Pulmonology

Symptoms affecting the lower respiratory tract, such as chronic cough, shortness of breath, or wheezing, are key indicators of impaired lung health. Early detection of these symptoms is crucial for preventing diseases from becoming chronic and preserving quality of life.

What are respiratory diseases?

Pulmonology is the medical field concerned with the diagnosis, treatment, and follow-up of disorders affecting the lungs, lower respiratory tract, and the tissues surrounding these organs in the rib cage. Essentially, it is the branch of medicine that investigates the source of symptoms such as shortness of breath, cough, and chest pain, and aims to preserve respiratory function.

Since the lungs are responsible for the vital oxygen and carbon dioxide cycle in the body, the pulmonology department handles the treatment and monitoring of both acute infections and chronic respiratory failure.

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What diseases does a Pulmonologist treat?

The Pulmonology department diagnoses, treats, and monitors diseases affecting the region extending from the trachea (windpipe) to the alveoli, the furthest units of the lungs. Pulmonologists study various diseases that obstruct the airways, damage lung tissue, or affect the respiratory muscles. The most common chest diseases are as follows:

• Asthma and allergic lung diseases: It includes chronic cough and wheezing problems that develop due to sensitivity of the airways.
• COPD (Chronic Obstructive Pulmonary Disease): It is a progressive lung disease, usually caused by tobacco use, characterized by shortness of breath and phlegm.
• Lung cancer: These are malignant tumors that form when cells in the lung tissue multiply uncontrollably.
• Pneumonia: It is a serious health problem caused by an infection of the lung tissue, characterized by symptoms such as fever, cough, and fatigue.
• Pulmonary Embolism: It is a problem that develops as a result of blood clots blocking the blood vessels in the lungs and requires emergency intervention.
• Tüberküloz (verem): It is a contagious lung disease with systemic effects caused by the bacterium Mycobacterium tuberculosis.
• Sleep apnea These are disorders characterized by cessation or reduction of breathing during sleep, and are diagnosed in a sleep laboratory.
• Sarcoidosis and interstitial lung diseases: These are inflammatory problems that can lead to hardening of the lung tissue (pulmonary fibrosis).
• Pleural Effusion: It is the abnormal accumulation of fluid between the membranes of the lungs.

What are the diagnostic methods for respiratory diseases?

Pulmonary disease diagnostic methods encompass all radiological, functional, and interventional techniques used to diagnose problems originating from the lungs, pleura (lung membrane), mediastinum, and chest wall. The diagnostic methods frequently used in the pulmonary department include the following:

• Chest X-ray (X-ray): A two-directional chest image allows for the examination of the overall condition of the lungs, the cardiac shadow, and the structure of the diaphragm.
• Computed Tomography (CT): A two-directional chest image allows for the examination of the overall condition of the lungs, the cardiac shadow, and the structure of the diaphragm.
• Lung Ultrasonography: This is a non-radiation imaging method used to determine the location and amount of fluid, especially in cases of pleural effusion (fluid accumulation).
• Magnetic Resonance Imaging (MRI): It is preferred for examining chest wall involvement and vascular relationships due to its high soft tissue resolution.
• Spirometry: This is the standard test for diagnosing COPD and asthma, performed by having the patient take a deep breath and then quickly exhale.
• Diffusion Capacity (DLCO): It measures how healthy the passage of oxygen from the lungs to the blood is; it is critical in emphysema and interstitial lung diseases.
• Lung Volumes (Plethysmography): This is an advanced test that accurately calculates the amount of air remaining in the lungs and their total capacity.
• Thoracentesis This procedure involves draining fluid that has accumulated between the lung membranes using a needle and analyzing it in a laboratory.
• Pleural Biopsy: It is a procedure in which a tissue sample is taken from the lung membrane using special needles.
• Transthoracic Needle Aspiration (TTIA): This involves taking a biopsy directly from the mass in the lung by entering through the chest wall.
• Mediastinoscopy: This is a surgical diagnostic procedure performed to access the lymph nodes in the middle part of the chest cavity (mediastinum).
• Skin Prick Test: It measures the body's response to commonly encountered allergens.
• Specific IgE in blood: It examines immune system responses in cases of suspected allergic asthma.
• Polysomnography (Sleep test): To diagnose sleep apnea, the patient's brain waves, breathing, and oxygen levels are recorded throughout the night.
• Bronchoscopy: It is the process of visualizing the inside of the bronchial tree using a thin, flexible tube with a camera and light at its end.

