What Is Pulmonology?

Pulmonology, also known as pulmonary medicine, is a medical specialty that focuses on the diagnosis, treatment, and prevention of conditions that affect the respiratory system, which includes the lungs, bronchi, trachea, and other structures involved in breathing.

Pulmonologists are doctors who specialize in this field and have extensive training in internal medicine, as well as additional training in pulmonary medicine. They are experts in diagnosing and managing a wide range of respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pneumonia, tuberculosis, and other respiratory infections. (1)

Overview and Definition 

Pulmonology, a subspecialty of internal medicine, is a branch of medicine that focuses on treating respiratory system disorders affecting the lungs, airways, chest wall, and thoracic cavity. This field also covers ailments involving the nose, larynx, pharynx, trachea, bronchioles, and alveoli. Additionally, pulmonology is involved in intensive care medicine, where it provides life support and mechanical ventilation to critically ill patients. The discipline is alternatively known as pneumology or respiratory medicine.

Pulmonologists also provide care for patients with sleep disorders, such as sleep apnea and insomnia, which can have a significant impact on respiratory health. They may perform various diagnostic tests, such as spirometry, which measures lung function, and bronchoscopy, which allows them to view the airways and obtain tissue samples for examination. (2)

Education and Training

The training and education process for pulmonology involves several years of medical school, residency training, and specialized fellowship training.

After completing a four-year medical degree, aspiring pulmonologists must first complete a three-year residency program in internal medicine, during which they gain broad knowledge in the diagnosis and treatment of various medical conditions.

Once they have completed their internal medicine residency, they can then apply for a fellowship in pulmonary and critical care medicine, which typically lasts three years. During this fellowship, they receive specialized training in the diagnosis, treatment, and management of respiratory conditions, such as asthma, COPD, lung cancer, and other lung diseases. They also receive training in the use of specialized equipment, such as bronchoscopes and mechanical ventilators.

In addition to clinical training, pulmonologists must also obtain a medical license and pass a board certification exam in pulmonary medicine. Continuing education and training are also required to maintain certification and stay up to date with the latest developments in the field.

Overall, the education and training process for pulmonology is rigorous and requires a significant time commitment, but it is essential to ensure that pulmonologists have the necessary skills and expertise to provide high-quality care to patients with respiratory conditions. (3,4)

Practicing as a pulmonologist

A pulmonologist is a specialized physician who is trained to diagnose and treat respiratory system disorders. They may have expertise in specific areas such as critical care, sleep medicine, or asthma. Some pulmonologists also specialize in treating specific age groups, such as children or the elderly. The primary focus of a pulmonologist is to treat conditions that affect the lungs, which may result from inflammation, tissue overgrowth, infections, or other factors. These conditions often require long-term treatment plans and sometimes lifelong care. To develop effective treatment plans, pulmonologists collaborate with primary care physicians and other specialists as needed.

Accurate diagnosis is crucial when dealing with respiratory diseases, and a pulmonologist uses various diagnostic procedures such as spirometry, chest X-rays, CT scans, bronchoscopies, and sleep studies. Treatment plans may involve medications, therapies, and pulmonary rehabilitation. If surgery is required, a heart and lung specialist surgeon will typically perform the procedure. As lung diseases often require long-term care, pulmonologists work closely with patients, their families, and healthcare teams to adapt treatment plans and coordinate care with other healthcare providers.(5,6)

Procedures Performed

Pulmonologists perform a range of procedures to diagnose and treat lung conditions. These include:

• Flexible bronchoscopy

To examine the respiratory system, flexible bronchoscopy is a commonly used interventional pulmonology procedure. The procedure involves inserting a flexible endoscope (known as a bronchoscope) into a patient's windpipe through their nose or mouth. A video screen displays images from inside the lungs.

The bronchoscope features a channel at its tip, allowing the doctor to use small tools to perform various other interventional pulmonology procedures.

• Bronchoscopy

During bronchoscopy, bronchoalveolar lavage may also be performed. This involves injecting sterile water into a lung segment through the bronchoscope, then suctioning it back out for testing. Bronchoalveolar lavage can help diagnose conditions such as infection, bleeding, cancer, and other respiratory issues.

• Rigid bronchoscopy

Rigid bronchoscopy involves inserting a rigid bronchoscope, a long metal tube, into a person's windpipe and airways to perform interventional pulmonology procedures with advanced surgical tools and techniques.

• Pleuroscopy 

Pleuroscopy is another procedure where small incisions are made in the chest wall, and a pleuroscope is used to diagnose pleura-related conditions and view the outer edges of the lung, which is not possible with bronchoscopy.

• Thoracentesis

To remove the fluid buildup around the lungs (pleural effusion), a medical professional uses a needle to puncture the chest wall. After that, a plastic tube is passed through the needle, and the excess fluid is removed through suction. Finally, the tube is removed and disposed of.

• Pleurodesis

Pleurodesis is a procedure for people with recurrent pleural effusions. It involves making a chest wall incision and inserting a plastic tube to spray an irritating chemical around the lung. This causes the lung lining to stick to the chest wall, preventing fluid from building up again.

• Indwelling pleural catheter

A pleural catheter is another option for managing recurrent pleural effusion. A plastic catheter is placed inside the chest cavity through minor surgery, and the tip is tunneled beneath the skin. The person can drain the accumulated pleural fluid at home using sterile supplies.

• Bronchoscopic thermoplastic

Thermoplasty is a procedure for severe asthma patients who don't respond to medication. It involves using heat during bronchoscopy to destroy the airway's smooth muscle layers that cause asthma symptoms. (7)