Pulmonology

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Respiration
Respiratory system complete en.svg
Schematic view of the human respiratory system with their parts and functions.
System Respiratory
Significant diseases Asthma, Lung Cancer, Tuberculosis, Occupational lung disease
Significant tests Bronchoscopy, Sputum studies, Arterial blood gases
SpecialistRespiratory Physician, Pulmonologist

Pulmonology is a medical specialty that deals with diseases involving the respiratory tract. [1] The term is derived from the Latin word pulmō, pulmōnis ("lung") and the Greek suffix -λογία , -logia ("study of"). Pulmonology is synonymous with pneumology (from Greek πνεύμων ("lung") and -λογία), respirology and respiratory medicine.

A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (pediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a medical specialist.

Respiratory disease disease of the respiratory system

Respiratory disease, or lung disease, is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, and the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, acute asthma and lung cancer.

Respiratory tract Organs involved in transmission of air to and from the point where gases diffuse into tissue

In humans, the respiratory tract is the part of the anatomy of the respiratory system involved with the process of respiration. The respiratory tract is lined with respiratory mucosa or respiratory epithelium. Air is breathed in through the nose or the mouth. In the nasal cavity, a layer of nasal mucosa acts as a filter and traps pollutants and other harmful substances found in the air. Next, air moves into the pharynx, a passage that contains the intersection between the oesophagus and the larynx. The opening of the larynx has a special flap of cartilage, the epiglottis, that opens to allow air to pass through but closes to prevent food from moving into the airway.

Contents

Pulmonology is known as 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 and mechanical ventilation. Pulmonologists are specially trained in diseases and conditions of the chest, particularly pneumonia, asthma, tuberculosis, emphysema, and complicated chest infections. [2]

Medicine The science and practice of the diagnosis, treatment, and prevention of physical and mental illnesses

Medicine is the science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.

Internal medicine or general medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians in Commonwealth nations. Internists are skilled in the management of patients who have undifferentiated or multi-system disease processes. Internists care for hospitalized and ambulatory patients and may play a major role in teaching and research.

Intensive care medicine medical specialty concerned with patients who have potentially life-threatening organ failure

Intensive care medicine, or critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions that may require sophisticated life support and intensive monitoring.

Journals of pulmonology

American Association for Respiratory Care

The American Association for Respiratory Care (AARC) is a non profit organization and is the only professional organization supporting Respiratory Care in the United States. In addition to attempting to help lobby for beneficial legislation nationally and locally, the AARC is trying to promote the profession as a whole to increase interest and membership. The AARC began in 1943, as the Inhalation Technician Association and has evolved rapidly and repeatedly since.

The American College of Chest Physicians (CHEST) is a medical association in the United States consisting of physicians and non-physician specialists in the field of chest medicine, which includes pulmonology, critical care medicine, and sleep medicine. The group was founded in 1935.

The American Lung Association is a voluntary health organization whose mission is to save lives by improving lung health and preventing lung disease through education, advocacy and research.

History of pulmonology

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. [3]

Pulmonary circulation The part of the circulatory system which carries blood from heart to lungs and back to the heart

The pulmonary circulation is the portion of the circulatory system which carries deoxygenated blood away from the right ventricle, to the lungs, and returns oxygenated blood to the left atrium and ventricle of the heart. The term pulmonary circulation is readily paired and contrasted with the systemic circulation. The vessels of the pulmonary circulation are the pulmonary arteries and the pulmonary veins.

Blood specialized bodily fluid in animals

Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells.

Heart organ for the circulation of blood in animal circulatory systems

The heart is a muscular organ in most animals, which pumps blood through the blood vessels of the circulatory system. Blood provides the body with oxygen and nutrients, as well as assisting in the removal of metabolic wastes. In humans, the heart is located between the lungs, in the middle compartment of the chest.

