When do I need to see a pulmonologist, and what to expect?

The respiratory system includes the lungs, trachea, bronchi, pharynx and other organs, and they help facilitate breathing. Suppose you have been diagnosed with lung disease or have trouble breathing, like shortness of breath (dyspnoea); your general practitioner may refer you to a pulmonologist. But what is the role of a pulmonologist? A pulmonologist is a specialist who diagnoses and treats respiratory conditions. These specialists are equipped with the experience and expertise required to address any respiratory illness that you may have. If you have not consulted a pulmonologist before, we will walk you through what can be expected at the clinic and how you can prepare for your visit.

What conditions do pulmonologists treat?

Pulmonologists are trained to diagnose and manage various lung diseases. Some conditions treated or managed by pulmonologists include, but aren’t limited to:

  • Aspergillosis: This is a fungal infection caused by common mould (aspergillus) and causes breathing difficulties.
  • Asthma: Bronchial asthma is a long-term condition that causes breathing difficulties due to the narrowing of the airways.
  • Bronchiectasis: This condition occurs when the airways become widened, thickened, and permanently damaged, making the lungs vulnerable to infection.
  • Bronchitis: In bronchitis, the airways (bronchial tubes) leading to the lungs are inflamed and filled with mucus resulting in a nagging cough.
  • Chronic Obstructive Pulmonary Disease (COPD): COPD is a chronic inflammatory lung disease that causes airflow limitation and breathing difficulties.
  • Emphysema: This type of COPD develops over time and damages the lung tissue due to noxious elements like cigarette smoke.
  • Interstitial lung disease: Interstitial lung disease or diffuse parenchymal lung disease (DPLD) comprises a large group of diseases (over 200 conditions) that causes inflammation and scarring in the lungs.
  • Lung cancer: Lung cancer or carcinoma refers to cancer that forms in the tissues of the lungs; this may spread to lymph nodes and other organs and may even lead to severe consequences and death
  • Pneumonia: Pneumonia can be a viral, bacterial, or fungal infection that causes inflammation in one or both lungs. Symptoms include cough with phlegm or pus, fever, and difficulty in breathing.
  • Pulmonary fibrosis: In this condition, the lungs become thickened and scarred, resulting in breathing difficulties.
  • Pulmonary hypertension: This is a severe condition with abnormally high pressure in the blood vessels that supply blood to the lungs resulting in fatigue and shortness of breath.
  • Sarcoidosis: This rare condition is characterised by clusters of inflammatory cells known as ‘granulomas’; the cause is unknown, but most evidence suggests that it occurs due to an aberrant immune response.
  • Sleep apnea: If you snore loudly and still feel exhausted after a good night’s sleep, you may have sleep apnea; this potentially serious sleep disorder is characterised by frequent breathing ‘stops’ and ‘starts’.
  • Tuberculosis (TB): TB is a potentially serious bacterial infection that mainly affects the lungs but can also affect other parts of the body.

What symptoms and signs indicate you need to consult a pulmonologist?

There are a number of symptoms and signs that may suggest a visit to the clinic. Let’s take a look at a few symptoms:

  • Shortness of breath: If you have been experiencing breathing difficulties during physical activity or rest, this could indicate an underlying respiratory condition.
  • Fatigue: Feeling tired after an activity is normal, but if you feel worn out all the time, this could be a sign of a lung condition such as COPD.
  • Chronic cough: A severe cough or a lingering cough that has lasted for more than three weeks needs to be investigated.
  • Wheezing: This is a high-pitched whistling sound that may occur while breathing; this may be a symptom of conditions such as asthma, pneumonia, bronchitis, and more.
  • Recurrent colds or respiratory infections: Frequent infections need to be further investigated by a pulmonologist.
  • Abnormal imaging investigation findings: If you have any abnormalities on your chest X-ray or CT scan, you may need to get it evaluated by a pulmonologist.
What to expect at the clinic and how to be prepared?

At first, the specialist will take a detailed medical and family history, followed by a physical examination. This is performed to determine the diagnosis and to commence the required management. Depending on your symptoms and medical history, they may also require a few investigations, such as a chest X-ray, spirometry, bronchoscopy, or a CT scan, to make the proper diagnosis.

Being prepared before your appointment will help you make the most out of your visit. Make sure that you bring any relevant past medical records and make a note of your past and current medications, including any over-the-counter (OTC) supplements or vitamins.

It is advisable to wear loose-fitting and comfortable clothing, as you may be required to undergo tests that require deep breathing or physical activity. If you have any questions or concerns, don’t forget to write them down so that you can get them clarified at the clinic. Lastly, it is recommended that you bring a family member to accompany you at the appointment. This will help you be at ease and free from anxiety or stress.

Smoking and lung cancer

Smoking is one of the most harmful habits a person can get into. It is a major contributor of several chronic illnesses and lung cancer, so it would be wise to think twice before lighting that cigarette. For many smokers, it is not too late for a lifestyle change and there are now proven ways that can help smokers kick the habit. 

What is lung cancer?

