# Pulmonology

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Study of respiratory diseases

"Pulmonary medicine", "Pediatric pulmonology", "Respiratory medicine", "Respirology", and "Diseases of the chest" redirect here. For the medical journals, see [Pulmonary Medicine (journal)](/source/Pulmonary_Medicine_(journal)), [Pediatric Pulmonology](/source/Pediatric_Pulmonology), [Respiratory Medicine](/source/Respiratory_Medicine), [Respirology (journal)](/source/Respirology_(journal)), and [Diseases of the Chest](/source/Diseases_of_the_Chest)

Medical specialty

Pulmonology 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 Specialist Respiratory Physician, Pulmonologist

**Pulmonology** ([/ˌpʌlməˈnɒlədʒi/](https://en.wikipedia.org/wiki/Help:IPA/English), [/ˌpʊlməˈnɒlədʒi/](https://en.wikipedia.org/wiki/Help:IPA/English), from [Latin](/source/Latin) *pulmō, -ōnis* "lung" and the [Greek](/source/Ancient_Greek) suffix [-λογία](https://en.wiktionary.org/wiki/-%CE%BB%CE%BF%CE%B3%CE%AF%CE%B1) *-logía* "study of"), **pneumology** ([/nʊˈmɒlədʒi, njʊ-/](https://en.wikipedia.org/wiki/Help:IPA/English), built on Greek πνεύμων *pneúmōn* "lung") or **pneumonology**[1] ([/nʊmənˈɒlədʒi, njʊ-/](https://en.wikipedia.org/wiki/Help:IPA/English)) is a [medical specialty](/source/Specialty_(medicine)) that deals with [diseases](/source/Respiratory_disease) involving the [respiratory tract](/source/Respiratory_tract).[2] It is also known as **respirology**, **respiratory medicine**, or **chest medicine** in some countries and areas.

Pulmonology is considered a branch of [internal medicine](/source/Internal_medicine), and is related to [intensive care medicine](/source/Intensive_care_medicine). Pulmonology often involves managing patients who need life support and [mechanical ventilation](/source/Mechanical_ventilation). Pulmonologists are specially trained in diseases and conditions of the [chest](/source/Chest), particularly [pneumonia](/source/Pneumonia), [asthma](/source/Asthma), [tuberculosis](/source/Tuberculosis), [emphysema](/source/Emphysema), and complicated chest infections.[3][4]

Pulmonology/respirology departments work especially closely with certain other specialties: [cardiothoracic surgery](/source/Cardiothoracic_surgery) departments and [cardiology](/source/Cardiology) departments.

## Journals of pulmonology

- [American Association for Respiratory Care](/source/American_Association_for_Respiratory_Care)

- [American College of Chest Physicians](/source/American_College_of_Chest_Physicians)

- [American Lung Association](/source/American_Lung_Association)

- [American Thoracic Society](/source/American_Thoracic_Society)

- [British Thoracic Society](/source/British_Thoracic_Society)

- [European Respiratory Society](/source/European_Respiratory_Society)

## History of pulmonology

One of the first major discoveries relevant to the field of pulmonology was the discovery of [pulmonary circulation](/source/Pulmonary_circulation). Originally, it was thought that [blood](/source/Blood) reaching the right side of the [heart](/source/Heart) passed through small 'pores' in the [septum](/source/Interventricular_septum) into the left side to be oxygenated, as theorized by [Galen](/source/Galen); however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth-century [anatomist](/source/Anatomist) and [physiologist](/source/Physiologist) [Ibn Al-Nafis](/source/Ibn_Al-Nafis) accurately theorized that there was no 'direct' passage between the two sides ([ventricles](/source/Ventricle_(heart))) of the heart. He believed that the blood must have passed through the [pulmonary artery](/source/Pulmonary_artery), through the lungs, and back into the heart to be [pumped](/source/Circulatory_system) around the body. This is believed by many to be the first scientific description of pulmonary circulation.[5]

Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, [William Welch](/source/William_H._Welch) and [William Osler](/source/William_Osler) founded the 'parent' organization of the [American Thoracic Society](/source/American_Thoracic_Society),[6] the National Association for the Study and Prevention of [Tuberculosis](/source/Tuberculosis).[7] The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right, [phthisiology](/source/Phthisiology).[8] When the specialty began 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.[9]