The procedures performed during a bronchoscopic examination are listed below:

• Bronchoalveolar lavage (BAL): Fluid is injected into the affected area and then drained allowing the cells to be examined under a microscope.
• Transbronchial Biopsy: This is a procedure where a tissue sample is taken from the lung by passing through the bronchial wall.
• EBUS (Endobronchial Ultrasound): The ultrasound at the tip of the bronchoscope allows for needle biopsies to be taken from lymph nodes adjacent to the bronchi.

In what situations should one consult the Pulmonology Department?

Since the respiratory system maintains the body's oxygen balance, even the slightest disruption in this system can affect the entire metabolism and may directly indicate a problem originating in the lungs. Symptoms that warrant an examination by a pulmonologist include:

• Persistent cough: Coughing fits that last longer than three weeks and do not respond to treatment can be classified as persistent cough.
• Shortness of breath (Dyspnea): It is difficulty breathing that occurs while moving or at rest.
• Respiration with wheezing. It is the sound, similar to a whistling sound, heard when breathing.
• Chest pain It is a stabbing sensation that intensifies especially when taking deep breaths or coughing.
• Expectoration: These are cases where colored (yellow, green) or bloody sputum is passed.
• Night sweats It is a condition characterized by excessive sweating accompanied by fever, requiring a change of clothing.
• Back pain It includes breathing-related back and shoulder pain seen in conditions affecting the lung lining.

What treatment methods are used in the Department of Pulmonology?

Respiratory disease treatments are procedures applied to eliminate infections, allergic or genetically inherited disorders affecting the respiratory tract. The primary focus of the pulmonology department is to regulate oxygen intake and output (respiration) and to reduce damage to lung tissue. The main treatment methods for respiratory diseases, applied according to the nature of the illness, are as follows:

• Pharmacological treatments: Antibiotics, bronchodilators (airway widening medications), and steroid inhalers can be used.
• Invasive and interventional procedures: These are stent placement or biopsy procedures performed via bronchoscopy.
• Respiratory support systems: Sleep apnea and respiratory failure problems are managed using devices such as CPAP and BPAP. A CPAP device is a mask system that delivers continuous positive air pressure. BPAP therapy is a system that provides two levels of air pressure support.
• Pulmonary rehabilitation: It includes specialized exercise and training programs aimed at increasing lung capacity.
• Bronchial thermoplasty: In patients with severe asthma, heat is applied to the smooth muscles of the airways to reduce narrowing.
• Endobronchial valve implantation: In patients with emphysema, it is preferred to reduce lung volume, allowing healthy tissue to function more freely.
• Cryo-biopsy: This method involves obtaining larger and higher-quality samples of lung tissue through cryotherapy (freezing).
• Vaccination practices: Seasonal flu and pneumococcal (pneumonia) vaccines aim to reduce the risk of infection.
• Smoking cessation assistance: Professional support may be needed to reduce the risk of COPD and cancer.

How is a Chest Diseases Examination Performed?

A pulmonary examination is a process that begins with listening to the patient's complaints and continues with a physical examination. A standard chest examination includes the following steps:

• History (complaint): The patient's complaints, smoking history, family history, and working conditions are thoroughly investigated.
• Inspection (observation): The structure of the rib cage, respiratory rate, and whether accessory muscles are used during breathing are observed.
• Palpation (manual examination): Chest wall vibrations and tenderness are checked.
• Percussion (striking): The density of air or fluid in the lungs is assessed by the quality of the sound produced when tapping the chest wall with a finger.
• Auscultation (listening): Using a stethoscope, all lobes of the lungs are listened to, looking for sounds such as wheezing (rhonchi) or crackling (rales).