What Is Pulmonology?

Pulmonologist analyzing chest x-ray

Getty Images/ Virojt Changyencham

Pulmonology is the specialty area of medicine that focuses specifically on the pulmonary system. The pulmonary system, also sometimes called the respiratory system, consists of the lungs, trachea, bronchi, bronchioles, associated blood vessels, and all other components involved in and directly related to breathing and the process of respiration (gas exchange).

History of Pulmonology

Pulmonology has always been an important part of medical care, but it did not become a distinct and separate field of medicine until the 1950's when the work of Dr. Richard Riley attracted other physicians to the field.

While not comprehensive, the following is a timeline outlining the emergence and some of the major developments in pulmonology.

129–216 CE: The Greek physician Galen, through his animal dissections, discovers that breathing is required to maintain blood circulation.

Circa 1543: Vesalius discovers how to perform a tracheotomy as a means to give artificial respirations through his experiments on and dissections of human cadavers.

1667: Robert Hook proves Galen's hypothesis that breathing is necessary to maintain the beating of the heart and blood circulation, through an experiment involving a dog.

1774: A year of great discoveries in the area of pulmonology in which two separate scientists, Joseph Priestly and Willhelm Scheele both discover oxygen, and another scientist named Antoine Lavoisier discovers the role of oxygen in the process of respiration.

Late 1800s: Mechanical ventilators and the first iron lung are invented. The administration of continuous oxygen is used for the first time to treat pneumonia.

1904: The American Thoracic Society is founded, with an emphasis on the study and prevention of tuberculosis.

1940s: Charles C. Macklin and Madge Thurlow Macklin discover what leads to pneumothorax and barotrauma of the lungs.

1950s: Great progress is made in the battle against polio when Bjorn Ibsen discovers the role of respiratory failure in the disease process and recommends positive pressure ventilation.

Richard Riley, MD arrives at Johns Hopkins and his work in pulmonology attracts other physicians including Leon Farhi, Mary Ellen Avery, Reuben Cherniack, John Clements, Moran Campbell, Peter Macklem, Jack Howell, John Cotes, and Solbert Permutt. The first ICU's emerge.

1960s: The dangers of oxygen toxicity are discovered. In 1963, the first lung transplant is performed.

1975: The first infant is treated using extracorporeal membrane oxygenation (ECMO).

1990s–present: Further progress in understanding the dangers of mechanical ventilation and how it can lead to multi-organ system failure is made. There are ongoing research and advancements in the prevention and management of acute respiratory distress syndrome (ARDS).

Progress continues to be made in managing respiratory illnesses such as asthma and mitigating the complications of ventilation, such as ventilator acquired pneumonia.

Pulmonologists

A pulmonologist is a specialty physician whose focus is the diagnosis, management and treatment of diseases involving the respiratory system.

Because the respiratory system is closely related to cardiology (the area of medicine that focuses on the heart and circulation system), some pulmonologists may also be adept at managing cardiac conditions that are directly related to pulmonary disease.

Pulmonologists are often specialists in critical care and treat very sick patients in ICU settings who require mechanical ventilation in order to breathe.

Training

The education of a pulmonologist is similar to that of other physicians in that after obtaining a four-year college degree they must apply to, be accepted to, and attend medical school. Pulmonology is a subspecialty of internal medicine, so after graduating from medical school you do a three-year residency program in internal medicine.

Residency is followed by your fellowship training, (approximately three more years), which is typically in pulmonology and critical care medicine. Or, if you want to work with children you can do a fellowship in pediatric pulmonology after completing a pediatrics residency. After completing these requirements some pulmonologists choose to become board certified by taking a special exam.

Typical Job Duties

Pulmonologists may work in clinics, emergency rooms, or intensive care units (ICUs). Depending on the setting, pulmonologist may perform some of the following duties as part of their practice:

  • Diagnosis of pulmonary diseases such as asthma, chronic obstructive pulmonary disease (COPD), or pulmonary hypertension
  • Analyzing a variety of medical tests, including blood gases, pulmonary function tests, bronchoscopies, lung X-rays, and other imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT) scans
  • Performing certain diagnostic testing, such as bronchoscopy, which involves the insertion of a tiny camera into the trachea
  • Following and managing the course of disease in people with asthma, COPD, or other respiratory diseases
  • Prescribing medications, such as inhalers or steroids to help manage respiratory disease
  • Prescribing interventions, such as the administration of oxygen for the management of respiratory disease
  • Performing procedures, such as obtaining biopsies of the lungs or the insertion of chest tubes
  • Managing critically ill patients who require mechanical ventilation

Who Needs a Pulmonologist?

Pulmonologists are not the only physicians who are trained to handle breathing issues, and not every person experiencing a respiratory problem will need one. For example, many people with asthma are treated by general practitioners or by doctors trained in internal medicine, pediatrics, or allergy treatment.

However, severe asthma that is resistant to treatment, severe or rare chronic conditions, (such as pulmonary hypertension for example), or difficult diagnosis may all warrant the specialty expertise of a pulmonologist.

Related Conditions

In addition to managing patients who require mechanical ventilation or experience breathing difficulty due to injury or trauma, the field of pulmonology specializes in managing many diseases and conditions of the lungs including:

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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