Pulmonology is a branch of internal medicine dedicated to the treatment, diagnostics and management of pulmonological (i.e. lung) diseases. Lung diseases can be treated on both inpatient and outpatient basis. The better the level of primary healthcare in a country, the less patients need to be sent to a pulmonologist for treatment and diagnosis. However, diagnosing lung diseases is not easy as all these diseases have rather similar symptoms.
Cough and chronic cough are the most frequent symptoms why people consult a pulmonologist. Cough, including suppurative cough (where purulent sputum is produced), and shortness of breath are non-specific symptoms related to airways diseases. In other words, these symptoms may be present in many different diseases. Cough is indicative of a certain disease only when combined with other symptoms or test results. Pneumonia, lung tuberculosis, lung cancer, lung sarcoidosis, lung fibrosis, pleuritis, Chlamydia pneumoniae infection and ordinary upper airways viral infections may all cause cough. However, in case of breathing difficulties or shortness of breath, very often a heart disease is the culprit.
DIAGNOSTIC METHODS IN PULMONOLOGY
Radiological methods are very often used to study lungs. The most common of these is chest X-ray, which is usually the first diagnostic step when a pulmonological disease is suspected. In more complicated cases when chest X-ray is not enough to diagnose or assess the disease, additional information can be obtained by means of computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET).
Spirography is a method for studying breathing and lung function. In this test, the vital capacity and elasticity of the lungs and the passability of the airways are measured during forced breathing. Spirography is suitable for diagnosing asthma and chronic obstructive pulmonary disease (COPD), and also for assessing the efficacy of treatment. To make spirography more informative, it is advisable to use a smooth muscle relaxant or do a bronchodilator test beforehand.
One important method for diagnosing lung diseases is bronchoscopy (endoscopic examination of the airways). Bronchoscopy enables to observe and assess the condition of the larger airways by means of a fiber-optic probe equipped with a camera. If necessary, biopsies can be taken and foreign bodies removed from the airways during this procedure.
Two invasive (that is, surgical) diagnostic methods are used in pulmonology – mediastinoscopy and thoracoscopy. To study diseases affecting the mediastinum (the central compartment of the thoracic cavity), mediastinoscopy is used, which is essentially an endoscopic examination of the mediastinum. Mediastinoscopy is usually performed by thoracic surgeons who perform other pulmonary operations as well, including the removal of lung tumors and metastases.
Thoracoscopy is an endoscopic examination of the pleural cavity. This method enables to study disease processes and tumors between the lungs and the chest wall or further away from the bronchi. During the procedure, biopsies can be taken, smaller tumors can be removed, and the existence and location of the pathological process can be determined.
Besides other methods, genetic tests to predict the risk of getting a hereditary form of lung cancer are more and more used nowadays. Genetic testing is also mandatory in diagnosing cystic fibrosis.
Spirometry is a widely used pulmonary function test for assessing lung volume and possible obstructions (flow problems) in the airways. During this test, forced inhalation and exhalation are performed, at maximum depth and speed. Spirometry allows to detect decrease in lung function that accompanies various pulmonological (i.e. lung) diseases. The test is useful for diagnosing several common lung diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, and for monitoring their progression and treatment.