## Pulmonology and its relevance in other medical fields

[Surgery](/source/Surgery) of the respiratory tract is generally performed by specialists in [cardiothoracic surgery](/source/Cardiothoracic_surgery)[10] (or [thoracic surgery](/source/Thoracic_surgery)),[11] though minor procedures may be performed by pulmonologists. Pulmonology is closely related to critical care medicine[12] 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](/source/Interventional_pulmonology) is a relatively new field within pulmonary medicine[13] that deals with the use of procedures such as [bronchoscopy](/source/Bronchoscopy)[14] and pleuroscopy to treat several pulmonary diseases.[15] Interventional pulmonology is increasingly recognized as a specific medical specialty.[16]

## Diagnosis

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

- [hereditary](/source/Heredity) diseases affecting the [lungs](/source/Human_lung) ([cystic fibrosis](/source/Cystic_fibrosis),[17] [alpha 1-antitrypsin deficiency](/source/Alpha_1-antitrypsin_deficiency))

- exposure to [toxicants](/source/Toxicant) ([tobacco smoke](/source/Tobacco_smoking),[18] [asbestos](/source/Asbestos), [exhaust fumes](/source/Exhaust_gas), [coal mining](/source/Coal_mining) fumes, [e-cigarette aerosol](/source/Composition_of_electronic_cigarette_aerosol)[19])

- exposure to [infectious agents](/source/Infectious_disease) (certain types of [birds](/source/Bird), malt processing)

- an [autoimmune](/source/Autoimmunity) [diathesis](/source/Diathesis_(medicine)) that might predispose to certain conditions ([pulmonary fibrosis](/source/Pulmonary_fibrosis), [pulmonary hypertension](/source/Pulmonary_hypertension))

Physical diagnostics[20] are as important as in other fields of [medicine](/source/Medicine).

- Inspection of the hands for signs of [cyanosis](/source/Cyanosis) or [clubbing](/source/Nail_clubbing), the chest wall, and the respiratory rate.

- Palpation of the [cervical lymph nodes](/source/Cervical_lymph_nodes), [trachea](/source/Vertebrate_trachea) and chest wall movement.

- [Percussion](/source/Percussion_(medicine)) of the lung fields for dullness or hyper-resonance.

- [Auscultation](/source/Auscultation) (with a [stethoscope](/source/Stethoscope)) of the lung fields for diminished or unusual [breath sounds](/source/Breath_sounds). - [Rales](/source/Rales) or [rhonchi](/source/Rhonchi) are heard over the lung fields with a [stethoscope](/source/Stethoscope).

As many [heart diseases](/source/Cardiology) can give pulmonary signs,[21] a thorough cardiac investigation is usually included.

## Procedures

### Clinical procedures

Pulmonary clinical procedures include the following pulmonary tests and procedures:[22][23]

- [Medical laboratory](/source/Medical_laboratory) investigation of blood ([blood tests](/source/Blood_test)). Sometimes [arterial blood gas tests](/source/Arterial_blood_gas_test) are also required.

- [Spirometry](/source/Spirometry) is the determination of maximum airflow at a given lung volume as measured by breathing into a dedicated machine; this is the key test to diagnose airflow obstruction.

- [Pulmonary function testing](/source/Pulmonary_function_testing) including spirometry, as above, plus response to bronchodilators, lung volumes, and diffusion capacity, the latter being a measure of lung oxygen absorptive area

- [Bronchoscopy](/source/Bronchoscopy)[24] with [bronchoalveolar lavage](/source/Bronchoalveolar_lavage) (BAL), endobronchial and transbronchial [biopsy](/source/Biopsy) and [epithelial](/source/Epithelium) brushing

- [Chest X-rays](/source/Chest_radiograph)[25]

- [CT scan](/source/CT_scan)[26]

- [Scintigraphy](/source/Scintigraphy) and other methods of [nuclear medicine](/source/Nuclear_medicine)

- [Positron emission tomography](/source/Positron_emission_tomography)[27] (especially in [lung cancer](/source/Lung_cancer))

- [Polysomnography](/source/Polysomnography) (sleep studies[28]) is commonly used for the diagnosis of [sleep apnea](/source/Sleep_apnea)

### Surgical procedures

Major surgical procedures on the heart and lungs are performed by a [thoracic surgeon](/source/Thoracic_surgery).[29] Pulmonologists often perform specialized procedures to get samples from the inside of the chest or the inside of the lung. They use radiographic techniques to view the vasculature of the lungs and heart to assist with diagnosis.

