Many medical specialties evolve over time. Diseases evolve, medications evolve, technologies change. The field of pulmonology is no different.
A pulmonary specialist, or pulmonologist, is a physician who possesses specialized knowledge and skill in the diagnosis and treatment of lung conditions and diseases. Pulmonology is a subspecialty of internal medicine. Because of the variety of clinical conditions seen by a pulmonologist, expertise in a myriad of specialties is needed.
A pulmonologist treats asthma, bronchitis, chronic coughs, chronic obstructive pulmonary disease (COPD), cystic fibrosis, emphysema, hemoptysis (coughing up blood), lung cancer, obstructive sleep apnea, pleural effusion (excessive build-up of fluid around the lungs), sarcoidosis (organ inflammatory disease affecting primarily the lungs), and tuberculosis, to name a few conditions.
Dr. James Cafaro has been practicing pulmonology in the Cedar Valley for 37 years and is the only pulmonologist in Cedar Valley Medical Specialists' Pulmonology Department. He has seen the prevalence of diseases change over the years, as has the technology in treating these diseases.
“The most common conditions we see (locally) are COPD, asthma and lung cancer,” he says. “Bronchiectasis (chronic damage to the bronchial tubes) is not as common as it used to be because people are treated earlier with antibiotics. We’re not sure why asthma is becoming more common. In kids, it’s usually because of allergies.”
Dr. Cafaro explains the primary cause of COPD is smoking, but it also can be associated with exposures. 15 percent of patients with COPD have no smoking history or exposure.
“Hog farmers can develop chronic bronchitis from hog dust. It’s pretty common in the Midwest,” Dr. Cafaro notes.
Farmers also have concern with chemicals used in the fields, for example. The simple cure was to avoid the exposures that bothered them, but that can be a difficult answer for people earning their livelihoods.
“We see less of these kinds of conditions,” Dr. Cafaro says. “The University (of Iowa) has a program devoted to the risks of agricultural work. Farmers are more educated and know they should wear masks when working in grain bins. The cabs on the tractors and combines are so much cleaner and airtight now. Farmers are not exposed to the pesticides as much now.
“The exposures in factories have lessened a lot as well,” he explains. “Even though many companies have systems to clean the air, certain chemicals still may be present that can cause breathing problems. It’s pretty hard to avoid because some things are just part of the job. But not all people are bothered by the same exposures.”
Pulmonology is a specialty of diagnosis. Dr. Cafaro says the biggest advancement in his effort to diagnose a condition correctly and quickly has been the introduction and improvement of CAT scans.
“CAT scans of the chest show many more things that you couldn’t see with just X-rays in the clinical exam,” he says. “We now can do biopsies with needles that required surgery before the availability of CAT scans. They are much faster and show finer detail. That has been very helpful.”
He also says the bronchoscopy technique (looking into the lungs with a tube) has become more sophisticated. “We now have ultrasound with the procedure and other computerized machinery that allows us to see lesions that we may not have been able to biopsy before.”
Dr. Cafaro says there are several new drugs to aid in the treatment of pulmonary fibrosis where previously there was no treatment at all. “For lung cancer, we have medications and markers that can target, or narrow down, the types of drugs that would be helpful in treating a certain person. Targeting is only going to get better and better.”
Patients needing inhalers for asthma, emphysema and COPD have numerous options to choose from. They work faster because the medicine goes directly into the lungs, unlike pills.
Another treatment option is portable oxygen. There are newer, smaller concentrators on the market that allow patients to get out for longer periods of time. The older tank oxygen units are unwieldy and don’t last as long.
Pulmonology has several crossover diseases. For instance, pulmonologists help to diagnose sleep disorders, including sleep apnea. Neurologists and ear, nose and throat (ENT) specialists become involved once the diagnosis has been confirmed. Dr. Cafaro says more people are becoming aware they have pulmonary conditions.
Studies are always being conducted in efforts to treat or control pulmonary conditions. “They are still doing research, but the important focus should be on preventive care,” says Dr. Cafaro.