Pulmonology — Find Specialists & Top Hospitals Worldwide | MyMedicPlus

Pulmonology — also called respiratory medicine or chest medicine — is the medical specialty focused on the diagnosis and treatment of diseases affecting the lungs, airways, pleura (the lining around the lungs), and the respiratory system as a whole. The respiratory system performs the essential function of gas exchange, delivering oxygen to the bloodstream and removing carbon dioxide, and disorders that impair this function can have life-threatening consequences.

Pulmonologists are internal medicine specialists with advanced training in lung physiology, airway mechanics, and respiratory pathology. They manage both acute and chronic respiratory diseases, from life-threatening acute respiratory distress syndrome (ARDS) in the intensive care unit to long-term conditions such as COPD, asthma, and interstitial lung disease in outpatient clinics. Many pulmonologists are dual-trained in critical care medicine, allowing them to manage the sickest patients in hospital intensive care units.

Several subspecialties exist within pulmonology. Interventional pulmonology uses advanced bronchoscopic techniques for diagnosis and treatment of airway and lung conditions. Sleep medicine addresses sleep-disordered breathing including obstructive sleep apnoea and central sleep apnoea, as well as narcolepsy and other sleep disorders with respiratory consequences. Pulmonary hypertension specialists manage the complex haemodynamic abnormalities of this progressive vascular lung disease. Interstitial lung disease (ILD) specialists focus on fibrotic lung conditions such as idiopathic pulmonary fibrosis (IPF) and hypersensitivity pneumonitis. Transplant pulmonologists manage patients before and after lung transplantation for end-stage lung disease.

Pulmonologists diagnose and manage a broad spectrum of respiratory conditions:

• Asthma: Chronic inflammatory airway disease causing reversible airflow obstruction, wheezing, cough, and breathlessness, managed with inhaled corticosteroids, bronchodilators, and biologic therapies for severe eosinophilic asthma.
• Chronic obstructive pulmonary disease (COPD): Progressive, largely irreversible airflow obstruction from cigarette smoking or occupational exposures, causing dyspnoea, chronic cough, and recurrent exacerbations.
• Idiopathic pulmonary fibrosis (IPF): Progressive scarring (fibrosis) of the lung tissue causing declining lung function and exercise capacity, managed with antifibrotic agents (pirfenidone, nintedanib) and ultimately lung transplant evaluation.
• Sarcoidosis: Multi-system granulomatous disease predominantly affecting the lungs, lymph nodes, and skin, managed with corticosteroids and immunosuppressants for symptomatic or progressive disease.
• Pulmonary hypertension: Elevated pressure in the pulmonary circulation causing right heart strain, treated with disease-specific vasodilator therapies including prostacyclins, endothelin receptor antagonists, and PDE-5 inhibitors.
• Obstructive sleep apnoea (OSA): Repetitive partial or complete collapse of the upper airway during sleep causing fragmented sleep, daytime sleepiness, and cardiovascular risk, treated with CPAP therapy.
• Pleural disease: Including pleural effusion (fluid around the lung), pneumothorax (collapsed lung), pleural infection (empyema), and malignant mesothelioma.
• Tuberculosis (TB) and non-tuberculous mycobacterial (NTM) infections: Mycobacterial lung infections requiring prolonged multi-drug antibiotic regimens and careful monitoring.
• Lung cancer staging and evaluation: Pulmonologists perform bronchoscopic biopsies and EBUS-guided sampling for tissue diagnosis and staging of suspected lung cancer.
• Respiratory failure and ARDS: Critical illness requiring mechanical ventilation, lung-protective strategies, and prone positioning in the ICU.

Pulmonologists perform and supervise a wide range of diagnostic and therapeutic respiratory procedures:

• Spirometry and pulmonary function tests (PFTs): Comprehensive assessment of lung volumes, airflow rates, and diffusion capacity to diagnose and classify obstructive, restrictive, and mixed ventilatory defects.
• Flexible bronchoscopy: Direct visual inspection of the airways using a thin camera, enabling bronchoalveolar lavage (BAL), endobronchial biopsy, and removal of foreign bodies or mucus plugs.
• Endobronchial ultrasound (EBUS): Real-time ultrasound guidance during bronchoscopy to sample mediastinal and hilar lymph nodes for lung cancer staging and sarcoidosis diagnosis without open surgery.
• CT-guided percutaneous lung biopsy: Image-guided needle sampling of peripheral lung masses or nodules for histological diagnosis.
• Thoracentesis: Needle aspiration of pleural fluid under ultrasound guidance for diagnosis (cell count, culture, protein, LDH, cytology) or therapeutic drainage in large effusions.
• Pleurodesis and intercostal drain insertion: Placing a chest drain to evacuate pneumothorax, haemothorax, or large pleural effusion; talc pleurodesis seals the pleural space in recurrent malignant effusions.
• Polysomnography (sleep study): Overnight monitoring of brain activity, breathing, oxygen levels, and limb movements to diagnose sleep-disordered breathing.
• CPAP and BPAP titration: Determining optimal positive airway pressure settings to eliminate obstructive events in sleep apnoea.
• Cardiopulmonary exercise testing (CPET): Measuring peak oxygen consumption and ventilatory responses during graded exercise to quantify disability and pre-operatively assess surgical risk.
• Bronchial thermoplasty: Thermal ablation of airway smooth muscle in severe persistent asthma to reduce bronchoconstriction, using heated radiofrequency energy delivered bronchoscopically.

