The pulmonologist begins the diagnostic process with a general review focusing on:
- hereditary diseases affecting the lungs (cystic fibrosis, alpha 1-antitrypsin deficiency)
- exposure to toxins (tobacco smoke, asbestos, exhaust fumes, coal mining fumes)
- exposure to infectious agents (certain types of birds, malt processing)
- an autoimmune diathesis that might predispose to certain conditions (pulmonary fibrosis, pulmonary hypertension)
Physical diagnostics are as important as in the other fields of medicine.
- Inspection of the hands for signs of cyanosis or clubbing, chest wall, and respiratory rate.
- Palpation of the cervical lymph nodes, trachea and chest wall movement.
- Percussion of the lung fields for dullness or hyper-resonance.
- Auscultation (with a stethoscope) of the lung fields for diminished or unusual breath sounds.
- Rales or rhonchi heard over lung fields with a stethoscope.
As many heart diseases can give pulmonary signs, a thorough cardiac investigation is usually included.
- Laboratory investigation of blood (blood tests). Sometimes arterial blood gas measurements are also required.
- 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 Tests spirometry, as above, plus response to bronchodilators, lung volumes, and diffusion capacity, the latter a measure of lung oxygen absorptive area
- Bronchoscopy with bronchoalveolar lavage (BAL), endobronchial and transbronchial biopsy and epithelial brushing
- Chest X-rays
- CT scanning (MRI scanning is rarely used)
- Scintigraphy and other methods of nuclear medicine
- Positron emission tomography (especially in lung cancer)
- Polysomnography (sleep studies) commonly used for the diagnosis of Sleep apnea
Major surgical procedures on the heart and lungs are performed by a thoracic surgeon. 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 is often necessary in severe respiratory disease (emphysema and pulmonary fibrosis). When this is insufficient, the patient might require mechanical ventilation.
Pulmonary rehabilitation has been defined as 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 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 may include a rehabilitation physician, a pulmonary medicine specialist, and allied health professionals including a rehabilitationnurse, 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.