If you first think of tires when you hear the word “tire,” you’re not far off: just like a tire, the human lung is filled primarily with air. The pulmonologist is therefore the specialist for lung diseases. From asthma to lung cancer, everything is covered in principle.
What is a pulmonologist?
The pneumologist deals not only with diseases of the lungs themselves, but also with problems that affect the surrounding tissues such as the lung and pleura (pleura) or the mediastinum (middle pleura). As pulmonary medicine, pneumology is a branch of medicine and is sometimes referred to as pulmonology or pulmonology. It is a specialty within the broad field of internal medicine. Here, the pulmonologist deals not only with diseases of the lungs themselves, but also with problems affecting the surrounding tissues such as the pleura (lung), pleura (ribs) or mediastinum (middle pleura).
Treatments
The pulmonologist’s treatment spectrum thus encompasses a wide range of common civilization diseases, and the age structure of the patient population is very mixed for the pulmonologist. He takes over juvenile asthmatics from the pediatrician as soon as they have passed his age limit, treats acute and chronic bronchitis of all ages, and in middle-aged as well as older patients has much to do with chronic obstructive pulmonary disease (COPD) and pulmonary emphysema], the overinflation of the lungs. In the area of occupational diseases, there are various pulmonary fibroses and work-specific diagnoses such as farmer’s lung, grower’s lung, and woodworker’s lung, all of which are caused by short-term or year-long inhalation of organic dusts. Another major area of his specialty is bronchial carcinoma, the classic “lung cancer,” and all other tumor diseases of the lung and pleura, such as asbestos-related pleural mesothelioma. Other lung-associated diseases such as pulmonary embolism, which can develop as an acute vascular occlusion following thrombosis, or pleural effusion as a sign of cardiac insufficiency, also belong strictly speaking to the field of pneumology, but are often treated by other general internists or cardiologists. The same applies to acute infections such as acute bronchitis, tuberculosis or pneumonia – if there is a pneumology ward in larger hospitals, pneumonia will always end up there. Again, among younger patients, there are chronic conditions such as cystic fibrosis, which requires long-term care first by a pediatrician, then by a pulmonologist, and unfortunately often leads to death in young adulthood. Another quite common and serious disease, which is clearly the responsibility of the pulmonologist, is chronic hypertension of the pulmonary circulation, also known as pulmonary hypertension.
Methods of diagnosis and examination
Because many patients also owe their chronic lung disease to smoking, pulmonary specialists must place a great deal of emphasis on education and prophylactic measures such as smoking cessation. Measures frequently used in diagnostics are then first of all the usual general medical means such as taking a medical history, auscultation with the stethoscope or percussion, in which the physician taps the patient’s chest with his finger, looking for sound attenuation or amplification as an indication of compression or collapse of the lungs. Things then get technical with the classic “chest X-ray,” which is an X-ray of the lungs, and the radiological imaging measures that build on it, such as chest CT or lung scintigraphy. Analogous to gastroscopy, the bronchial system can also be viewed optically with a flexible thin tube (bronchoscopy) – the patient can remain awake if necessary – , the same principle also works for the mediastinum and the thorax (mediastinoscopy and thoracoscopy), although these are larger procedures in the operating room and under general anesthesia. Another major area of pneumological diagnostics is functional diagnostics, which requires the active cooperation of the patient: In spirometry and bodyplethysmography, the patient breathes into a tube or mask and a device records the physical movement of air; this allows parameters such as the volume of inhalation and exhalation and the respiratory flow rate of the lungs to be derived.Special diseases such as infections or allergies must be determined accordingly via smear and pathogen diagnostics or allergy tests. Therapeutically, in addition to physical measures such as respiratory training or special training for chronic patients, there is a lot that can be achieved, especially with medication. Frequently prescribed medications in pneumology are bronchodilators or cortisone preparations that suppress the immune system. Both can be used optimally as a spray, but in more severe cases also as a tablet or as an injection into the vein. If the air quality deteriorates permanently, a pulmonologist can also prescribe home oxygen equipment for permanent ventilation after exhausting the other options. If the patient is heading for surgery, for example in the case of bronchial carcinoma, the pulmonologist refers the patient to his or her surgical colleague in thoracic surgery.
What should the patient watch out for?
When choosing a suitable pulmonologist, one should, of course, consider the experience of the physician, i.e., how long he has worked in the hospital, whether he was a senior physician there, what diseases he primarily dealt with there, and whether he perhaps also has or had special scientific interests as a researcher. Of course, all this is difficult to find out overnight. If in doubt, you should ask your family doctor to recommend a suitable specialist. Strategic things such as the distance of the practice from the place of residence also play an important role, of course. In the end, you have to rely on your gut feeling anyway, whether you feel you are in good hands after the first consultation with a doctor, or whether you would rather look for alternatives again. One should be cautious with evaluations on the Internet. As a rough assessment, they can sometimes be very interesting and helpful, but they are not really credible: If you really want to, you can always write your own recommendations or have them written. At the same time, almost every doctor’s Google search will always find a frustrating negative review from a patient who did not receive the miracle cure he was expecting after his first appointment – this only spoils the mood of the seeker and the trusting doctor-patient relationship right from the start. To rely on his own assessment or the well-founded explained experiences of acquaintances or other doctors, is there always better suited.
