Evolution in Respiratory Medicine

Pulmonology
• Pulmonology is the medical specialty dealing
with disease involving the respiratory tract.
The term is derived from the Latin word pulmō,
spumonis ("lung") and the Greek -λογία, -logia.
• Pulmonology is also occasionally referred to as
pneumology, from the Greek πνεύμων ("lung")
and -λογία, -logia,
• Sometimes also called Respirology.
 Pulmonology
• Pulmonology is called chest medicine and
respiratory medicine in some countries and
areas.
• Pulmonology is considered to be a branch of
internal medicine, and is related to intensive
care medicine.
• Doctors who practice pulmonology are called –
pulmonologist , chest physician ,respiratory
physician , respirologist
 Respiratory physicians
• Doctors who practice pulmonology are called –
pulmonologist or chest physician or chest
specialist.
• In the United Kingdom, Ireland, South Africa, and
Australia the term “Respiratory physician" is used
(rather than pulmonologist) to distinguish a
physician that practices pulmonology.
• In Canada, Respirology and Respirologist are used.
 Pulmonologist -Role
Mainly deals with chest diseases
•Common- TB ,Asthma, COPD, Pneumonia, lung cancer

• Uncommon – Sarcoidosis ,cystic

fibrosis , hypersensitivity
pneumonitis , pulmonary
hypertension ,aviation
medicine ,diving medicine
,interstitial lung diseases (IPF),
occupational diseses , eosinophlic
lung diseases , CTD associated
lung disorders , alveolar
microlithiasis
 Cardiothoracic surgery
•Surgery of the respiratory tract is performed by
specialists in cardiothoracic surgery (or thoracic surgery)

•Minor procedures may be performed by

pulmonologists.
 Respiratory physicians
Pulmonology is closely related to critical care medicine when
dealing with patients that require mechanical ventilation.

Many pulmonologists are taking up certification to practice

critical care medicine in addition to pulmonary medicine
 Indian scenario
Pulmonologist considered as TB specialist

?
 Indian scenario
• Pulmonologist considered as TB specialist
• Less in numbers
• Usually taken up by low rankers in PG
• Training in TB sanatorium Ignored
• Away from city specialty
• Dealing only with TB patients
• Working and formulating TB programs
• Medical student don’t want to involve – lack of
money and glamour – stigma of TB
 Evolution already in speed
• Now sanatorium approach not needed- home
treatment of TB
• Sanatorium turned into institute
• Awareness regarding TB and other respiratory
diseases
• Knowledge gap filled
• Ignorant physician
• Air pollution and occupational hazards
• Worldwide appreciation in this branch ?
 Evolution already in speed
• Worldwide appreciation in this branch-
• Dealing in high prevalent diseases COPD ,asthma
• New diseases –lung cancer
• New procedures – E-BUS
• Association with critical care
• New sub specialities
• MDR, XDR TB and associated HIV
• Now comparatively higher rank doctors taking up
---?
Scope is grown enormously
Pulmonology wide scope –subspeciality
• Critical care
• OSA/sleep medicine
• Respiratory allergy
• Lung cancer
• Bronchology – and interventional pulmonology
• Pulmonary rehabilitation
• Smoking cessation
Having these subspecialty now its time to
recognise this specialty as superspeciality
Pulmonology –The superspeciality
• Masters in there field
• Critical care
– Intubation /ventilation-invasive non invasive
– Respiratory physiology -Better understanding
better tx ARDS
– ICU bronchoscopy
– Difficult intubation
– Can take care of other disease better than
anesthetist
 Pulmonology –The superspeciality
Masters in there field
• OSA
– Common disorder
– Cessation of respiration during sleep
– Diagnosis –polysomnography
• Polysomnography-
– Polysomnography (PSG), a type of sleep study, is a multi-parametric
test used in the study of sleep and as a diagnostic tool in sleep
medicine.
– Comprehensive recording of biophysiological changes during sleep.
– The test result is called a polysomnogram, also abbreviated PSG
PSG
 Pulmonology –The superspeciality
Masters in there field

• Respiratory allergy
• Allergy- An allergy is a reaction
of your immune system to
something that does not
bother most other people.
• Treatment- drugs and
Immunotherapy
Pulmonology –The superspeciality
• Lung cancer -
Uncontrolled growth of
abnormal cells that start
off in one or both lungs;
usually in the cells that
line the air passages.
• Tumors that remain in one
place and do not appear
to spread are known as
“benign tumors”.
Treatment – chemotherapy ,surgery ,Radiotherapy
 Bronchology
The study and treatment of
diseases of the tracheobronchial
tree.
Pulmonology –The superspeciality
Masters in there field - Intervention

• Common • High skilled

– Pleural biopsy – Bronchoscopy-FOB/rigid
– Chest tubes – TBLB
– Pleural fluid aspiration – TBNA
– FNAC – EBUS
– Trans thoracic FNAC – Photodynamic therapy –
– Lung biopsy diagnosis
– LASERS
– Stenting
– Glue for closure of BPF
– Pleuroscopy
– Pleurodesis
Pleural fluid aspiration
Chest tubes
Lung biopsy
TBLB
EBUS -TBNA
Lung stenting
 Pulmonology –The superspeciality
Masters in there field -Using highest diagnostic modality
– ABG – Immunological/
– CT scans/PET scan enzyme testing
– Spirometery – DNA/PCR
– Diffusion testing – Allergy testing
– Plathysmography – Sleep study/PSG
– MRI – Flocytometery
– Echocardiography – Cytopathology/histopat
hology/immunohistoch
– Ventilation perfusion
emistry/marker study
scan
– Pulmonary and CT – FeNo
angiography – Exhaled co2
ABG
Spirometery
Diffusion testing
Plathysmography
V/Q Scan
 Pulmonary medicine and drug revolution

