Pulmonologists: Background and Role in Lung Disease

Definition, Training, and Scope of Practice of Pulmonologists

Pulmonologist (lung physician) listening to patient

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A pulmonologist is a physician who specializes in treating diseases of the lungs. Common conditions they treat include COPD, interstitial lung diseases such as pulmonary fibrosis, and asthma. They also work with oncologists to help manage people with lung cancer. Pulmonologists often perform procedures such as removing fluid from the lungs (thoracentesis), lung biopsies, and bronchoscopies. In addition to treating patients with medications and assisting with diagnoses, lung specialists play a very important role in helping people with lung disease live as well as they can with their condition.

The area of medicine that studies diseases of the lungs is called pulmonology or pulmonary medicine.

Training

A pulmonologist begins her career with a 4-year undergraduate degree, often in a science field such as biology or chemistry. This is followed by 4-years of medical school. After graduating medical school, she will do a 3-year residency in Internal Medicine. After becoming board certified, she will then do a fellowship in pulmonary disease for 2 years or in pulmonary medicine and critical care for 3 years. In total, becoming a pulmonologist requires a minimum of 13 years of training after high school.

Conditions Treated

Pulmonologists treat conditions related to the lungs, but not everyone with a lung problem sees a pulmonologist. For example, many people with mild asthma are cared for by their pediatrician, internist, or family doctor. Pulmonologists are most often involved in treating complicated lung diseases and lung cancer.

Examples of some conditions that pulmonologists treat include:

  • Asthma
  • Bronchiectasis
  • Chronic bronchitis
  • Emphysema
  • Sleep apnea
  • Interstitial lung diseases such as pulmonary fibrosis, including idiopathic pulmonary fibrosis
  • Complicated lung infections such as pneumonia and tuberculosis
  • Pneumoconioses, such as black lung disease
  • Pleural effusions, including malignant pleural effusions
  • Pneumothorax (collapsed lung)
  • Lung cancer
  • Sarcoidosis
  • Care before and after lung surgery, lung cancer surgery, or a lung transplant
  • Neuromuscular diseases that affect the lungs, for example, ALS

Procedures

Pulmonologists aren't surgeons, that is, they don't do surgery to remove a lung. But they do perform many procedures. Some include:

Thoracentesis

A thoracentesis is a procedure in which a needle is inserted through the chest wall to withdraw fluid from a pleural effusion (a build up of fluid in the pleural space). Pleural effusions have many potential causes. When small, they may not cause any symptoms, but when large, can significantly compromise breathing. After a thoracentesis, a pulmonologist can send a sample of the fluid to the lab, and this may help with diagnosing the cause of an effusion as well.

Pulmonary function tests

Pulmonary function tests include several tests that evaluate breathing. They can measure how effectively the lungs are taking in air, and how well air is diffusing from the small airways into the circulation. Technicians usually perform the tests which are then interpreted by a pulmonogist to help diagnose or monitor lung diseases.

In performing pulmonary function tests, including specialized tests such as lung plethysmography, pulmonologists often play a critical role in distinguishing between obstructive and restrictive lung diseases; conditions that have very different treatments.

Lung Biopsy

Some lung biopsies are performed by pulmonologists whereas others may be performed by a radiologist or surgeon. Pulmonologists most commonly perform procedures such as a needle lung biopsy (percutaneous) or transbronchial biopsy (a biopsy done during a bronchoscopy), whereas thoracic surgeons usually perform "open" biopsies, such as video-assisted thoracoscopic biopsies.

In the setting of biopsies for lung cancer, it's critical for specialists to work together (multidisciplinary approach), as some types of biopsies are performed by pulmonologists, some by surgeons, and liquid biopsies (frequently done along with a tissue biopsy) are often ordered by thoracic oncologists.

Chest Tube Placement

For those who have a collapsed lung (pneumothorax) or pleural effusion that needs draining, a pulmonologist can insert a chest tube into the space between the membranes lining the lungs.

Bronchoscopy

A bronchoscopy is a procedure in which a flexible tube is inserted into nose (or very rarely, the mouth) and down the trachea into the bronchus to look for any abnormal tissues that might be cancer. A biopsy is sometimes done during a bronchoscopy with the help of an ultrasound machine (an endobronchial ultrasound).

Pulmonary Rehabilitation

Pulmonary rehabilitation has now become a standard treatment for COPD, with studies suggesting it can be very helpful for people with lung cancer as well. Pulmonologists often play a central role in this therapy, designing therapies to improve the quality of life for people living with lung disease.

Pulmonologists and Lung Cancer Care

You may see a pulmonologist as part of a lung cancer team, who will help guide you through lung cancer. Most people who are diagnosed with lung cancer today are cared for by several doctors in what has been coined "multidisciplinary care." This allows each specialist to use their own expertise to maximize your care.

Your pulmonologist may assist in making the diagnosis of your cancer, but can play an important role throughout your care. She can help determine if you are a candidate for lung cancer surgery, and if you are, can work with you to maximize your breathing capacity after the surgery. With more advanced lung cancers, pulmonologists can make sure your have the treatments needed to breath as well as possible despite a cancer being present.

A Word From Verywell

Pulmonologists provide care for people with a number of different lung conditions. While many people see a pulmonologist while trying to obtain a diagnosis, these physicians have the expertise to help you keep breathing as well as possible no matter the condition involving your lungs.

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