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When to See a Pulmonary Specialist

when to see a pulmonary specialistIf you have COPD, you may be wondering when to see a pulmonary specialist. Because a pulmonary specialist, or pulmonologist, specializes in diseases of the lungs and bronchial tubes, adding one to your repertoire of health care providers is something you may want to consider. But should you consult with a pulmonary specialist at the onset of your symptoms? Or should you wait to see a pulmonary specialist after you’re diagnosed?

What is a Pulmonologist?

A pulmonologist is a medical doctor that has specialized knowledge and skill in the diagnosis and treatment of conditions and diseases of the lungs. Pulmonology is considered a subspecialty of internal medicine. In order for a physician to become a pulmonologist, they must have graduated from an approved medical school. They must have completed an internal medicine residency program which takes a minimum of 3 years in which they will have treated patients with a wide range of illnesses and medical conditions. They must then take and pass a certification examination administered by the Board of Internal Medicine. But this is not all. In the final stages of their training, they must complete a 2-year minimum pulmonary fellowship, during which time they will learn the symptoms and treatment of minor and major respiratory conditions from asthma, pneumonia and tuberculosis to COPD, interstitial lung disease and cystic fibrosis. At the end of the fellowship, the pulmonologist must pass a second set of board certification examinations in their specialty.

The Role of the Primary Care Provider in COPD

Although there are many different specialists that can make up a COPD treatment team, as long as your COPD is uncomplicated, most of your treatment can come from your primary care provider. Primary care providers play a critical role in the screening, diagnosis and treatment of COPD. They are usually the ones who end up catching COPD early, even before symptoms begin, by screening smokers using a simple breathing test known as spirometry.

Your primary care provider can also prescribe all of your COPD medications for you, including inhalers, steroids, oxygen and antibiotics. So if your primary care provider can treat your COPD effectively, when should you see a pulmonary specialist?

The Role of the Pulmonologist in COPD

Seeing a pulmonologist may be necessary if you have a more complicated case of COPD. For example, your primary care provider may refer you to a pulmonologist if you’re not responding well to COPD treatment, you’re hospitalized for COPD exacerbation or your disease has reached a more advanced stage of COPD.

A pulmonologist may order a different combination of medications or special treatments for you. To better-assess your condition or implement diagnostic studies, they can also perform a bronchoscopy using a flexible scope to look down your airway and inside your lungs. A pulmonologist may also have a staff that is very much geared for the lung patient that a primary care provider may not have or be able to afford in their office. A pulmonologist may also be used to reinforce what the primary care provider has already initiated, especially the importance of smoking cessation in a patient who continues to smoke.

How Do I Get a Referral to a Pulmonologist?

You don’t have to wait for your primary care provider to refer you to a pulmonary specialist. If you feel you need one, you can self-refer, if you have PPO insurance, or you can request a referral from your primary care provider. If your primary care provider doesn’t want to give you a referral, speak to your health insurance company as it is within your rights to see a specialist if you have reason to believe you need one.

What Does a Pulmonologist Do at Your First Visit?

What should you expect when you make your first appointment with a lung specialist? You will be asked a number of questions about your symptoms and what you have been experiencing that made you decide to come in. Then you will receive a physical exam, where your lung doctor will listen to your lungs and your breathing. Your pulmonologist will want to measure your blood oxygen level and your lung function with a number of tests. First they will use a pulse oximeter, possibly followed by an arterial blood gas study, to test the oxygen in your blood as well as identify potential problems with lung function. Your lung specialist will also ask you to blow into a device called a spirometer to test how well air flows through your respiratory system. Finally, your lung doctor may need to conduct other tests to make a diagnosis, including a bronchoscopy, chest x-ray or CT scan. This allows your pulmonologist to get a thorough picture of your lung health and assess any airway or lung damage they are able to identify. 

What Should I Ask My Pulmonologist?

Try to come to your first appointment with your lung specialist prepared with any questions you have, as well as a list of any symptoms or concerns you would like to share and discuss. Before your appointment, write down all the symptoms you have been experiencing, how they are presenting for you and any changes you have recently experienced in your symptoms. You want to be thorough in asking questions as well. Only you know what you feel like, so be open and honest. Ask about anything that confuses or concerns you. If you want to know if a certain symptom is related to your condition, ask about it. It is also a good idea to ask about the tests you are receiving, how frequently you will need to undergo those tests and what you can expect to learn from them. Ask about any new prescriptions or medical guidance for lifestyle changes, including any restrictions, and how you can best manage your symptoms. You should also inquire about ongoing appointments and treatment. If you feel as though something is not working for you, ask! This is your medical care for your health, so take ownership of the experience to ensure that you help your lung doctor provide you with the best care and treatment possible. 

Your appointments will also move much more efficiently if you come prepared with a summary of your medical history, current medications and any past test results. If you have seen another lung doctor or required emergency medical care for a related issue, bring the documentation. Your pulmonologist relies on information from you first to begin reaching a conclusion, so be as thorough as you can be.