Lung cancer is a type of cancer that begins in the lungs and may spread to other parts of the body, including the lymph nodes, liver, bones, and brain. The lungs may also get affected by cancer cells from other organs; this is referred to as metastasis.

The leading cause of lung cancer worldwide is cigarette smoking. This also includes the smoking of pipes as pipe tobacco contains many of the same type of carcinogens as cigarette tobacco. 

Cancer risk increases with the time and number of cigarettes smoked. However, if a person quits smoking (even after smoking for many years), the chances of reducing the risk of developing lung cancer can be significant. Smoking cessation medications and counselling can be effective in helping you stay away from smoking in the long term. 

Active smoking is not the only way an individual may get lung cancer. Inhaling secondhand smoke, also known as involuntary or passive smoking, can pose a considerable risk. Therefore, stopping smoking will not only reduce the risk of lung cancer and improve the health of the smoker but that of household members as well.

Other risk factors associated with lung cancer include:

  • Family history of lung cancer.
  • Occupational exposure to substances such as asbestos, arsenic, chromium, beryllium, nickel, or tar.
  • Exposure to radiation from radiation therapy, radon, or imaging investigations, such as CT scans.
  • Air pollution


Types of lung cancers in smokers

Smoking has the potential to cause two particular types of lung cancer. They are:

  • Small cell lung cancer (SCLC): This type of cancer is uncommon and is usually found in individuals with a long history of tobacco smoking; Early diagnosis and management  has the potential to increase life expectancy.
  • Non-small cell lung cancer (NSCLC): This epithelial lung cancer accounts for more than 80% of lung cancers and can be classified into three subtypes – squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Squamous cell cancer is typically associated with long-term smoking.
What are the symptoms and signs of lung cancer?

The following symptoms and signs may be seen with lung cancer:

  • Headache
  • Chronic cough
  • Chest pain
  • Breathing difficulties
  • Hoarse voice
  • Blood in sputum (phlegm or mucus)
  • Loss of appetite
  • Unintended weight loss
  • Fatigue
  • Bone pain
  • Swelling of the face and neck veins

In the early stages of lung cancer, patients may be asymptomatic (no symptoms). Symptoms usually occur when the disease is advanced. As such, if you believe you are at risk or have symptoms that do not resolve on their own, it is advisable to see a lung specialist who will be able to conduct a thorough evaluation of your respiratory condition and advise on appropriate treatment if necessary.

How does smoking cause lung cancer?

The lung isn’t the only place affected by cigarette smoking. It can affect other parts of the body, such as the mouth, voice box, trachea, oesophagus, stomach, colon, rectum, liver, pancreas, and so on. It also significantly impacts an individual’s DNA or deoxyribonucleic acid (the hereditary component in humans). It can increase DNA methylation — a biological process that can change the activity of DNA segments and cause DNA damage. Smoking provides direct exposure of the epithelial tissue to at least 60-70 harmful carcinogens that may result in the damage of segments of DNA and thereby leading to lung cancer.

Some examples of such toxic carcinogens include:

  • Arsenic
  • Benzene
  • Cadmium
  • Formaldehyde
  • Nickel
  • Lead
  • Isoprene
How to diagnose and treat lung cancer?

The following investigations may be carried out to diagnose lung cancer:

  • Medical and family history.
  • Physical examination.
  • Imaging tests, such as chest X-ray or CT scan.
  • Lab investigations (including blood and sputum tests).
  • Lung biopsy.

Once the diagnosis is made, the specialist will classify the cancer according to the stages — this will offer integral information regarding the extent of cancer and the required response to the treatment. Screening for lung cancer is generally performed using a low-dose computerised tomography scan (LDCT). This scan doesn’t take up much time and isn’t painful.

How to prevent lung cancer?

Here are some strategies which can help prevent lung cancer:

  • Stop smoking.
  • Avoid secondhand smoke.
  • Reduce exposure to toxic chemicals such as asbestos, arsenic, radon, and lead.
Electronic cigarettes

While electronic cigarettes (e-cigarettes) appear less harmful than cigarettes, they are not safe. E-cigarettes (also known as vaping products) contain many harmful chemicals such as nicotine and heavy metals that can be inhaled deep into the lungs. The flavours in e-cigarettes are also known to be carcinogenic. Vaping comes with the risk of serious lung diseases like asthma, lung scarring, popcorn lung among others. It is generally believed that e-cigarettes don’t usually contain tobacco but this is not always the case; E-cigarettes often contain nicotine which comes from tobacco and is the key ingredient responsible for continued addiction. As such, e-cigarettes are classified as tobacco products by the Food & Drug Administration (FDA) in the U.S.

There are several harmful health effects linked with prolonged tobacco use. They include:

  • Heart disease
  • Stroke
  • Leukaemia
  • Type 2 Diabetes
  • Cataracts

Cigarette smoking is one of the major causes of illness and death in Singapore. According to statistics, over 90% of lung cancer cases are caused by smoking. Therefore, it is wise to consult a lung specialist if you need any assistance with quitting smoking.