Since, medicine is an ever changing and evolving branch, General Medicine (internal medicine) is further specialized in various super speciality branches like cardiology (deals with heart), gastroenterology (deals with gastrointestinal tract), oncology (deals with cancers), Pulmonology (deals with lungs), urology (deals with kidney) and neurology (deals with brain).
Amongst all these, Pulmonary Medicine (Pulmonology) is the branch of Medicine that deals with Lungs and its related disorders. The basic function of the lungs is to provide oxygen to the body and remove carbon dioxide from the body. This is done by breathing air in and out.
The Symptoms Associated With Pulmonology Are As Follows
- A cough (dry)
- Breathlessness or shortness of breath or breathing difficulty
- Chest pain
- Hemoptysis (blood in sputum)
- Weight loss
- Decreased appetite
- Fever
Excessive expectoration.
Amongst these symptoms, the most common symptoms a pulmonologist encounters are a cough and breathlessness.
The Diseases Associated With Pulmonology Are As Follows
- Asthma
- COPD (chronic obstructive Pulmonary disease)
- ACOS (asthma COPD overlap syndrome)
- Various types of primary lung cancers and metastases (secondary) lung lesions
- Bronchiectasis (BRE)
- Pleural effusion including Hemothorax and pyothorax
- Pneumothorax
- Lung abscess
- Interstitial lung disease (ILD)
- Occupational lung diseases like silicosis, asbestosis, berylliosis, coal miners lung etc
- Obstructive sleep apnea
- Tuberculosis including drug sensitive and drug-resistant TB
- Pneumonia including bacterial and viral (swine flu)
- ARDS (acute respiratory distress syndrome)
- Respiratory failure
- Other lung infections like Fungal infections (Aspergillosis, Histoplasmosis)
- Pulmonary Hypertension
- Bronchiolitis Obliterans Organising Pneumonia (BOOP) etc.
- Pulmonary embolism
Pulmonologists are doctors who practice in diseases associated with pulmonary medicine (above mentioned). They have certified post-graduate degree in Pulmonary Medicine.
Nowadays, in India, patients are directly approaching Pulmonologists, especially in metro cities. But still, the majority of patients are referred by their primary doctors either General practitioner or Physician.
In the Western world, patients need a referral from a Primary care physician (PCP) about Pulmonologist consultation.
So by enlarge, Pulmonologists see patients who are already seen and treated by other doctors. So for patients, it is advisable to carry all the previous records (blood reports, chest x rays, CT scans, prescriptions etc) whenever they visit a Pulmonologist.
During your first visit, Pulmonologist will ask detailed history about respiratory symptoms, he will measure your blood pressure, heart rate, saturation of oxygen, he will auscultate your chest by Stethoscope and asks for some investigations for final diagnosis.
When To See Pulmonologist?
Chronic Cough
A cough is said to be chronic if it is more than 14 days in duration. A most common cause for chronic cough is lung infections like Tuberculosis, Pneumonia, ILD, lung cancer etc.
Breathlessness
Breathlessness is seen with Pulmonary diseases, heart diseases, kidney diseases, and anaemia. So to confirm that your breathlessness is due to pulmonary disease, you have to consult a pulmonologist.
Common diseases that cause Breathlessness are asthma, COPD, ACOS, pleural effusion, Pneumothorax, ARDS, severe pneumonia etc.
Hemoptysis
When a patient coughs out blood in sputum, he is said to have hemoptysis.
In India common causes of hemoptysis are Tuberculosis, Chronic Bronchitis, Lung cancer and bronchiectasis.
In the Western world, common causes of hemoptysis are chronic bronchitis, lung cancer, pneumonia because tuberculosis is less common in those countries.
Unexplained Chest Pain
You might be referred to a pulmonologist for the diagnosis of your non-cardiac chest pain.
Common pulmonary causes for chest pain are pneumonia, lung cancer, pleural effusion etc.
To Confirm That It Is TB
If your primary doctor fails in diagnosing your symptoms (a cough, fever, weight loss), you should definitely see a Pulmonologist to rule out tuberculosis. Not only for diagnosis but for monitoring and follow up of tuberculosis you should see a Pulmonologist regularly.
For Special Investigations
Like PFT (Pulmonary Function Test), Bronchoscopy, Thoracoscopy, Sleep Study
PFT is a must for the diagnosis of asthma, COPD and ACOS. Not only for diagnosis, for treatment (inhalers) and regular monitoring of disease, it is advisable to meet a Pulmonologist regularly. Asthma patients need regular PFT and close watch on treatment plan so they should see a Pulmonologist monthly.
Procedures like bronchoscopy and Thoracoscopy are done by pulmonologists only. Lung cancer, pneumonia, hemoptysis need bronchoscopy for diagnosis. So when you are suspected of these diseases, you should see Pulmonologist for bronchoscopy. Pleural Effusion, Pneumothorax, Hemothorax need Thoracoscopy for treatment.
Intercostal Drainage (ICD) Tube Insertion
Some of the pulmonary diseases like pneumothorax, pyothorax, Hemothorax are life-threatening. The immediate treatment is ICD tube insertion. It is an emergency life-saving procedure. You may need to consult a pulmonologist for ICD insertion.
During Pre Operative Workup
If you are having lung disease (asthma or COPD) and wants surgery under general anaesthesia, you will need Fitness of Respiratory system and for these, you need to see a Pulmonologist.
Any Abnormality In Chest X-Ray
If you have any abnormality (lesion) on chest x-ray, you should see a Pulmonologist to identify the lesion on chest x-ray whether it is tubercular or pneumonia or lung cancer.
Dr. Kaushal M Bhavsar pursued his MD in Pulmonology. He is an Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad.
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