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 [4] , the National Association for the Study and Prevention of Tuberculosis [5] . The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right, phthisiology [6] . 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. [7]

William H. Welch American physician and scientist

William Henry Welch was an American physician, pathologist, bacteriologist, and medical school administrator. He was one of the "Big Four" founding professors at the Johns Hopkins Hospital. He was the first dean of the Johns Hopkins School of Medicine and was also the founder of the Johns Hopkins School of Hygiene and Public Health, the first school of public health in the country. Welch was more known for his cogent summations of current scientific work, than his own scientific research. The Johns Hopkins medical school library is also named after Welch. In his lifetime, he was called the "Dean of American Medicine" and received various awards and honors throughout his lifetime, and posthumously.

William Osler Canadian pathologist, physician, educator, bibliophile, historian, author, cofounder of Johns Hopkins Hospital

Sir William Osler, 1st Baronet, was a Canadian physician and one of the four founding professors of Johns Hopkins Hospital. Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training. He has frequently been described as the Father of Modern Medicine and one of the "greatest diagnosticians ever to wield a stethoscope". Osler was a person of many interests, who in addition to being a physician, was a bibliophile, historian, author, and renowned practical joker. One of his achievements was the founding of the History of Medicine Society of the Royal Society of Medicine, London.

The American Thoracic Society (ATS) is a nonprofit organization focused on improving care for pulmonary diseases, critical illnesses and sleep-related breathing disorders. It was established in 1905 as the American Sanatorium Association, and changed its name in 1938 to the American Trudeau Society. In 1960, it changed its name again to the American Thoracic Society. Originally the medical section of the American Lung Association, the Society became independently incorporated in 2000 as a 501 (c) (3) organization.

Pulmonology and its relevance in other medical fields

Surgery of the respiratory tract is generally performed by specialists in cardiothoracic surgery [8] (or thoracic surgery) [9] , though minor procedures may be performed by pulmonologists. Pulmonology is closely related to critical care medicine [10] 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 [11] that deals with the use of procedures such as bronchoscopy [12] and pleuroscopy to treat several pulmonary diseases [13] . Interventional pulmonology is increasingly recognized as a specific medical specialty [14] .

Surgery Medical specialty

Surgery is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.

Cardiothoracic surgery medical specialty involved in surgical treatment of organs inside the thorax

Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thorax —generally treatment of conditions of the heart and lungs. In most countries, cardiac surgery and general thoracic surgery are separate surgical specialties; the exceptions are the United States, Australia, New Zealand, and some EU countries, such as the United Kingdom and Portugal.

Interventional pulmonology is a maturing medical sub-specialty from its parent specialty of pulmonary medicine. It deals specifically with minimally invasive endoscopic and percutaneous procedures for diagnosis and treatment of neoplastic as well as non-neoplastic diseases of the airways, lungs, and pleura. Many IP procedures constitute efficacious yet less invasive alternatives to thoracic surgery.

Diagnosis

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

Physical diagnostics [18] are as important as in other fields of medicine.

As many heart diseases can give pulmonary signs, [19] a thorough cardiac investigation is usually included.

Procedures

Clinical procedures

Pulmonary clinical procedures include the following pulmonary tests and procedures [20] [21] :

Surgical procedures

Major surgical procedures on the heart and lungs are performed by a thoracic surgeon [27] . 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.

Treatment and therapeutics

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 [28] is often necessary in severe respiratory disease (emphysema and pulmonary fibrosis). When this is insufficient, the patient might require mechanical ventilation.

Pulmonary rehabilitation [29] 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 [30] 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 [31] may include a rehabilitation physician, a pulmonary medicine specialist, and allied health professionals including a rehabilitation nurse, a respiratory therapist, 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.

Education and training

Pulmonologist

Pulmonologist
Bronchoscopy nci-vol-1950-300.jpg
Physician performing a bronchoscopy.
Occupation
Names
  • Pulmonologist
  • Pneumonologist
  • Respirologist
  • Respiratory physician
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, clinics

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 [32] . 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.

Pediatric pulmonologist

In the United States, pediatric pulmonologists [33] are physicians who, after receiving a medical degree (MD or DO), complete residency training in pediatrics, followed by at least three additional years of subspeciality fellowship training in pulmonology.

Scientific research

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.