A pulmonology referral is warranted in the following clinical situations:

• Persistent shortness of breath: Dyspnoea disproportionate to apparent cause, or not improving with standard treatment, requires respiratory evaluation with spirometry and imaging.
• Chronic cough lasting more than eight weeks: After common causes (post-nasal drip, GERD, ACE inhibitor use) have been addressed, a pulmonologist should evaluate for cough-variant asthma, eosinophilic bronchitis, and rare lung conditions.
• Asthma not controlled with standard therapy: Patients requiring frequent oral corticosteroids, multiple hospital admissions, or with atypical features need specialist reassessment for accurate diagnosis and biologic therapy evaluation.
• Haemoptysis (coughing up blood): Any episode of coughing blood requires urgent evaluation with chest X-ray, CT thorax, and bronchoscopy to exclude malignancy, TB, and bronchiectasis.
• Abnormal chest imaging: New lung nodules, ground-glass opacity, honeycombing, mediastinal adenopathy, or other unexplained radiological findings require pulmonological investigation.
• Suspected interstitial lung disease: Progressive exertional dyspnoea with bibasilar crackles and reduced diffusion capacity on PFTs points toward ILD requiring high-resolution CT and specialist evaluation.
• Suspected or confirmed lung cancer: Patients with a lung mass or positive biopsy should be assessed by an interventional pulmonologist for staging EBUS and by a thoracic multidisciplinary tumour board.
• Oxygen therapy evaluation: Patients with resting hypoxia (SpO2 below 88%) or exercise-induced oxygen desaturation may qualify for long-term oxygen therapy after formal assessment.

Pulmonologists complete a lengthy specialised training pathway. In the United States, training begins with a four-year medical degree (MD or DO), followed by a three-year internal medicine residency. This is followed by a two- to three-year fellowship in pulmonary disease and/or critical care medicine. Many pulmonologists train in a combined pulmonary and critical care medicine fellowship, as the two fields share substantial overlap in managing critically ill patients with respiratory failure.

Fellowship training provides intensive exposure to outpatient pulmonology clinics, inpatient pulmonology consultation, medical intensive care units (ICUs), bronchoscopy suites, sleep laboratories, pulmonary function testing laboratories, and pulmonary hypertension programmes. Interventional pulmonology subspecialty training requires an additional one- to two-year advanced bronchoscopy fellowship covering EBUS, navigational bronchoscopy, bronchoscopic lung volume reduction, and pleural procedures.

Board certification is awarded by the American Board of Internal Medicine (ABIM) in Pulmonary Disease and separately in Critical Care Medicine. In the UK, respiratory physicians hold MRCP and complete a Certificate of Completion of Training (CCT) in respiratory medicine. Sleep medicine and interventional pulmonology offer additional certification pathways. Continuing education in emerging therapies — including antifibrotic agents, biologic asthma therapy, and pulmonary arterial hypertension vasodilators — is essential throughout a pulmonologist's career.

Your GP or internist will refer you to a pulmonologist based on respiratory symptoms or abnormal chest imaging or lung function tests. For routine referrals such as COPD management, asthma optimisation, or evaluation of a lung nodule, bring your spirometry results, chest X-ray and CT reports, a list of all current inhalers and medications, and a description of your symptoms including how breathlessness affects your daily activities and exercise capacity.

For suspected interstitial lung disease, pulmonary hypertension, or lung transplant evaluation, referral to a specialist centre with an ILD multidisciplinary team or pulmonary hypertension programme is strongly recommended, as management requires subspecialty expertise and access to advanced diagnostic tools. Ask your pulmonologist whether you qualify for any disease-specific clinical trials, particularly if you have IPF, severe asthma, or pulmonary arterial hypertension, where clinical trial access may provide earlier access to emerging therapies.