## Treatment and therapeutics

See also: [Cardiothoracic surgery](/source/Cardiothoracic_surgery) and [Pulmonary rehabilitation](/source/Pulmonary_rehabilitation)

[Medication](/source/Medication) is the most important treatment for most diseases of pulmonology, either by inhalation ([bronchodilators](/source/Bronchodilator) and [steroids](/source/Steroid)) or in oral form ([antibiotics](/source/Antibiotic), [leukotriene antagonists](/source/Leukotriene_antagonist)). A common example being the usage of [inhalers](/source/Inhalers) in the treatment of inflammatory lung conditions such as [asthma](/source/Asthma) or [chronic obstructive pulmonary disease](/source/Chronic_obstructive_pulmonary_disease). [Oxygen therapy](/source/Oxygen_therapy)[30] is often necessary in severe respiratory disease ([emphysema](/source/Emphysema) and [pulmonary fibrosis](/source/Pulmonary_fibrosis)). When this is insufficient, the patient might require [mechanical ventilation](/source/Mechanical_ventilation).

Pulmonary rehabilitation[31] 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[32] is intended to educate the patient, the family, and improve the overall quality of life and [prognosis](/source/Prognosis) for the patient. Interventions can include exercise, education, emotional support, oxygen, [noninvasive mechanical ventilation](/source/Non-invasive_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[33] may include a rehabilitation physician, a pulmonary medicine specialist, [physician assistant](/source/Physician_assistant) and allied health professionals including a rehabilitation [nurse](/source/Nurse), a [respiratory therapist](/source/Respiratory_therapist), a [speech-language pathologist](/source/Speech%E2%80%93language_pathology), a [physical therapist](/source/Physical_therapist), an [occupational therapist](/source/Occupational_therapist), a [psychologist](/source/Psychologist), and a [social worker](/source/Social_worker) among others. Additionally, breathing games are used to motivate children to perform pulmonary rehabilitation.

## Education and training

### Pulmonologist

Pulmonologist Physician performing a bronchoscopy Occupation Names Pulmonologist Pneumologist Respirologist Respiratory physician or chest physician Occupation type Specialty Activity sectors Medicine Description Education required Doctor of Medicine (M.D.) Doctor of Osteopathic Medicine (D.O.) Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB) Fields of employment Hospitals, clinics

In the [United States](/source/United_States), pulmonologists are physicians who, after receiving a medical degree ([MD](/source/Doctor_of_Medicine) or [DO](/source/Doctor_of_Osteopathic_Medicine)), complete [residency](/source/Residency_(medicine)) training in [internal medicine](/source/Internal_medicine), followed by at least two additional years of subspeciality [fellowship](/source/Fellowship_(medicine)) training in pulmonology.[34] 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](/source/United_States), pediatric pulmonologists[35] are [physicians](/source/Physicians) who, after receiving a medical degree (MD, DO, MBBS, MBBCh, etc.), complete residency training in [pediatrics](/source/Pediatrics), followed by at least three additional years of subspeciality fellowship training in pulmonology. Pediatric pulmonologists treat diseases of the airways, lungs, respiratory mechanics and aerodigestive system.

## Scientific research

Pulmonologists are involved in both clinical and basic research of the [respiratory system](/source/Respiratory_system), ranging from the anatomy of the [respiratory epithelium](/source/Respiratory_epithelium) to the most effective treatment of [pulmonary hypertension](/source/Pulmonary_hypertension). Scientific research also takes place to look for causes and possible treatment in diseases such as [pulmonary tuberculosis](/source/Pulmonary_tuberculosis) and [lung cancer](/source/Lung_cancer).

