What is a Pulmonologist?

A pulmonologist is a doctor that has specialized training and education on the respiratory system. Pulmonologists primarily focus on diagnosing and treating conditions and diseases affecting the lungs or respiratory system. Pulmonologists are able to provide treatment for respiratory conditions such as sleep breathing disorders, infections, autoimmune, inflammation, lung transplants, and other respiratory conditions. Pulmonologists are also able to diagnose and treat lung diseases such as neuromuscular disease, obstructive, interstitial, and other lung diseases. There are also some pulmonary conditions that can involve other areas of specialized healthcare such as cardiovascular. The pulmonary vascular disease is a prime example of how certain diseases may require two healthcare specialists from two different healthcare fields. This disease is a condition that affects not only the respiratory system, but it also affects the cardiovascular system that may need a cardiologist to get involved with treating the patient.

Pulmonologists Training and education


Similar to any other specialty type doctor there is extensive education and training requirements in place to become a pulmonologist. The basic level of education requirement for anyone to become a practicing pulmonologist is a doctorate degree. There are basic classes and pathways that college students can take that will help them in pursuing this degree. Most pulmonologist start out by obtaining their bachelor’s degree from an accredited college. Most of the students complete undergraduate studies and go ahead and finish their bachelor’s degree in order to gain entry into medical school. Another successful route for students to become a pulmonologist is to begin studying in a pre-med program from an accredited institution.

Medical School

In order to be accepted to certain medical schools students benefit greatly from a couple different additional activities or studies. Additional studies that students can undertake during their college courses involve classes that satisfy prerequisite classes. These classes range from science and math courses to more specialized courses such as physics, biology, and chemistry. Students having completed these types of classes in their undergraduate studies have an advantage when applying to medical schools.

Another extracurricular set of activities that benefit students applying for medical school involve volunteering in fields that are related to healthcare. Students can find local hospitals that allow for volunteer workers to come in and help and this type of volunteer work not only gives students a better understanding of field work, but it also aides them when applying to medical school. Students could also apply for volunteer work at hospital and other places such as nursing homes to gain additional field experience. Any of these options give students a greater chance of being accepted to medical school when applying.

After students have completed their undergraduate work they must then apply to an accredited medical school. A medical school is where future pulmonologists take specialized medical courses and obtain their doctorate degree in order to become a pulmonologist. Acceptance into medical school is not always easy and it does involve quite a lengthy process. An applicant must have an acceptable GPA which will vary from school to school. Applicants must also have several letters of recommendations from previous professors upon applying. Any additional experiences such as volunteer work in the healthcare field and other extracurricular activities are also evaluated to help decide acceptance.

The largest factor that plays a role in being accepted into a medical school is a student’s MCAT score. MCAT stands for Medical College Admissions Test. The Medical College Admissions Test is a standardized exam given to students in a multiple choice format. Most college students typically choose to complete the MCAT during their senior of junior year of college. This multiple choice exam tests on student’s knowledge in several areas including critical thinking, problem solving, and an understanding of science concepts.

Specialty Training and Education

Upon acceptance to an accredited medical school program a pulmonologist must successfully complete an additional four years of medical school that will focus on a broader range of healthcare. The first couple of years would include classes that focus on courses such as medical ethics, psychology, anatomy, microbiology, pathology, biochemistry, pharmacology, and physiology.

Following these two years of course work students must complete two additional years in the field. During these years in the field students will be trained on patient care by working with local clinics and hospitals. Students will work under the guidance of experienced healthcare providers and medical staff to gain a firsthand understanding of patient care. During these clinical trials students may work in several different subspecialty medical fields such as a family practice, gynecology, obstetrics, or even cardiology.

Medical Residency

Student must then successfully complete a residency in internal medicine. It is required that medical students complete a minimum of three years of internship from an accredited internal medicine residency program before they may begin training in specialized areas such as pulmonology. Upon successful complete of their internship and graduate school studies medical students are then permitted to take another test. The Internal Medicine board certification exam is the next step to becoming a pulmonologist. Medical students that successfully pass this examination can then begin their studies in the specialized area of pulmonology.

There are typically two additional years of specialized training that follow a medical student’s residency that provides further experience and knowledge focused on pulmonology. During these two years of specialized training doctors focus on areas such as pulmonary physiology, molecular biology, and pulmonary immunology. Some pulmonologists may choose to study in even more specialized areas of pulmonology such as pediatric pulmonology. Specialized training such as this usually requires an additional three years of training but will provide experience and knowledge in healthcare fields like newborn care, clinical training for ambulatory care, continuous child care, and newborn care.

Licensing and Board Certification

Following the years required in specialized healthcare training to become a pulmonologist, a physician must obtain a license. In the United States all Doctors are federally required to obtain a medical practice license in order to begin their medical practice. There are two methods pulmonologists can use to obtain this license which are by passing the U.S. Medical Licensing Examination (USMLE) or by passing the Comprehensive Osteopathic Medical Licensing Examination (COMLEX). Beyond obtaining these licenses to practice medicine within the United States pulmonologists may also look into becoming board certified. A pulmonologist is not required to become board certified; however if they choose to become board certified they must pass the board certification examination in pulmonary medicine. Successful complete of the exam demonstrates a pulmonologists devotion to achieving excellence within healthcare and to provide exceptional care for their patients.