Related Research Articles

Respiratory therapist health profession

A respiratory therapist is a specialized healthcare practitioner trained in pulmonary medicine in order to work therapeutically with people suffering from pulmonary disease. Respiratory therapists graduate from a college or university with a certification in respiratory therapy and have passed a national board certifying examination. The NBRC is the not-for-profit organization responsible for credentionaling the seven areas of Respiratory Therapy in the United States.

Spirometry

Spirometry is the most common of the pulmonary function tests (PFTs). It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is helpful in assessing breathing patterns that identify conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD. It is also helpful as part of a system of health surveillance, in which breathing patterns are measured over time.

Pulmonary hypertension hypertension characterized by an increase of blood pressure in the pulmonary artery, pulmonary vein or pulmonary capillaries

Pulmonary hypertension is a condition of increased blood pressure within the arteries of the lungs. Symptoms include shortness of breath, syncope, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual.

Lung transplantation

Lung transplantation, or pulmonary transplantation, is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor. Donor lungs can be retrieved from a living donor or a deceased donor. A living donor can only donate one lung lobe. With some lung diseases, a recipient may only need to receive a single lung. With other lung diseases such as cystic fibrosis, it is imperative that a recipient receive two lungs. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for end-stage pulmonary patients.

Idiopathic pulmonary fibrosis chronic, irreversible and ultimately fatal disease characterized by a progressive decline in lung function

Idiopathic pulmonary fibrosis (IPF) is a type of chronic scarring lung disease characterized by a progressive and irreversible decline in lung function. Symptoms typically include gradual onset of shortness of breath and a dry cough. Other changes may include feeling tired, and abnormally large and dome shaped finger and toenails. Complications may include pulmonary hypertension, heart failure, pneumonia, or pulmonary embolism.

Endobronchial valve

An endobronchial valve(EBV), is an implantable medical device—a small, one-way valve, which is implanted in an airway in the pulmonary system to treat one of several lung conditions. Endobronchial valves are typically implanted using a flexible delivery catheter advanced through a bronchoscope, and thus they are minimally invasive. The valves are also removable if they are not working properly.

Pulmonary hygiene, is a set of methods used to clear mucus and secretions from the airways. The word pulmonary refers to the lungs. The word toilet, related to the French toilette, refers to body care and hygiene; this root is used in words such as toiletry that also relate to cleansing.

Stanisław Kuczborski was a Polish pulmonologist.

Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.

Asphyxiating thoracic dysplasia human disease

Asphyxiating thoracic dysplasia, also known as “Jeune syndrome”, is a rare inherited bone growth disorder that primarily affects the thoracic region. It was first described in 1955 by the French pediatrician Mathis Jeune. Common signs and symptoms can include a narrow chest, short ribs, shortened bones in the arms and legs, short stature, and extra fingers and toes (polydactyly). The restricted growth and expansion of the lungs, caused by this disorder, results in life-threatening breathing difficulties. Due to this critical condition, people who are affected with this disorder live short lives either only into infancy or early childhood. If they live beyond childhood, breathing problems can improve with age, but there is a possibility of developing severe kidney or heart problems. Several mutations in different genes such as IFT80, DYNC2H1, WDR19, IFT140 and TTC21B have been identified in some families, with the condition, as possible causes of the disorder. Treatment is based on the signs and symptoms present in each person.

Ravi Kalhan is the director of the Asthma and COPD Program at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital.

Randeep Guleria is an Indian pulmonologist and the head of the Department of Pulmonology and Sleep Disorders at the All India Institute of Medical Sciences, credited with the establishment of India's first centre for pulmonary medicines and sleep disorders at AIIMS. He was honoured by the Government of India in 2015 with Padma Shri, the fourth highest Indian civilian award. He is an alumnus of St. Columba's School, Delhi.

William N. Rom is the Sol and Judith Professor of Medicine and Environmental Medicine at New York University School of Medicine and director of the Environmental lung disease laboratory at New York University and Bellevue HospitalCenter.

Mihir Suryakant "Max" Parikh is an Indian interventional pulmonologist at Beth Israel Deaconess Medical Center and at Beth Israel Deaconess Hospital-Milton where he studies lung cancer staging and diagnosis, lung nodules, pleural effusions and both alignant and benign airway obstructions.

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