Why and When to See a Pulmonologist?

Who Is a Pulmonologist?

A pulmonologist is a specialist who treats conditions and pathologies affecting the lungs. The diagnosis is based on presenting symptoms and diagnostic tests like imaging and pathological studies. Apart from the lungs, pulmonologists also deal with issues within the nose, throat, trachea, airways, and the associated muscles and blood vessels. Pulmonary conditions are closely associated with cardiac disorders, and often one may precipitate the other, or pathological conditions occur that involve both organs. Cardiologists and pulmonologists play equally important roles in maintaining the vital cardiopulmonary health of individuals. Any changes in the cardiac structure put undue load over the lungs, and the same holds true for vice versa.

What Are the Common Conditions Under the Purview of Pulmonologists?

Common conditions treated by pulmonologists may be categorized into pathological and occupational.

Pathological Conditions:

• Aspergillosis.

• Asthma.

• Bronchiectasis.

• Bronchitis.

• Chronic obstructive pulmonary disease (COPD).

• COVID-19.

• Cystic fibrosis.

• Emphysema.

• Interstitial lung disease.

• Lung cancer.

• Pulmonary hypertension.

• Sarcoidosis.

• Sleep apnea.

• Tuberculosis.

Occupational Conditions:

• Asbestosis.

• Berylliosis (chronic beryllium disease).

• Black lung disease (coal workers’ pneumoconiosis).

• Silicosis.

Aspergillosis:

Aspergillosis is a fungal condition that may affect the skin, sinuses, central nervous system, eyes, and nails and disseminate throughout the body. It is advisable to see a doctor if there are changes in the breathing pattern, weakened immunity, unexplained fever, shortness of breath, or blood in the cough.

Asthma:

Asthma is a respiratory condition that leads to the narrowing and swelling of the airways. There is excessive mucus production making the patient difficult to breathe and triggering coughing, wheezing, and shortness of breath. It may be exercise, occupation, or allergy-induced. Patients with a suspected or established diagnosis if they had a rapid worsening of breathing, wheezing, respiratory exertion with minimal physical activity. A specialist’s appointment must be scheduled immediately if the symptoms do not improve even after using the prescribed inhaler.

Bronchiectasis:

Bronchiectasis is an irreversible two-stage damage to the airway tubes of the lungs, which widens the tube or develops pouches. This makes it difficult to clear out the mucus, and the patients present with persistent coughs with pus and mucus. Apart from the obvious cough, patients with fevers, chills, tiredness, bloody mucus, chest pain, and difficulty in breathing should immediately consult a pulmonary specialist.

Bronchitis:

Bronchitis is the inflammation of the airways that make the path swell up and fill with mucus. They usually have a pathogenic origin. The patient must visit the doctor if the cough lasts beyond three weeks, fevers over 102 degrees Fahrenheit for over five days, shortness of breath, and bloody sputum.

Chronic Obstructive Pulmonary Disease:

COPD is a cumulative term for a range of progressive pulmonary disorders like bronchitis and emphysema. Patients with a history of diagnosed bronchitis and emphysema must always look out for changes in the breathing pattern or any niggle or discomfort in the chest. A pulmonologist visit becomes mandatory if a patient has a mucoid cough persisting for a long time, has difficulty breathing, breathing difficulties with mild and daily activities, and consistent wheezing.

COVID-19:

COVID-19 creates havoc on the respiratory system causing pneumonia, bronchitis, sepsis, or ARDS (acute respiratory distress syndrome). It is possible for the lungs to recover gradually, but the progress might be very slow. COVID-19 patients should look out for any symptoms of the lungs, including prolonged coughing, bloody sputum, breathlessness, etc. Regular follow-up with a pulmonologist is also essential to avoid derailing the recovery trail.

Cystic Fibrosis:

Cystic fibrosis is an inherited disorder causing severe damage to the lungs and several parts of the body. Is it better to be safe and consult a specialist if someone in the family has the condition and schedule regular follow-ups for the same. Immediate consultation may be required if new or worsening symptoms occur like an increase in mucus discharge, feeling lethargic, weight loss, severe constipation, bloody cough, chest pain, difficulty breathing, and severe stomach pain with distension.

Emphysema:

Emphysema is shortness of breath caused due to damage to the lung alveoli. The damage decreases the surface area within the lungs, which decreases the oxygen transport into the bloodstream. A pulmonologist appointment should be scheduled in case it becomes hard to breathe, and more mucus is produced, more coughing than usual, medications are not effective anymore, or feeling more drained.

Interstitial Lung Disease:

Interstitial lung disease is a result of conditions causing inflammation and scarring of the lungs. It is important to see a doctor if one has shortness of breath, with or without exercise, and a persistent dry cough. Patients living or working without proper airway protection should be vigilant.

Lung Cancer:

Lung cancers are the third most common cancer in the US. Although cancers are primarily dealt with by oncologists, a comprehensive treatment plan includes several departments, including pulmonologists. They monitor the function, damage, and effectiveness throughout and beyond the cancer treatment.