History and Evolution of Pulmonology

Alvan L. Barach MD

Pulmonology was not really specialty healthcare field until around 1950. The need for pulmonologists grew as a result of the growth in chronic obstructive pulmonary disease (COPD) cases during the 1950s. A physician by the name of Alvan L. Barach MD became known as the pioneer in pulmonary medicine. Barach had a long career ranging from the 1920s all the way until the 1970s. Barach was a doctor associated with Columbia University located in New York. During his time he published a great deal of writings that are still in use today. Most of his writings were published on the PubMed database and currently still has 128 publications to date listed on PubMed.

Dr. Barach contributed significantly to the field of pulmonology through several medical breakthroughs. Barach published a description on the use of an oxygen tent in 1926. This breakthrough was significant because it described the use of oxygen tents on patients to relieve them of the respiratory distress associated with patients who fell critically ill with pneumonia. Roughly 10 years later around 1936 Barach went on to publish a work describing the use of heliox to relieve dyspnea in patients diagnosed with emphysema and asthma. One of his largest contributions to the field of pulmonology came about in 1945. That year Barach discovered that penicillin could be used in the treatment of pneumonia and would publish another one of his writings describing the benefits of penicillin. Although Barach was the pioneer that had thorough knowledge and understanding of COPD and how to treat it, it would take contributions from a fellow pulmonologist some years later.

Thomas L Petty MD

It wasn’t until around 1960 that Thomas L Petty MD started making his major contributions to the field of pulmonology. Petty would later be described as the most accomplished pulmonologist of any generation. He was the first pulmonologist to develop and standardize an out-patient rehabilitation program designed to help people with pulmonary diseases. Petty’s programs aimed to help patients understand more about their disease, used breathing retraining for patients, informed patients about bronchial hygiene, physical reconditioning, utilized pharmacologic therapy, and used supplemental oxygen on patients for the first time.

In the year 1969 Petty had enough data and knowledge to publish his most significant findings based on his rehabilitation treatments. A paper called “A Comprehensive Care Program for Chronic Airway Obstruction” was published. This publication documented their findings based on his rehabilitation methods and their patient outcomes. The paper described their findings with 124 of their patients of which 94 patients were reported as “better” as a direct result of Petty’s rehabilitation program. This paper also documented the fact that patients had reduced hospitalizations, improved exercise tolerance, and a return to employment as a result of his rehabilitation model. Following this publication rehabilitation programs began to pop up around the country following Petty’s design model. By 1980 the American Thoracic Society issued an official statement that echoed Petty’s findings. Their statement described the important components of an effective rehabilitation program design for pulmonary diseases and designated exercise conditioning to be a critical and essential component.

A few years later the idea of rehabilitative exercise was called into question and doubt began to grow. During the 1980s it was argued that exercise conditioning was only as strong as a patient lungs and exercise does not improve lung function. Beyond this argument there was also doubt that patients suffering from chronic obstructive pulmonary disease could exercise intensely enough to improve muscle functions. Consequently in 1981 a publication was released that stated “Exercise training fails to increase skeletal muscle enzymes in patients with chronic obstructive pulmonary disease.” This statement was based on a study conducted by Bellman and Kendregan that also treated patients suffering from chronic obstructive pulmonary disease. Their exercise studies training programs did not show any biochemical markers of improvement. Their study was later criticized for having an exercise too low in intensity that would improve any biochemical adaptations that would improve COPD within their patients.

By early the early 1990s the University of California in San Diego started conducting their own line of research. Their research was carried out on patients with chronic obstructive pulmonary disease and exposed them to high intensity exercise training. Their research concluded that prior studies conducted by Bellman and Kendregan were in fact too low in intensity to draw a valid conclusion. Their studies also concluded that there were in fact positive results such as reduced ventilatory response when exposed to high intensity exercise. This resulted in today’s standard of Pulmonary rehabilitation being used to improve dyspnea and raise health-related quality of life issues patients often lack when diagnosed with chronic obstructive pulmonary disease.

Pulmonologists Devices

Pulmonology advancements have come a long way and the technology available to pulmonologists in the field today have drastically improved healthcare for patients with chronic obstructive pulmonary disease. One of the most commonly used advancements in technology used by pulmonologists today is an x-ray. A chest x-ray can provide images to a pulmonologist to see how well lung structure and lung function are in their patients. This can also be used in determining how well the heart works and signify any heart related problems that may result in changes to your lungs.

There are a number of other imaging devices that are used in today’s field of pulmonology. One example of this is an ultrasound. An ultrasound on a patient’s chest can show a pulmonologist images of organ structure and function using sound waves sent throughout the chest. A more detailed imaging system used by pulmonologists is called a Computed Tomography Scan or also known as a CAT Scan. A CAT scan uses both x-ray imaging and computer driven technology that sends images through sliced images of organs throughout the body. These images can show pulmonologists highly detailed images of a patient’s lung health. Other types of imaging technology involve looking at other respiratory organs such as a chest fluoroscopy. A chest fluoroscopy is an x-ray device used to look at all other parts of the respiratory tract. This device can be used to obtain images of the patient’s lungs, throat, nose, bronchi, and trachea.

