologists use and interpret exam and test results to help them determine a lung-related diagnosis. Exams and tests they may use include:
- CT scan to get detailed images of the bones, muscles, fat, organs, and blood vessels in your chest
- ultrasound to examine the organs and other structures of the chest
- pulmonary function test, which is a breathing test that reveals how well your lungs are functioning
- pulse oximetry test to determine the oxygen saturation level of your blood
- pleural biopsy to remove a small tissue sample from the pleura
- bronchoscopy to examine your airway and determine if you have any issues in your windpipe, lower airways, throat, or voice box
- sleep study to help diagnose sleep disorders such as sleep apnea
Some procedures a pulmonologist may perform include:
- thoracentesis to remove fluid or air from the pleural space around the lungs
- tracheal or bronchial stent placement to help open up areas such as the windpipe or bronchi
In the case of more serious lung diseases and conditions, a pulmonologist may refer you to a chest surgeon. A chest surgeon may perform procedures such as a lung transplant or a lobectomy to remove a portion of a diseased lung.
Did you know?
Thoracentesis can be used to help diagnose or treat symptoms such as fluid in the pleural space which surrounds your lungs.
If you’re having any unusual or worrisome respiratory symptoms, meet with your primary care physician, if you have one. They’ll perform a medical exam and assess your overall condition. They may refer you to a pulmonologist if you:
- have difficulty breathing
- are wheezing
- have a persistent cough
- regularly cough up blood or mucus
- have unexplained weight loss
- have trouble exercising due to breathing problems
By one estimate, there were over 12,000 pulmonologists practicing in the United States in 2013, and 90.3 percent of adults lived within 20 miles of a pulmonologist.
If you think you may need to see a pulmonologist, one of the first steps you can take is to ask a primary care physician for a referral. Depending on the insurance plan, if you have one, you may be required to get a referral before seeing a specialist such as a pulmonologist.
After you receive the referral, check whether the pulmonologist is in network with your insurance plan. If not, then follow up with your insurance provider to see if there are any pulmonologists who are in network with your plan.
All pulmonologists who practice in the United States will be board certified by the American Board of Internal Medicine. If necessary, you can use online doctor reviews to help narrow your search and identify the pulmonologist who may be the best fit for you.
If you have a temporary respiratory condition, such as a cold or mild pneumonia, you may not need to seek professional care at all, let alone care from a specialist. However, if your symptoms are more severe or you have a chronic condition such as COPD, you may benefit from seeing a pulmonologist.
They can diagnose the condition that’s causing your symptoms. They can also determine the best treatment, which may include a mix of lifestyle changes, medical devices (such as a CPAP machine), and prescription medications.