Pulmonologists are physicians with deep knowledge of the respiratory system, and they are often the specialists that primary care physicians turn to when their patients are experiencing pleural effusion and other mesothelioma symptoms. Pulmonologists’ expertise in lung function plays an important role in including mesothelioma in the patient’s differential diagnosis, as well as in managing the rare asbestos-related disease. They are critical members of any pleural mesothelioma multidisciplinary team.
What is a Pulmonologist?
A pulmonologist is an internal medicine physician who has specialized in the respiratory system. Their expertise applies beyond the lungs to include the airways, respiratory muscles, chest wall, and thoracic cavity. They have extensive knowledge of all aspects of breathing and have the necessary knowledge to diagnose and participate in the treatment of all conditions that can impact this area of the body, from chronic illnesses to cancer. Some pulmonologists specialize in specific diseases, including asthma, asbestosis, pulmonary fibrosis, and COPD. Others pursue specialized training in interventional procedures.[1]
Pulmonologists treat a wide range of conditions, including:
- Acute respiratory distress syndrome
- Asthma
- Bronchitis
- COPD (Chronic obstructive pulmonary disease)
- COVID-19
- Cystic fibrosis
- Dyspnea (shortness of breath)
- Emphysema
- Interstitial lung disease (scarring of the lungs)
- Lung cancer
- Lung transplants
- Malignant pleural mesothelioma
- Occupational lung diseases
- Pulmonary hypertension
- Sleep apnea
- Tuberculosis
- Upper airway disorders
How Does a Doctor Become a Pulmonologist?
Following their undergraduate education and graduation from an accredited medical school, doctors who are interested in pulmonary medicine complete a three-year internal medicine internship and residency that includes clinical rotations through multiple areas of patient care. They then spend two-to-three years as fellows focused on the diagnosis and treatment of patients with respiratory conditions. Fellowships in pulmonology include in-depth instruction in pulmonary physiology, molecular biology, pulmonary immunology, and other areas. Pulmonologists can further specialize in interventional pulmonology, interstitial pulmonology, lung transplants, sleep disorders, and pulmonary hypertension.[2]
How Do Pulmonologists Diagnose Mesothelioma?
Patients with malignant pleural mesothelioma present with several symptoms that are similar to those of other, more benign illnesses, including:
- Chest pain
- Coughing
- Coughing up blood
- Difficulty swallowing
- Fatigue and muscle weakness
- Night sweats and fever
- Shortness of breath
- Weight loss
- Wheezing
Because pleural mesothelioma’s symptoms are so similar to those of other illnesses that impact the respiratory system, the pulmonologist’s expertise is critical to diagnosis: Their knowledge helps to distinguish the condition from other conditions and helps to move the patient into the oncology care that will make the biggest difference in their outcome and long-term survival. Their initial diagnosis is likely to include the use of:[3]
- Bloodwork
- Bronchoscopy – looking at the lungs through a specialized scope
- Chest X-rays
- CT scan
- Pleuroscopy – a procedure to examine the space between the lungs and chest wall and obtain a tissue sample through a small incision
- Pulmonary Function Testing (PFT) – a series of tests to see how well the lungs are functioning
- Spirometry – a test that measures how much air you can breathe in and out of your lungs, as well as how easily and fast you can then blow the air out of your lungs
Pulmonologists Are Key Members of the Mesothelioma Multidisciplinary Team
Once mesothelioma is suspected and confirmed, the patient generally receives treatment from a specialized team that will include either a pulmonologist or an interventional pulmonologist. Though much of the care they receive will be from medical oncologists, thoracic surgical oncologists, and radiation oncologists focused on eradicating cancerous cells, the pulmonologist will also be integral to care, providing treatments including:[4]
- Pluerodesis – a procedure to treat and reduce the recurrence of pleural effusion, a common complication of pleural mesothelioma. It involves adhering the two layers of pleural tissue together so that fluid cannot accumulate.
- Thoracentesis – a treatment to relieve an excess build-up of fluid in the chest cavity
- Trans-tracheal oxygen therapy – therapy that delivers oxygen directly into the lungs through a small, flexible catheter that passes from the neck into the trachea or windpipe.
Pulmonologists’ knowledge of the respiratory system is critical to comprehensive perioperative management of mesothelioma, including palliative care.
