pulmonology

• American Association for Respiratory Care
• American College of Chest Physicians
• American Lung Association
• American Thoracic Society
• British Thoracic Society
• European Respiratory Society

One of the first major discoveries relevant to the field of pulmonology was the discovery of pulmonary circulation. Originally, it was thought that blood reaching the right side of the heart passed through small 'pores' in the septum into the left side to be oxygenated, as theorized by Galen; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth-century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no 'direct' passage between the two sides (ventricles) of the heart. He believed that the blood must have passed through the pulmonary artery, through the lungs, and back into the heart to be pumped around the body. This is believed by many to be the first scientific description of pulmonary circulation.{{cite journal|author=Sharif Kaf A-Ghazal|date=2002|title=The discovery of the pulmonary circulation – who should get the credit: ibn Al-Nafis or William Harvey|url=http://www.ishim.net/ishimj/2/09.pdf|journal=Journal of the International Society for the History of Islamic Medicine|volume=2|page=46|access-date=2010-07-17|archive-date=2010-06-12|archive-url=https://web.archive.org/web/20100612141149/http://ishim.net/ishimj/2/09.pdf|url-status=live}}

Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, William Welch and William Osler founded the 'parent' organization of the American Thoracic Society,{{Cite web|url=http://www.thoracic.org/about/overview.php|title=American Thoracic Society - Overview|website=www.thoracic.org|access-date=2019-01-25|archive-date=2019-04-26|archive-url=https://web.archive.org/web/20190426111925/http://www.thoracic.org/about/overview.php|url-status=live}} the National Association for the Study and Prevention of Tuberculosis.{{Cite journal|last=Jacobs|first=Henry Barton|date=1904-12-03|title=National Association for the Study and Prevention of Tuberculosis.|url=https://jamanetwork.com/journals/jama/fullarticle/463708|journal=Journal of the American Medical Association|language=en|volume=XLIII|issue=23|pages=1712|doi=10.1001/jama.1904.02500230042014|issn=0002-9955|access-date=2019-01-25|archive-date=2021-12-13|archive-url=https://web.archive.org/web/20211213053250/https://jamanetwork.com/journals/jama/article-abstract/463708|url-status=live}} The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right, phthisiology.{{Cite journal|last1=Lauzardo|first1=Michael|last2=Ashkin|first2=David|date=2000-05-01|title=Phthisiology at the Dawn of the New Century|journal=Chest|volume=117|issue=5|pages=1455–1473|doi=10.1378/chest.117.5.1455|pmid=10807837|issn=0012-3692}} When the specialty did begin to evolve, several discoveries were being made linking the respiratory system and the measurement of arterial blood gases, attracting more and more physicians and researchers to the developing field.[http://www.hopkinsmedicine.org/pulmonary/about/history.html History of the Division] {{Webarchive|url=https://web.archive.org/web/20170811150722/http://www.hopkinsmedicine.org/pulmonary/about/history.html |date=2017-08-11 }}. Hopkinsmedicine.org. Retrieved on 2011-09-30.

Surgery of the respiratory tract is generally performed by specialists in cardiothoracic surgery{{Cite web|url=https://www.essentiahealth.org/services/heart-vascular-services/cardiothoracic-surgery/|title=Cardiothoracic Surgery {{!}} Essentia Health {{!}} MN, WI, ND|website=www.essentiahealth.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126001042/https://www.essentiahealth.org/services/heart-vascular-services/cardiothoracic-surgery/|url-status=live}} (or thoracic surgery),{{Cite web|url=https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/cardiothoracic-surgery|title=Cardiothoracic surgery|date=2015-04-07|website=Health Careers|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126000937/https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/cardiothoracic-surgery|url-status=live}} though minor procedures may be performed by pulmonologists. Pulmonology is closely related to critical care medicine{{Cite web|url=https://www.acponline.org/about-acp/about-internal-medicine/subspecialties/pulmonary-disease|title=Pulmonary Disease {{!}} Internal Medicine Subspecialties {{!}} ACP|website=www.acponline.org|access-date=2019-01-25|archive-date=2015-09-09|archive-url=https://web.archive.org/web/20150909203508/https://www.acponline.org/patients_families/about_internal_medicine/subspecialties/pulmonology/|url-status=live}} when dealing with patients who require mechanical ventilation. As a result, many pulmonologists are certified to practice critical care medicine in addition to pulmonary medicine. There are fellowship programs that allow physicians to become board certified in pulmonary and critical care medicine simultaneously. Interventional pulmonology is a relatively new field within pulmonary medicine{{Cite web|url=https://www.webmd.com/lung/interventional-pulmonology-uses-effects|title=Interventional Pulmonology: Procedures, Uses, and Effects|website=WebMD|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126000919/https://www.webmd.com/lung/interventional-pulmonology-uses-effects|url-status=live}} that deals with the use of procedures such as bronchoscopy{{Cite journal|last1=Seijo|first1=Luis M.|last2=Sterman|first2=Daniel H.|date=2001-03-08|title=Interventional Pulmonology|journal=New England Journal of Medicine|volume=344|issue=10|pages=740–749|doi=10.1056/NEJM200103083441007|issn=0028-4793|pmid=11236779}} and pleuroscopy to treat several pulmonary diseases.{{Cite web|url=http://www.pamf.org/pulmonary/interventional/procedures.html|title=Interventional Pulmonology Diagnostic and Therapeutic Procedures|website=www.pamf.org|access-date=2019-01-25|archive-date=2019-01-17|archive-url=https://web.archive.org/web/20190117162112/http://www.pamf.org/pulmonary/interventional/procedures.html|url-status=live}} Interventional pulmonology is increasingly recognized as a specific medical specialty.{{cite journal |author=Luis M. Seijo|author2=Daniel H. Sterman|name-list-style=amp |title=Interventional Pulmonology |journal=N. Engl. J. Med. |volume=344 |issue=10 |pages=740–49 |date=2001 |pmid=11236779 |doi=10.1056/NEJM200103083441007}}

