Our lungs work hard every day to make sure we’re able to do all the things we need to do, extracting oxygen from the air we breathe and sending it onward to cells in every corner of the body. The lungs also remove the waste carbon dioxide that the body produces, a process repeated thousands of times each day through the simple act of breathing. The National Institutes of Health reports that “during a normal day, you breathe nearly 25,000 times,” but for people with lung diseases, what should be an unconscious process can be much more difficult.
The lungs are brilliantly adapted to their purpose, but problems can arise caused by genetic conditions, infections or exposure to tobacco smoke or occupational hazards. The lungs are unique in that they routinely make contact with air and particulate matter from outside the body; your other internal organs don’t have that same level of exposure to potential toxins and pathogens from the environment, and therefore the lungs are susceptible to a range of disease and problems.
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These diseases and conditions can run the gamut from genetic conditions, like cystic fibrosis, and acute ailments, such as pneumonia or bronchitis, to chronic conditions such as asthma or chronic obstructive pulmonary disease. The term lung disease can also refer to influenza, tuberculosis and lung cancer. The NIH reports that “if all types of lung disease are lumped together, it is the number three killer in the United States.”
Your primary care doctor may be able to help you with most lung conditions, but in certain cases you may need a lung specialist, called a pulmonologist, “a physician who specializes in the diagnosis and management of lung diseases and disorders,” says Dr. Luke J. Benvenuto, a pulmonologist at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City. These lung specialists complete extensive training in internal medicine and pulmonary medicine and have specialized expertise in managing and treating a broad spectrum of lung conditions.
“The most common condition we see would be COPD, due to the significant prevalence of smoking in our population,” says Dr. Robert Kotloff, chairman of the department of pulmonary medicine at the Cleveland Clinic in Ohio. “Asthma is another common disorder that we see, and then we also tend to see patients with symptoms rather than a specific diagnosis. The two most common symptoms that end up being referred to a pulmonologist are unexplained shortness of breath or protracted cough.”
Because many lung conditions have the same symptoms — coughing and shortness of breath — your doctor may need to run some tests to determine the appropriate diagnosis and treatment protocol. These exams could include pulmonary function testing, which may include a spirometry test where you’ll be asked to blow into a device that measures the strength of your exhale or a chest X-ray or CT scan to look for any abnormal structures or masses in the lungs and airways. “We also rely on a careful history and a meticulous physical examination because we can often get important clues from both of those,” Kotloff says.
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Once a diagnosis has been determined, you may be able to get some relief for your lung condition through medications, surgery or rehabilitation. Some lung diseases, such as COPD, can’t be cured, but your doctor can help you manage the disease and slow its progression through the use of inhalers and exercises.
For some severe cases of certain diseases, such as advanced COPD, cystic fibrosis, pulmonary hypertension or interstitial lung disease, you may end up needing a lung transplant. Benvenuto specializes in transplantation for patients who have idiopathic pulmonary fibrosis, a form of interstitial lung disease, and says transplantation is “definitely a last resort. The lung transplant is far from perfect, and there’s a large shortage of donors out there.”
No matter which lung disease you’re dealing with, when it comes time to find a pulmonologist, Benvenuto recommends asking your primary care doctor for a referral. “In general, relying on your primary care doctor to decide for you when you should see a pulmonologist is a good idea. And relying on someone that your primary care doctor recommends is also a good idea, because taking care of patients is a team effort. If that pulmonologist can communicate well with the primary care doctor, that’s a good option,” he says.
That said, Benvenuto notes that in some cases of more complicated disease such as IPF, cystic fibrosis or pulmonary hypertension, “you should be seen at a center of excellence or a specialty center that sees a lot of these patients, because these conditions are somewhat less common.” Moving to a larger or academic-based practice at a major hospital might enable you to access doctors with more specific experience in your disease.
Kotloff agrees that turning to your primary care doctor for help in finding the right specialist for your situation is a smart move. “Your primary care doctor should know the specialists practicing in their community and have contact with them. It’s hard for a patient to come up with a pulmonologist that they want to seek out on their own.”
But even with a strong referral from your primary care doctor, you should also do a little research of your own. Find out what the doctor’s credentials are and any areas of subspecialty that might be helpful for your situation; does the doctor focus on treating asthma or allergies, for example? Or does the doctor more often handle conditions like emphysema or lung cancer instead? Kotloff says you can also look at online patient evaluations of doctors, but cautions that you should take these with a grain of salt. “You have to be a little careful. These reviews can represent a skewed population — the one patient who’s dissatisfied who leaves a comment that sounds disparaging as opposed to the 99 patients who are very satisfied.”
If you need a recommendation for a good pulmonologist for a rare or complicated disease, Benvenuto recommends reaching out to “patient advocacy groups,” such as the Cystic Fibrosis Foundation or the Pulmonary Fibrosis Foundation. “They will tell you which centers are considered centers of excellence, and those groups are a great place to start,” in your search for the right doctor.
[See: 7 Lifestyle Tips to Manage Your Asthma.]
Depending on what condition you’re dealing with, you may end up having a long-term relationship with the pulmonologist, so Kotloff says you need to think about how the doctor listens to you and whether you feel like there’s a good fit in your personalities. “The most important things to look for in any physician, whether it’s a pulmonologist or another doctor, is not just the physician’s skill set — that can be very hard for the patient to assess. Rather look at the interpersonal skills — how does the patient relate to that physician? Does the patient feel comfortable? Do they feel comfortable asking questions? I would advise against maintaining a long-term relationship with a physician who takes it as an affront when they’re challenged or when the patient comes in with information from the internet. That’s all perfectly appropriate.”
He says it’s also very important that physicians take adequate time to explain things to patients, particularly as some of the more complicated lung diseases may alter how the patient lives daily life. “One of the common complaints I hear from patients is, ‘the doctor gave me a diagnosis but really didn’t explain what that means. I don’t exactly know what to expect from the treatment or what my prognosis is and what symptoms I should look for.'” He says this can be resolved when the physician spends enough time listening to the patient and answering all questions. Therefore, it’s a good idea to bring a list of questions you have to any appointment with your pulmonologist and if something is unclear or you don’t understand some aspect of the diagnosis or your treatment plan, ask for clarification. If things still don’t make sense, consider getting a second opinion to make sure the diagnosis is accurate and that you’ve got the right care plan in place.
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How Can I Find the Best Pulmonologist? originally appeared on usnews.com
