Pulmonology/respirology departments work especially closely with certain other specialties:cardiothoracic surgery departments andcardiology departments.
One of the first major discoveries relevant to the field of pulmonology was the discovery ofpulmonary circulation. Originally, it was thought thatblood reaching the right side of theheart passed through small 'pores' in theseptum into the left side to be oxygenated, as theorized byGalen; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth-centuryanatomist andphysiologistIbn 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 thepulmonary artery, through the lungs, and back into the heart to bepumped around the body. This is believed by many to be the first scientific description of pulmonary circulation.[4]
Although pulmonary medicine only began to evolve as a medical specialty in the 1950s,William Welch andWilliam Osler founded the 'parent' organization of theAmerican Thoracic Society,[5] the National Association for the Study and Prevention ofTuberculosis.[6] The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right,phthisiology.[7] 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.[8]
Pulmonology and its relevance in other medical fields
Surgery of the respiratory tract is generally performed by specialists incardiothoracic surgery[9] (orthoracic surgery),[10] though minor procedures may be performed by pulmonologists. Pulmonology is closely related to critical care medicine[11] 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[12] that deals with the use of procedures such asbronchoscopy[13] and pleuroscopy to treat several pulmonary diseases.[14] Interventional pulmonology is increasingly recognized as a specific medical specialty.[15]
Spirometry 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 including spirometry, as above, plus response to bronchodilators, lung volumes, and diffusion capacity, the latter being a measure of lung oxygen absorptive area
Major surgical procedures on the heart and lungs are performed by athoracic surgeon.[28] 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.
Pulmonary rehabilitation[30] 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[31] is intended to educate the patient, the family, and improve the overall quality of life andprognosis 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[32] may include a rehabilitation physician, a pulmonary medicine specialist,physician assistant and allied health professionals including a rehabilitationnurse, arespiratory therapist, aspeech-language pathologist, aphysical therapist, anoccupational therapist, apsychologist, and asocial worker among others. Additionally, breathing games are used to motivate children to perform pulmonary rehabilitation.
In theUnited States, pulmonologists are physicians who, after receiving a medical degree (MD orDO), completeresidency training ininternal medicine, followed by at least two additional years of subspecialityfellowship training in pulmonology.[33] 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.
In theUnited States, pediatric pulmonologists[34] arephysicians who, after receiving a medical degree (MD, DO, MBBS, MBBCh, etc.), complete residency training inpediatrics, 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.