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- [Medicine portal](https://en.wikipedia.org/wiki/Portal:Medicine)

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v t e Signs and symptoms relating to the respiratory system Auscultation Stethoscope Respiratory sounds Stridor Wheeze Crackles Rhonchi Stertor Squawk Pleural friction rub Fremitus Bronchophony Death rattle Elicited findings Percussion Pectoriloquy Whispered pectoriloquy Egophony Breathing Rate Apnea Prematurity Sleep Dyspnea Hyperventilation Hypoventilation Hyperpnea Tachypnea Hypopnea Bradypnea Pattern Agonal respiration Biot's respiration Cheyne–Stokes respiration Kussmaul breathing Ataxic respiration Other Respiratory distress Respiratory arrest Orthopnea/Platypnea Trepopnea Aerophagia Asphyxia Breath holding Mouth breathing Snoring Vocal fold Aphonia Muteness Selective Phoneme Dysphonia Hypophonia Other Chest pain In children Precordial catch syndrome Pleurisy Nail clubbing Cyanosis Cough Sputum Hemoptysis Epistaxis Silhouette sign Post-nasal drip Hiccup COPD Hoover's sign asthma Curschmann's spirals Charcot–Leyden crystals chronic bronchitis Reid index sarcoidosis Kveim test pulmonary embolism Hampton hump Westermark sign pulmonary edema Kerley lines Hamman's sign Golden S sign

v t e Tests and procedures involving the respiratory system Surgery Upper RT nose Rhinoplasty Septoplasty Somnoplasty Alarplasty Rhinectomy Rhinomanometry Acoustic rhinometry sinus Sinusotomy larynx Laryngoscopy Laryngectomy Laryngotomy Thyrotomy Laryngotracheal reconstruction Lower RT trachea Cricothyrotomy Tracheoesophageal puncture Tracheotomy bronchus Bronchoscopy lung Pneumonectomy Lobectomy Wedge resection Transplantation Decortication Heart–lung transplant Chest wall, pleura, mediastinum, and diaphragm pleura/pleural cavity Thoracentesis Pleurodesis Thoracoscopy Thoracotomy Chest tube mediastinum Mediastinoscopy Nuss procedure Tests Medical imaging Bronchography CT pulmonary angiogram High-resolution computed tomography Spiral CT Ventilation/perfusion scan Clinical prediction rule Pneumonia severity index CURB-65 Lung function test Body plethysmography Spirometry Bronchial challenge test Capnography Diffusion capacity Impulse oscillometry Cytology Bronchoalveolar lavage Nasopharyngeal swab Sputum culture Other Blood gas test Pneumography Other procedures Oxygen therapy Intubation Surgical airway management Mechanical ventilation Negative pressure ventilator Positive pressure ventilation Respiratory therapy Artificial respiration CPR Hyperbaric medicine Decompression chamber Heliox Nebulizer Postural drainage Hyperinflation therapy Pulmonary hygiene Pulmonary rehabilitation

