Pulmonology is the medical specialty dealing with disease involving the respiratory tract.

Pulmonology is called chest medicine and respiratory medicine in some countries and areas. Pulmonology is considered a branch of internal medicine, and is related to intensive care medicine. Pulmonology often involves managing patients who need life support andmechanical ventilation. Pulmonologists are specially trained in diseases and conditions of the chest, particularly pneumonia, asthma, tuberculosis, emphysema, and complicated chest infections.

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

  • hereditary diseases affecting the lungs (cystic fibrosis, alpha 1-antitrypsin deficiency)
  • exposure to toxins (tobacco smoke, asbestos, exhaust fumes, coal mining fumes)
  • 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 are as important as in the 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 hyperresonance.
  • 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, a thorough cardiac investigation is usually included

Procedures:

  • Laboratory investigation of blood (blood tests). Sometimes arterial blood gas measurements are also required.
  • Spirometry (the determination of lung volumes in time by breathing into a dedicated machine; response to bronchodilatators anddiffusion of carbon monoxide)
  • Bronchoscopy with bronchoalveolar lavage (BAL), endobronchial and transbronchial biopsy and epithelial brushing
  • Chest X-rays
  • CT scanning (MRI scanning is rarely used)
  • Scintigraphy and other methods of nuclear medicine
  • Positron emission tomography (especially in lung cancer)
  • Polysomnography (sleep studies) commonly used for the diagnosis of Sleep apnea

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