Pulmonary Hypertension:

Increased blood pressure within the pulmonary arteries gives rise to this condition. This is mostly due to hypoxia, underlying lung, or heart disease. It is advisable to visit the doctor if the patient develops a very rapid heart rate (more than 120 beats per minute), worsening cough, dizziness, fatigue, shortness of breath, nausea, joint swelling, and rapid weight gain.

Sarcoidosis:

Sarcoidosis is an inflammatory condition mostly affecting the lungs and lymphatics. Patients are on various treatments to suppress the condition. A pulmonologist may be referred if the individuals show persistent dry cough, shortness of breath, wheezing, along with chest pain.

Sleep Apnea:

Sleep apnea is a disorder that ceases breathing when the individual is asleep. Patients are under treatment with medications, oral devices, or CPAP (continuous positive airway pressure) machine. It is important to visit the emergency room in case the patient feels like having a heart attack or a stroke.

Tuberculosis:

Tuberculosis is a bacterial infection primarily affecting the lungs and can rapidly spread. BCG (Bacille Calmette-Guerin) vaccine is widely available to protect against any tuberculosis infection. Patients should be aware, especially if there are any other patients in the vicinity. Tubercular symptoms are quite distinctive, and healthcare providers must be contacted immediately to obtain a good prognosis with prompt treatment.

Asbestosis:

Asbestosis is caused due to inhalation of asbestos, which is present within old infrastructures. Workers or inhabitants in such environments should take steps to mitigate the risk by either using respirators or renovating respectively. Routine follow-ups may be needed to track pulmonary damage, and any bouts of persistent dry cough, shortness of breath, crackling sound in the lungs, or finger clubbing should warrant a specialist referral.

Berylliosis:

Berylliosis is a chronic pulmonary disease caused secondary to inhalation of beryllium dust or fumes present in the workplace. Workplace safety code violations with beryllium should be mitigated. Workers need to visit healthcare professionals for regular respiratory checkups to prevent existing damage into something much more serious. Shortness of breath, fatigue, weakness, lack of appetite, weight loss, joint pain, cough, and fevers should push an individual to consult a pulmonologist.

Black Lung Disease:

Also known as coal workers' pneumoconiosis, occurs from scarring of the lungs, commonly in coal miners due to consistent inhalation of coal dust. Coal mine workers should make it a priority to consult pulmonologists in case of persistent respiratory symptoms, including cough and shortness of breath.

Silicosis:

This occupational hazard is borne from inhaling tiny crystalline particles of silicon dioxide or silica. If an individual is regularly exposed to silica dust, then regular health monitoring is essential to maintain lung integrity, and immediate pulmonary intervention may be required in diagnosed patients with the appearance of fever, worsening breathing, unexplained weight loss, and persistent coughing.

What Tests Does a Pulmonologist Order?

The pulmonologist should perform an array of tests to accurately diagnose the respiratory condition and assess the extent of the damage. These tests include:

• Pulmonary function tests (a measure of inhaled and exhaled air).

• Chest X-rays (X-ray images of the patient’s chest are compared to the healthy ones).

• Computed tomography scans (CT provides a detailed 3D image of the lungs).

• Magnetic resonance imaging (provides structural and quantitative functional images of the lungs without ionizing radiation).

• Arterial blood gas (measures the amount of oxygen and carbon dioxide in arterial blood).

• Electrocardiogram to test for the electrical activity of the heart).

• Purified protein derivative (used to establish a tuberculosis diagnosis).

• Bronchoscopy (a bronchoscope is used to directly visualize the lungs).

• Biopsy (a small tissue sample is taken and microscopically analyzed).

• Thoracentesis (a lung fluid sample is taken for testing).

• Endobronchial ultrasound (a procedure to evaluate and biopsy lymph nodes).

• Mediastinoscopy (a surgical procedure to evaluate the mediastinum).

• Pulmonary artery catheterization (measures the pulmonary artery pressure).

• Doppler echocardiogram (a Doppler echo is used to evaluate blood flow across heart valves).

• Blood tests (complete blood tests, ACE-inhibitor levels, etc.).

• Polysomnogram (overnight sleep test to check for sleep apnea).

• Pulmonary ventilation or perfusion (VQ) scan (to look for blood clots within the lung).

• Pulse oximetry (to check for blood oxygen saturation).

• PET (positron emission tomography) scan (a radiotracer is injected in the vein and tracked for this accumulation).

• Gallium scanning (radioactive gallium-67 is injected, and the body is scanned to check for collection of the tracer).

• Laboratory study of sputum.

Pulmonary function tests are various measures of lung capacity, including tidal volume, minute volume, vital capacity, functional residual capacity, residual volume, total lung capacity, forces vital capacity, forced expiratory volume, forced expiratory flow, and peak expiratory flow rate.

Conclusion:

Pulmonary conditions may begin with a simple inconspicuous cough but may be the bell for a greater pathology. Being the gateway for oxygenation, any problem in the lungs, airways, or alveoli can have a much greater effect on other parts of the body. Heart functions are also somewhat dependent on lung function, so just pulmonary studies are not enough. A comprehensive approach should always be cardiopulmonary. Management of small coughs can prevent serious outcomes.