One of the most advanced devices used by pulmonologists to gather health information on their patients is called a Positron Emission Tomography Scan or better known as a PET Scan. A PET scan is an imaging device that utilizes nuclear medicine imaging. This scan is a more detailed scan and can be used to examine a variety of conditions by looking at metabolism, blood flow, and oxygen use. A PET scan is often used by pulmonologists in diagnosing patients with diseases such as lung cancer.

Pulmonologists Testing

In combination with more advanced devices being available there are also a number of advanced tests available for pulmonologists. Pulmonologists have the ability to conduct tests on the tissue of the lung itself from within a patient. A lung biopsy is a test in which a pulmonologist takes a small piece of the lung and examines it for various conditions or diseases. There are also biopsies called pleural biopsies in which a pulmonologist will take a small tissue sample from the membrane surrounding the lungs to test for any medical conditions or diseases.

There are also a wide range of easy and less invasive testing that pulmonologists use in the field. One example is a Pulmonary Function Test or PFT in which a pulmonologist tests how well the lungs are working. Another test is known as a Peak Flow Measurement which tests for air flowing out of the lungs. During this test a patient will be asked to forcefully blow into a mouthpiece device that measures expiratory flow rate. The pulmonologist can then determine the amount of air a patient can inhale and exhale and at what rate. This test is especially useful in patients that suffer from asthma.

Pulmonologists Procedures

Once a pulmonologist has conducted the needed test required to conclude his diagnose there are various procedures available for chronic and severe pulmonary diseases. Pulmonologists now have the ability to conduct an entire lung transplant in patients with lungs that are too diseased to continue properly functioning. There are other procedures that may require removing smaller portions of the lungs such as a lobectomy. A lobectomy is a surgery in which a pulmonologists may remove one of the lobes coming from the lungs to prevent further respiratory complications. One of the more serious procedures performed by a pulmonologist is called a pneumonectomy. A pneumonectomy is an extensive surgery in which one of the patient’s lungs is completely removed from the body. Causes that would lead to such surgery typically involves lung cancer that could spread and become worse if not completely removed. Another situation in which an entire lung would need to be removed could be situations in which trauma was involved and the lung needs to be removed to prevent complications.

Most common conditions treated by Pulmonologists

Pulmonologists are able to diagnose and treat any conditions or disease involving the respiratory system in patients. The five most common treated conditions make up the vast majority of all pulmonologist visits.

  • The fifth most common condition treated by a pulmonologist is difficulty breathing. Any patient experiencing difficulty breathing should seek care from a pulmonologist. This could signal a more serious underlying lung condition. Breathing problems that are left untreated could become worse and can become uncomfortable and tiring.
  • The fourth most common condition that pulmonologists treat is actually lung cancer. Cancer is a modern day black plague affecting many organs within the body and the lungs are not excluded from that list of organs. If lung cancer is not caught at the early stages of growth it can prove to be fatal so seeking the care of a pulmonologists as soon as possible is vital.
  • The third most common condition treated by pulmonologists is asthma. Asthma is a condition that affects mostly children, but can also affect adults as well. Asthma is a condition in which the bronchial tubes become inflamed making it difficult to breathe. This inflammation can cause other symptoms such as coughing, wheezing, shortness of breath, and tightness in chest. Asthma can lead to respiratory failure or can be fatal if it is severe enough and left untreated.
  • The second most common condition treated by pulmonologists is for a chronic cough. There are actual two types of cough and they are acute or chronic. An acute cough is often not very serious but still may require a prescription in order to get it cleared up. Most acute coughs are due to some sort of small respiratory infection that can be treated with antibiotics. A chronic cough can be a bit more of a serious condition. Chronic coughing is a cough that typically last for more than three weeks. A cough that lasts this long may signal a more serious respiratory issue that requires additional testing or a more intense treatment.
  • The most common respiratory condition that pulmonologists treat is for chronic obstructive pulmonary disease or COPD. Chronic obstructive pulmonary disease is a condition in which there are abnormalities inside the lungs that make it difficult for a patient to exhale normally. This condition can lead to excessive inflammation within the lung and may eventually lead to permanent abnormalities in the lung’s structure. If these abnormalities are left untreated they could eventually turn into permanent obstructions to airflow. Chronic obstructive pulmonary disease can be caused by several conditions, but the two most common conditions that lead to COPD is emphysema and chronic bronchitis.

 

 

References

http://avitahealth.org/uploads/images/Brochures/5%20REASONS%20TO%20SEE%20A%20PULMONOLOGIST.pdf

https://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/

http://doctorly.org/how-to-become-a-pulmonologist/

http://www.rcjournal.com/contents/09.08/09.08.1185.pdf

http://www.intercoastalmedical.com/Blog/TabId/33253/PostId/4439/questions-to-ask-your-pulmonologist

https://www.healthline.com/health/what-is-a-pulmonologist

 


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