• 2 decade back –ATT, bronchodilator, steroid

• The breakthrough - Inhaled therapy

• Interest in research devloped – devlopment of

ICS ,LABA , ultra LABA nebulization, newer
antibiots , inhaled antibiots, inhaled gases
-heliox
Pulmonary medicine and drug revolution

• New disease –new drugs- bosantan for

pulmonary HT. Anti IgE for asthma ,
perfenidone -IPF
• Anticancer drugs
• Newer diagnosis newer treatment – LMWH in
pulmonary thromboembolism
• Vaccine – influenza , pneumococcus
Now you have probably understand what is
pulmonologist and pulmonology

• He is consultant
• Technician
• Interventionist
• Critical care specialist
• Sleep specialist
• Allergy specialist
• Also treats nose
• Partial surgeon
What pulmonologist wants from medical
company representatives
 What pulmonologist wants from medical
company representatives
• Constant support in
• Improvement in knowledge and skills
– JOURNALS /CONFRENCES/WORKSHOP/skill upgradation
programme
• Dissemination of the factual status of pulmonogist among
doctors –Particularly GP and public
• Public awareness about diseases like asthma/health
education / inhalation therapy
• Public education materials
• Good quality product
 What pulmonologist wants from medical
company representatives
• Improvement in knowledge and skills
– JOURNALS Know his
– CONFRENCES interest
– WORKSHOP
– skill upgradation programme
……….And so on
 What pulmonologist wants from medical
company representatives
• Improvement in knowledge and skills
– CONFRENCES
Know his
– WORKSHOP interest
– skill upgradation programme

•ATS, BTS, ERS, Brobchocon ,ICCACON, NAPCON ,RAJCON,

sleepcon etc

•Primer institutes regularly organize workshops – on

ventilation ,allergy ,smoking cessation ,sleep , spirometery
 What pulmonologist wants from Pharma
company representatives
Dissemination of the factual status of pulmonogist
among
– Doctors –Particularly GP and superspecialist
– By –interactive sessions where involvement and interest of
various specialties eg
CHEST INFECTION AFTER RENAL TRANSPLANT NEPHROLOGIST
CONNECTIVE TISSUE DISEASES/PNEUMONITIS /SHADOWS LUNG RHEUMATOLOGIST

CARDIAC FAILURE/COR PULMONALE/PULMONARY HYPERTENSION /COPD/ASTHMA C ARDIOLOGIST

SPINE AND BONE TB ORTHO/NEURO

INFERTILITY/GENITAL TUBERCULOSIS GYNAECOLOGIST
SLEEP /OSA ENT/NEURO
MDR/XDR TB/PNEUMONIA- MICROBIPLOGIST
Lung Cancer ONCHOLOGIST/PATHOLOGIST
COPD/CHRONIC LUNG DISEASES REHAB SPECIALIST
ALLERGIC RHINITIS ENT
ALLERGIC DISORDER BOTNIST
IPF/VAP/ CHRONIC GOUGH/GERD GASTROENTROLOGIST
 TOPIC SPECIALIST
Chest infection after renal Nephrologist
transplant
CONNECTIVE TISSUE Rheumatologist
DISEASES/PNEUMONITIS
/unresolving SHADOWS LUNG
Cardiac failure/cor C ardiologist
pulmonale/pulmonary
hypertension /copd/asthma

Spine and bone tb Ortho/neuro

Infertility/genital tuberculosis Gynaecologist
 TOPIC SPECIALIST
SLEEP /OSA ENT/NEURO
MDR/XDR MICROBIPLOGIST
TB/PNEUMONIA-
Lung Cancer ONCHOLOGIST/PATH
OLOGIST
COPD/CHRONIC LUNG REHAB SPECIALIST
DISEASES
ALLERGIC RHINITIS ENT
ALLERGIC DISORDER BOTNIST
IPF/VAP/ CHRONIC GASTROENTROLOGI
GOUGH/GERD ST
 What pulmonologist wants from
Pharma company representatives
• Public awareness about
diseases like
asthma/health
education
• Diseases day
• Radio and TV
programme
• Public education
materials
• Use of internet like
videos on YOU TUBE
What pulmonologist wants from Pharma
company representatives

Platform to speak among peer group

 What pulmonologist can do for Pharma
company/ representatives

• Prescription Dr shiv Raj

MD Chest and TB
• Training
• Research
• Feedback
 Location
• Government –DTC, District hospital, CHC, Medical
college
• Private – ICU , Bronchopist , sleeep specialist ,allergist
• Pvt setup doing spirometery ,allergy testing, sleep
study set up
• IN RNTCP – consultants
Try to differentiate between physician
practicing chest medicine and Pulmonologist
To
Provide tailored service
 Understand Difference B/W Medical College
Corporate / Semi Urban Or Rural Doctors
Less resource Need
Diagnostic Cheap and easy diagnostic tool- hand
held PFT/pulse oxy
Academic Simple easy to understand and
practically useful journal/ books
/guidelines
Skill Trainings on various field – 6 min walk
development/ test
execution
Reorientation Regular postings at institutional level
– refresher course
Thanks

Questions