Pulmonology

Scope of Practice

While those who practice pulmonology may serve as specialty consultants for physicians in primary care, many pulmonologists also practice primary care medicine. The expertise of pulmonologists includes the disciplines of internal medicine with additional specialized expertise in the diagnosis and management of lung diseases.

Lung diseases diagnosed and treated by pulmonologists include but are not limited to asthma, chronic cough, coughing up blood, tobacco addiction, chronic obstructive pulmonary disease (COPD, a term which includes emphysema and chronic bronchitis), bronchitis, pneumonia, sleep apnea, cystic fibrosis, lung cancer, chest infections (tuberculosis; fungal diseases including histoplasmosis; coccidiodomycosis, also known as valley fever; blastomycosis); pulmonary embolism (blood clots in the lung); pulmonary fibrosis; occupational lung diseases (including asbestosis; silicosis, also known as sand-blasters disease); lung trauma; and sarcoidosis.

Procedures for which pulmonologists receive specialized training and hold specialty expertise include performance of and interpretation of the following:

• Lung function studies (used to diagnose and follow response to therapy of asthma, COPD, occupational lung diseases, pulmonary fibrosis)
• Interpretation of chest imaging studies including chest X-rays, computed tomography (CT) scans, angiograms, and so forth
• Application of mechanical ventilation (artificial means of breathing for a patient who is unable to breath for him- or herself)
• Bronchoscopy—bronchoscopy is a procedure performed by a pulmonologist which may be done as an outpatient. The pulmonologist monitors the administration of intravenous sedation to the patient while ensuring the patient's ability to breathe for him- or herself. Following topical sedation with lidocaine (similar to what a dentist uses), a flexible bronchoscope (a tube the approximate diameter of a pencil eraser with a light and camera on the tip) is then passed through the nose or mouth to the voice box, down between the vocal cords into the main breathing tube. Biopsies of irregular areas and washings of the breathing tubes are obtained with very rare complication. These biopsies (up to 2–3 mm in size) are sent to the laboratory
• Biopsy of the pleura and lung—the pleura is the membrane that covers the lung and is frequently a site of infection or tumor invasion. Pleural biopsies are performed by anesthetizing the chest wall and passing a biopsy needle through the chest wall to the pleural surface. Similarly, lung biopsies are performed by passing a needle through the chest wall and pleura to the lung. CT scans are frequently used to guide the placement of the needle being used for lung biopsy
• Placement of chest tubes (these are placed to treat lung collapse or to drain blood or fluid which has collected around the lung)
• Tracheostomy (placement of a tube in the windpipe)
• Placement of central venous catheters (these are large intravenous lines placed in the large, central veins, such as the subclavian, femoral, or internal jugular vein), particularly in intensive care unit patients, for the purpose of giving blood transfusions, intravenous fluids or medications, and nutritional support
• Placement of arterial lines (these are central monitoring lines placed in the arteries to monitor blood pressure and oxygenation status of critically ill patients)
• Placement of Swan-Ganz catheters (used to monitor heart function of critically ill patients)
• Placement of pacemakers (for disorders of heart

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