The pulmonologist begins the diagnostic process with a general review focusing on:

• hereditary diseases affecting the lungs (cystic fibrosis,{{Cite web|url=https://www.msdmanuals.com/professional/pediatrics/cystic-fibrosis-cf/cystic-fibrosis|title=Cystic Fibrosis - Pediatrics|website=MSD Manual Professional Edition|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126001145/https://www.msdmanuals.com/professional/pediatrics/cystic-fibrosis-cf/cystic-fibrosis|url-status=live}} alpha 1-antitrypsin deficiency)
• exposure to toxicants (tobacco smoke,{{cite journal|last1=Breland|first1=Alison|last2=Soule|first2=Eric|last3=Lopez|first3=Alexa|last4=Ramôa|first4=Carolina|last5=El-Hellani|first5=Ahmad|last6=Eissenberg|first6=Thomas|title=Electronic cigarettes: what are they and what do they do?|journal=Annals of the New York Academy of Sciences|volume=1394|issue=1|year=2017|pages=5–30|issn=0077-8923|doi=10.1111/nyas.12977|pmc=4947026|pmid=26774031|bibcode=2017NYASA1394....5B}} asbestos, exhaust fumes, coal mining fumes, e-cigarette aerosol{{cite journal|last1=Perikleous|first1=Evanthia P.|last2=Steiropoulos|first2=Paschalis|last3=Paraskakis|first3=Emmanouil|last4=Constantinidis|first4=Theodoros C.|last5=Nena|first5=Evangelia|title=E-Cigarette Use Among Adolescents: An Overview of the Literature and Future Perspectives|journal=Frontiers in Public Health|volume=6|year=2018|page=86|issn=2296-2565|doi=10.3389/fpubh.2018.00086|pmc=5879739|pmid=29632856|doi-access=free}})
• exposure to infectious agents (certain types of birds, malt processing)
• an autoimmune diathesis that might predispose to certain conditions (pulmonary fibrosis, pulmonary hypertension)

Physical diagnostics{{Cite web|url=https://www.msdmanuals.com/professional/pulmonary-disorders/approach-to-the-pulmonary-patient/evaluation-of-the-pulmonary-patient|title=Evaluation of the Pulmonary Patient - Pulmonary Disorders|website=MSD Manual Professional Edition|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126001121/https://www.msdmanuals.com/professional/pulmonary-disorders/approach-to-the-pulmonary-patient/evaluation-of-the-pulmonary-patient|url-status=live}} are as important as in other fields of medicine.

• Inspection of the hands for signs of cyanosis or clubbing, chest wall, and respiratory rate.
• Palpation of the cervical lymph nodes, trachea and chest wall movement.
• Percussion of the lung fields for dullness or hyper-resonance.
• Auscultation (with a stethoscope) of the lung fields for diminished or unusual breath sounds.
• Rales or rhonchi heard over lung fields with a stethoscope.

As many heart diseases can give pulmonary signs,{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/|title=Pulmonary Tests and Procedures {{!}} Johns Hopkins Medicine Health Library|website=www.hopkinsmedicine.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126064134/https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/|url-status=live}} a thorough cardiac investigation is usually included.