v t e Diseases of the respiratory system Upper RT (including URTIs, common cold) Head sinuses Sinusitis nose Rhinitis Vasomotor rhinitis Atrophic rhinitis Hay fever Nasal polyp Rhinorrhea nasal septum Nasal septum deviation Nasal septum perforation Cocaine-induced midline destructive lesions (CIMDL) Nasal septal hematoma tonsil Tonsillitis Adenoid hypertrophy Peritonsillar abscess Neck pharynx Pharyngitis Strep throat Laryngopharyngeal reflux (LPR) Retropharyngeal abscess larynx Croup Laryngomalacia Laryngeal cyst Laryngitis Laryngopharyngeal reflux (LPR) Laryngospasm vocal cords Laryngopharyngeal reflux (LPR) Vocal fold nodule Vocal fold paresis Vocal cord dysfunction epiglottis Epiglottitis trachea Tracheitis Laryngotracheal stenosis Lower RT/ lung disease (including LRTIs) Bronchial/ obstructive acute Acute bronchitis chronic COPD Chronic bronchitis Acute exacerbation of COPD) Asthma (Status asthmaticus AERD Exercise-induced Bronchiectasis Cystic fibrosis unspecified Bronchitis Bronchiolitis Bronchiolitis obliterans Diffuse panbronchiolitis Interstitial/ restrictive (fibrosis) External agents/ occupational lung disease Pneumoconiosis Aluminosis Asbestosis Baritosis Bauxite fibrosis Berylliosis Caplan's syndrome Chalicosis Coalworker's pneumoconiosis Siderosis Silicosis Talcosis Byssinosis Hypersensitivity pneumonitis Bagassosis Bird fancier's lung Farmer's lung Lycoperdonosis Other ARDS Combined pulmonary fibrosis and emphysema Pulmonary edema Löffler's syndrome/Eosinophilic pneumonia Respiratory hypersensitivity Allergic bronchopulmonary aspergillosis Hamman–Rich syndrome Idiopathic pulmonary fibrosis Sarcoidosis Vaping-associated pulmonary injury Obstructive / Restrictive Pneumonia/ pneumonitis By pathogen Viral Bacterial Pneumococcal Klebsiella Atypical bacterial Mycoplasma Legionnaires' disease Chlamydiae Fungal Pneumocystis Parasitic noninfectious Chemical/Mendelson's syndrome Aspiration/Lipid By vector/route Community-acquired Healthcare-associated Hospital-acquired By distribution Broncho- Lobar IIP UIP DIP BOOP-COP NSIP RB Other Atelectasis circulatory Pulmonary hypertension Pulmonary embolism Lung abscess Pleural cavity/ mediastinum Pleural disease Pleuritis/pleurisy Pneumothorax/Hemopneumothorax Pleural effusion Hemothorax Hydrothorax Chylothorax Empyema/pyothorax Malignant Fibrothorax Mediastinal disease Mediastinitis Mediastinal emphysema Other/general Respiratory failure Influenza Common cold SARS MERS COVID-19 Idiopathic pulmonary haemosiderosis Pulmonary alveolar proteinosis Tuberculosis

v t e Medicine Specialties and subspecialties Surgery Cardiac surgery Cardiothoracic surgery Endocrine surgery Eye surgery General surgery Colorectal surgery Digestive system surgery Hand surgery Neurosurgery Ophthalmology Oral and maxillofacial surgery Orthopedic surgery Otolaryngology ENT Pediatric surgery Plastic surgery Reproductive surgery Surgical oncology Transplant surgery Trauma surgery Urology Andrology Vascular surgery Internal medicine Allergy / Immunology Angiology Cardiology Interventional Endocrinology Gastroenterology Hepatology Geriatrics Hematology Hospital medicine Infectious diseases Nephrology Oncology Molecular oncology Pulmonology Rheumatology Obstetrics and gynaecology Gynaecology Gynecologic oncology Maternal–fetal medicine Obstetrics Reproductive endocrinology and infertility Urogynecology Diagnostic Pathology Anatomical Clinical pathology Clinical chemistry Cytopathology Medical microbiology Transfusion medicine Radiology Interventional radiology Neuroradiology Nuclear medicine Common Anesthesiology Obstetric anesthesiology Neurosurgical anesthesiology Dermatology Emergency medicine Mass gathering medicine Family medicine / General practice Hospital medicine Intensive care medicine Medical genetics Neurology Clinical neurophysiology Oral medicine Palliative care Pediatrics Neonatology Physical medicine and rehabilitation (PM&R) Preventive medicine Psychiatry Addiction psychiatry Neuropsychiatry Radiation oncology Transplantation medicine Other Addiction medicine Adolescent medicine Aviation medicine Disaster medicine Diving medicine Evolutionary medicine Expedition medicine Narcology Occupational medicine Pain management Phlebology Prison healthcare Reproductive medicine Sexual medicine Venereology Sleep medicine Sports medicine Tropical medicine Travel medicine Medical education Bachelor of Medicine, Bachelor of Surgery Bachelor of Medical Sciences Doctor of Medicine Doctor of Osteopathic Medicine Master of Medicine Master of Surgery Medical school Medical student MD–PhD Medical Scientist Training Program Related topics Allied health History of medicine Medical terminology Nanomedicine Personalized medicine Public health Rural health Therapy Veterinary medicine Physician Category Commons Wikiproject Portal Outline

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Adapted from the Wikipedia article [Pulmonology](https://en.wikipedia.org/wiki/Pulmonology) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Pulmonology?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.