Pulmonary Medicine

PictureWhat is Pulmonary Medicine?
Pulmonary medicine is a medical specialty that focuses on the diagnosis and treatment of diseases of the lung and lower respiratory tract. A physician who specializes in this field is called a pulmonologist or pulmonary physician.

About the Respiratory System

  • The Nose – Usually air will enter the respiratory system through the nostrils. The nostrils then lead to open spaces in the nose called the nasal passages. The nasal passages serve as a moistener, a filter, and to warm the air before it reaches the lungs.
  • Pharynx and Larynx – Air travels from the nasal passages to the pharynx, or more commonly known as the throat. When the air leaves the pharynx it passes into the larynx, or the voice box. The voice box is constructed mainly of cartilage, which is a flexible connective tissue. Food and liquids are blocked from entering the opening of the larynx by the epiglottis.
  • Trachea – The larynx goes directly into the trachea or the windpipe. The trachea is a tube approximately 12 centimeters in length and 2.5 centimeters wide. The trachea is kept open by rings of cartilage within its walls.
  • Bronchi – In the center of the chest, the trachea divides into two cartilage-ringed tubes called bronchi (bronchus-singular). The bronchi enter the lungs and spread into a treelike fashion into smaller tubes called bronchial tubes.
  • Bronchioles – The bronchial tubes divide and then subdivide. By doing this their walls become thinner and have less and less cartilage. Eventually, they become a tiny group of tubes called bronchioles.
  • Alveoli – Each bronchiole ends in a tiny air chamber that looks like a cluster of grapes. Each chamber contains many cup-shaped cavities known as alveoli (alveolus-singular). They are thin, moist, and are surrounded by capillaries. The exchange of oxygen and carbon dioxide between blood and air occurs through the aveoli. The estimation is that lungs contain about 300 million alveoli. Their total surface area would be about 70 square meters.

About Respiratory Diseases:
Respiratory diseases can be classified in many different ways; by the organ involved, by the pattern of symptoms or by the cause of the disease.

Read more about respiratory diseases.

How are Pulmonary Diseases diagnosed?
Common diagnostic testing for pulmonary disease include:

Imaging

  • Chest radiographs or chest x-rays can be used to diagnose many conditions in the chest cavity. Examples include pneumonia, pneumothorax or collapsed lung, and pleural effusion (fluid buildup between the lung and chest wall). It can also be used to screen for occupational exposures to dust, metal particles, etc.
  • Computed axial tomography scans (CAT or CT scans) of the chest can be used to visualize parts of the chest that cannot be seen on a chest x-ray. This scan produces a 3-dimensional image of the chest so the physician is able to assess the condition of the lungs in greater detail.
  • Positron emission tomography scan (PET scan) is most commonly used to diagnose and stage cancer.
  • Echocardiography is an ultrasound of the heart. This test is generally used to diagnose conditions of the heart but it is a significant test in pulmonary medicine because it can be used to diagnose diseases that are related to the supply of blood to and from the lungs.

Pulmonary Function Testing

  • Spirometry is the most common type of pulmonary function testing. Your physician may also order lung volume or DLCO testing. These tests measure the capacity of the lungs or how much volume the lungs can hold, and also the speed in which the air moves in and out of the lungs. Such tests can be used to evaluate for asthma and COPD.
  • Pulmonary stress test or 6-minute walk test is a test that evaluates the lungs’ ability to deliver oxygen to the body under exertion.

Laboratory

  • Specimens such as blood and/or sputum can be collected to help diagnose conditions of the lungs.

Surgery

  • Bronchoscopy is a procedure where the airways inside the lungs are visualized through a camera or scope. The bronchoscope is usually inserted into the mouth and guided down into the lungs while the patient is under anesthesia. The physician can then assess for tumors, inflammation, and/or foreign bodies. Tissue samples of the lungs can also be taken for biopsy.

How are Pulmonary Diseases Treated?
Treatment may involve:

  • Medications such as steroids and/or bronchodilators may be used to help open air passages. Antibiotics may be prescribed to fight any bacterial infection.
  • Supplemental oxygen therapy may be administered to individuals with decreased lung function.
  • Pulmonary rehabilitation is a treatment where an individual with worsening chronic lung disease receives education and instruction on how to improve the quality of his/her life by reducing symptoms of the lung condition.
  • Surgery- certain conditions can be improved or resolved through surgical intervention. Examples of procedures include thoracentesis and/or PleurX catheter placement to resolve a collapsed lung, and right heart catherization to treat pulmonary hypertension.

Procedures – Preparation and what to expect:

  • Spirometry testing – Patients are asked to withhold their bronchodilator the morning of testing, as tolerated.
  • Bronchoscopy – This is usually an outpatient procedure. Patients will be given specific directions from the facility where the procedure was scheduled but in general, sedation is involved so patients are asked to withhold from eating and drinking the night before the procedure. Patients may be asked to temporarily withhold certain medications such as blood thinners.