Pulmonary clinical procedures include the following pulmonary tests and procedures:{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/|title=Pulmonary Tests and Procedures {{!}} Johns Hopkins Medicine Health Library|website=www.hopkinsmedicine.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126064134/https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/|url-status=live}}{{Cite web|url=https://www.essentiahealth.org/services/pulmonary-medicine/diagnostic-tests-procedures/|title=Pulmonary Diagnostic Tests & Procedures {{!}} Essentia Health|website=www.essentiahealth.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126000903/https://www.essentiahealth.org/services/pulmonary-medicine/diagnostic-tests-procedures/|url-status=live}}

• Medical laboratory investigation of blood (blood tests). Sometimes arterial blood gas tests are also required.
• Spirometry the determination of maximum airflow at a given lung volume as measured by breathing into a dedicated machine; this is the key test to diagnose airflow obstruction.
• Pulmonary function testing including spirometry, as above, plus response to bronchodilators, lung volumes, and diffusion capacity, the latter being a measure of lung oxygen absorptive area
• Bronchoscopy{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/bronchoscopy_92,P07743|title=Bronchoscopy {{!}} Johns Hopkins Medicine Health Library|website=www.hopkinsmedicine.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126064132/https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/bronchoscopy_92,P07743|url-status=live}} with bronchoalveolar lavage (BAL), endobronchial and transbronchial biopsy and epithelial brushing
• Chest X-rays{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/chest_x-ray_92,p07746|title=How Do Chest X-Rays Work?|website=www.hopkinsmedicine.org|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126000917/https://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/chest_x-ray_92,p07746|url-status=live}}
• CT scan{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/ct_scan_of_the_chest_92,P07747|title=Computed Tomography (CT or CAT) Scan of the Chest {{!}} Johns Hopkins Medicine Health Library|website=www.hopkinsmedicine.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126065643/https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/ct_scan_of_the_chest_92,P07747|url-status=live}}
• Scintigraphy and other methods of nuclear medicine
• Positron emission tomography{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/positron_emission_tomography_pet_92,p07654|title=How Does a PET Scan Work?|website=www.hopkinsmedicine.org|language=en|access-date=2019-01-25|archive-date=2021-12-13|archive-url=https://web.archive.org/web/20211213053249/https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/positron-emission-tomography-pet|url-status=live}} (especially in lung cancer)
• Polysomnography (sleep studies{{Cite web|url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/sleep_study_92,p09032|title=How to Prepare for a Sleep Study|website=www.hopkinsmedicine.org|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126060858/https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/sleep_study_92,p09032|url-status=live}}) commonly used for the diagnosis of sleep apnea

Major surgical procedures on the heart and lungs are performed by a thoracic surgeon.{{Cite web|url=https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/cardiothoracic-surgery|title=Cardiothoracic surgery|date=2015-04-07|website=Health Careers|language=en|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126000937/https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/cardiothoracic-surgery|url-status=live}} Pulmonologists often perform specialized procedures to get samples from the inside of the chest or inside of the lung. They use radiographic techniques to view vasculature of the lungs and heart to assist with diagnosis.

{{see also|Cardiothoracic surgery|Pulmonary rehabilitation}}

Medication is the most important treatment of most diseases of pulmonology, either by inhalation (bronchodilators and steroids) or in oral form (antibiotics, leukotriene antagonists). A common example being the usage of inhalers in the treatment of inflammatory lung conditions such as asthma or chronic obstructive pulmonary disease. Oxygen therapy{{Cite web|url=https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/rehabilitation-for-lung-and-airway-disorders/oxygen-therapy|title=Oxygen Therapy - Lung and Airway Disorders|website=MSD Manual Consumer Version|language=en-AU|access-date=2019-01-25|archive-date=2021-12-13|archive-url=https://web.archive.org/web/20211213053257/https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/rehabilitation-for-lung-and-airway-disorders/oxygen-therapy|url-status=live}} is often necessary in severe respiratory disease (emphysema and pulmonary fibrosis). When this is insufficient, the patient might require mechanical ventilation.