Frequently Asked Questions: Seeing a Pulmonary Specialist

What is a lung doctor called? Is that different from a chest specialist or respiratory system doctor?

All of these names describe a pulmonary specialist. While certain pulmonary doctors may focus on particular areas of expertise, thereby making you think of them as a lung doctor or chest doctor, they still fall under the same umbrella of pulmonary specialist. 

Why would you need to see a pulmonary specialist?

A pulmonary doctor is trained to address any number of respiratory diseases, disorders and conditions. If you have COPD, lung cancer, pulmonary hypertension, rheumatoid lung disease or even a complicated case of pneumonia, you may be referred to a lung specialist. Once the lung doctor is called, make sure you have as much information as possible from your primary care physician, as well as a list of questions you may have, so you can go into your appointment with your pulmonary doctor prepared.

What does a pulmonary specialist treat?

A pulmonary doctor is able to diagnose and treat lung conditions and diseases. Your lung doctor can treat conditions that affect your entire respiratory system, including your chest wall, lungs, thoracic cavity and upper airways. As such, a pulmonary specialist commonly diagnoses and treats patients with asthma, chronic bronchitis, COPD, cystic fibrosis, emphysema, interstitial lung disease, pulmonary fibrosis, tuberculosis and more. A pulmonary doctor can also help treat sleep-disordered breathing, like sleep apnea, and work in tandem with a sleep lab. While patients with uncomplicated versions of these diseases can often receive treatment from their primary care physicians, a pulmonary specialist can help with difficult cases or respiratory conditions and diseases with complications. Additionally, a pulmonary specialist has expertise in treating respiratory failure and providing complex interventions like mechanical ventilation. As such, you will always find a pulmonary dr. in an intensive care unit. 

When should I see a pulmonary specialist?

Generally speaking, if you are having trouble managing a respiratory condition, disease or disorder or its symptoms, even with the treatment of a primary care doctor, it is time to see a pulmonary specialist. This could include asthma that is difficult to control, a complex case of COPD, cystic fibrosis, pulmonary embolism and more. 

Should I wait until I am older to see a pulmonary doctor?

If you are experiencing respiratory difficulties and are having trouble managing them, even if you are already under the care of a primary care physician, you should consider seeing a pulmonary specialist. Age is not a factor when it comes to seeing a lung doctor. Instead, a lung specialist will consider your particular condition, your overall health and any complications or unusual aspects of your condition. From there, a pulmonary specialist is able to begin to diagnose and treat your particular illness. 

Can a pulmonologist treat allergies?

Since pulmonologists treat lung conditions and diseases, it might be appropriate to see a pulmonologist if you experience asthma or breathing difficulties that are difficult to control as a result of your allergies. However, you will need to see an allergist, rather than a lung doctor, to treat your allergies themselves. Start by seeing your primary care provider or an allergist first if you are experiencing breathing difficulty with your allergies, but they may recommend that you see a lung specialist if they are unable to properly resolve your allergy-based lung condition. 

Should I see a pulmonologist for sleep apnea?

Not exactly. Most likely, you will start by seeing your primary care physician or a sleep specialist for a sleep apnea diagnosis. After that, you should see a specialist with training in the treatment of sleep disordered breathing. Many sleep specialists tend to be lung specialists with a pulmonology background, as understanding lung function is especially helpful for specialists studying sleep breathing disorders. So, while you may ultimately see a pulmonologist for your sleep apnea, the most important thing is that the doctor you see has the appropriate training in sleep-related breathing disorders. 

When should I see a pulmonologist for bronchitis?

While a pulmonologist may not typically treat a standard case of acute bronchitis without recurrences, it is highly likely that you would see a lung doctor for repeated cases of acute bronchitis or chronic bronchitis. Your primary care physician should be able to diagnose and treat a single case of bronchitis, but if it becomes severe, or you have repeated cases of bronchitis, you may be referred to a lung specialist for further testing of your respiratory health and function. If you have had severe bronchitis, talk to your primary care doctor about when you should be concerned about other associated health conditions, and when you should see a lung specialist for more information about your lung function.

By Deborah Leader RN, BSN, PHN

SOURCES

  • https://www.acponline.org/about-acp/about-internal-medicine/subspecialties/pulmonary-disease
  • https://www.verywellhealth.com/would-my-care-benefit-from-a-pulmonologist-200635
  • https://www.healthgrades.com/explore/7-reasons-to-see-a-pulmonologist
  • https://www.medicinenet.com/pulmonologist_doctor/article.htm
  • https://www.healthgrades.com/right-care/lungs-breathing-and-respiration/9-things-your-pulmonologist-wants-you-to-know
  • https://floridachest.com/pulmonary-blog/9-questions-to-ask-your-pulmonologist-before-your-first-appointment
  • https://copd.net/living/questions-for-pulmonologist/
  • https://www.lung.org/blog/know-your-providers-pulmonologist
  • https://www.sleepapnea.org/treat/getting-sleep-apnea-diagnosis/
  • https://aacos.com/blog/whats-the-difference-between-an-allergist-and-a-pulmonologist/
 
 

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