Pulmonary rehabilitation{{Cite web|url=https://www.essentiahealth.org/services/pulmonary-medicine/rehabilitation/|title=Pulmonary Rehabilitation {{!}} Essentia Health {{!}} MN, ND, WI|website=www.essentiahealth.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126000943/https://www.essentiahealth.org/services/pulmonary-medicine/rehabilitation/|url-status=live}} has been defined as a multidimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists, with the goal of achieving and maintaining the individual's maximum level of independence and functioning in the community. Pulmonary rehabilitation{{Cite web|url=https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/rehabilitation-for-lung-and-airway-disorders/overview-of-pulmonary-rehabilitation|title=Overview of Pulmonary Rehabilitation - Lung and Airway Disorders|website=MSD Manual Consumer Version|language=en-AU|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126001142/https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/rehabilitation-for-lung-and-airway-disorders/overview-of-pulmonary-rehabilitation|url-status=live}} is intended to educate the patient, the family, and improve the overall quality of life and prognosis for the patient. Interventions can include exercise, education, emotional support, oxygen, noninvasive mechanical ventilation, optimization of airway secretion clearance, promoting compliance with medical care to reduce numbers of exacerbations and hospitalizations, and returning to work and/or a more active and emotionally satisfying life. These goals are appropriate for any patients with diminished respiratory reserve whether due to obstructive or intrinsic pulmonary diseases (oxygenation impairment) or neuromuscular weakness (ventilatory impairment). A pulmonary rehabilitation team{{Cite web|url=https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/rehabilitation-for-lung-and-airway-disorders/overview-of-pulmonary-rehabilitation|title=Overview of Pulmonary Rehabilitation - Lung and Airway Disorders|website=MSD Manual Consumer Version|language=en-AU|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126001142/https://www.msdmanuals.com/en-au/home/lung-and-airway-disorders/rehabilitation-for-lung-and-airway-disorders/overview-of-pulmonary-rehabilitation|url-status=live}} may include a rehabilitation physician, a pulmonary medicine specialist, physician assistant and allied health professionals including a rehabilitation nurse, a respiratory therapist, a speech-language pathologist, a physical therapist, an occupational therapist, a psychologist, and a social worker among others. Additionally, breathing games are used to motivate children to perform pulmonary rehabilitation.

{{Infobox occupation

| name= Pulmonologist

| image= 200px

| caption= Physician performing a bronchoscopy.

| official_names=

• Pulmonologist
• Pneumologist
• Respirologist
• Respiratory physician or chest physician

| type= Specialty

| activity_sector= Medicine

| competencies=

| formation=

• Doctor of Medicine (M.D.)
• Doctor of Osteopathic Medicine (D.O.)
• Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB)

| employment_field= Hospitals, clinics

| related_occupation=

}}

In the United States, pulmonologists are physicians who, after receiving a medical degree (MD or DO), complete residency training in internal medicine, followed by at least two additional years of subspeciality fellowship training in pulmonology.{{Cite web|url=https://www.acponline.org/about-acp/about-internal-medicine/subspecialties/pulmonary-disease|title=Pulmonary Disease {{!}} Internal Medicine Subspecialties {{!}} ACP|website=www.acponline.org|access-date=2019-01-25|archive-date=2015-09-09|archive-url=https://web.archive.org/web/20150909203508/https://www.acponline.org/patients_families/about_internal_medicine/subspecialties/pulmonology/|url-status=live}} After satisfactorily completing a fellowship in pulmonary medicine, the physician is permitted to take the board certification examination in pulmonary medicine. After passing this exam, the physician is then board certified as a pulmonologist. Most pulmonologists complete three years of combined subspecialty fellowship training in pulmonary medicine and critical care medicine.

In the United States, pediatric pulmonologists{{Cite web|url=http://www.healthychildren.org/English/family-life/health-management/pediatric-specialists/Pages/What-is-a-Pediatric-Pulmonologist.aspx|title=What is a Pediatric Pulmonologist?|website=HealthyChildren.org|access-date=2019-01-25|archive-date=2019-01-26|archive-url=https://web.archive.org/web/20190126061055/https://www.healthychildren.org/English/family-life/health-management/pediatric-specialists/Pages/What-is-a-Pediatric-Pulmonologist.aspx|url-status=live}} are physicians who, after receiving a medical degree (MD, DO, MBBS, MBBCh, etc.), complete residency training in pediatrics, followed by at least three additional years of subspeciality fellowship training in pulmonology. Pediatric pulmonologists treat diseases of the airways, lungs, respiratory mechanics and aerodigestive system.

Pulmonologists are involved in both clinical and basic research of the respiratory system, ranging from the anatomy of the respiratory epithelium to the most effective treatment of pulmonary hypertension. Scientific research also takes place to look for causes and possible treatment in diseases such as pulmonary tuberculosis and lung cancer.

{{portal|Medicine}}

{{reflist}}

{{Respiratory system symptoms and signs}}

{{Respiratory system procedures}}

{{Respiratory pathology}}

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{{Authority control}}