Selected Podcast
When to See a Pulmonologist
Your chest is tight when you take a deep breath. You suddenly have trouble breathing when you walk up and down the stairs. You have a cough that won’t go away. There are many reasons your primary care provider might refer you to a pulmonologist who specializes in lung health and lung conditions. In this podcast, Dr. Peter Olivieri, a pulmonologist and critical care expert at UM Baltimore Washington Medical Center, talks about what pulmonology is, when you might need to see a pulmonologist, what happens at your initial visit and much more.
Featured Speaker:
He focuses on the evaluation and management of patients with nodules, masses, and enlarged lymph nodes in the chest, as well as fluid around the lungs (pleural effusions).
Dr. Olivieri graduated from Jefferson Medical College of Thomas Jefferson University
Peter Olivieri, III, MD
Peter Olivieri III, MD, is board-certified in pulmonary and critical care medicine. He cares for patients in UM Baltimore Washington Medical Center and in the outpatient pulmonary clinic at UM Baltimore Washington Medical Group - Pulmonology.He focuses on the evaluation and management of patients with nodules, masses, and enlarged lymph nodes in the chest, as well as fluid around the lungs (pleural effusions).
Dr. Olivieri graduated from Jefferson Medical College of Thomas Jefferson University
Transcription:
When to See a Pulmonologist
Joey Wahler: Pulmonary issues range from shortness of breath to chronic conditions and serious diseases. So, we're discussing when to see a pulmonologist. Welcome to the Live Greater Podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler.
Our guest, Dr. Peter Olier, a board certified pulmonary and critical care physician at, um, Baltimore, Washington Medical Center dr. Olivier, thanks for joining us.
Dr. Peter Olivieri: Good morning. Thanks for having me.
Joey Wahler: Great to have you. So, first, in a nutshell, what exactly does the area of pulmonology cover for someone like you?
Dr. Peter Olivieri: A pulmonologist is a physician who specializes in the respiratory system, which primarily consists of the lungs, but also includes things like the windpipe and the airways, as well as some other structures in the chest. So, pulmonary physicians tend to treat a variety of complaints and diseases that involve the chest.
Joey Wahler: And so that being said, what are some of the more common conditions or diseases that would require seeing someone such as yourself?
Dr. Peter Olivieri: Sure. So, some common things would be diseases such as asthma, COPD or chronic obstructive pulmonary disease, as well as some other just common undifferentiated complaints such as trouble breathing or shortness of breath or a longstanding cough.
Joey Wahler: So, let's take something like a cough for instance. At what point does a cough go from being something that's just annoying to being something where you might want to see a specialist?
Dr. Peter Olivieri: Yeah, that's a great question. I think for those types of symptoms, often patients will initially see a frontline provider such as their primary care physician or PCP or may even seek care at something like an urgent care facility. And those are quite reasonable because most coughs are short-lived and maybe due to things like viral infection such as a cold or even allergies. But when a cough lasts for a longer period of time, and by that I mean typically several weeks or the cough is not responding to the initial measures that have been tried or even just time, that would be a time when it would be reasonable to consider seeing a pulmonary physician. And this is often done under the guidance of a patient's primary care provider.
Joey Wahler: And so just to clarify that, typically patients are referred to a pulmonologist from a primary care doctor, right?
Dr. Peter Olivieri: Often that is the case, and some of that depends on the type of insurance that the patient has. Often patients will see their primary physician first, which is quite appropriate for many of these types of symptoms. And when necessary, the primary will refer a patient to see a specialist such as a pulmonologist. Some patients do have a type of insurance though that allows them to seek care with a specialist directly without a referral. And in those cases, sometimes patients will do research on their own about their symptoms or may be referred by a friend, family member, or colleague to see a pulmonologist directly.
Joey Wahler: Gotcha. So, always good for people to check with their insurance carrier first to make sure they're doing what they need to to be covered if they can be, right?
Dr. Peter Olivieri: Yeah, I think that's reasonable. If you call a pulmonology office, you're going to find out on the phone whether or not that's the case. But I think, again, seeing your primary is always a reasonable starting point if you can get in with them in a timely fashion.
Joey Wahler: Okay. So generally speaking, what happens during an initial consultation? What kinds of tests are performed, et cetera?
Dr. Peter Olivieri: Typically, the pulmonologist will take a detailed history pertinent to whatever the issue is at hand, and will perform a physical examination with an emphasis on evaluating the throat and upper airway, as well as listening to the chest with a stethoscope. They would review any pertinent tests that may have been done prior to the consultation. And based on their assessment, they may prescribe medications or, in some cases, order additional tests or procedures.
Joey Wahler: What are some of the factors in everyday life, doctor, that affect pulmonary health, be it pro or con?
Dr. Peter Olivieri: There are lots of things because, like some other organs, the lungs are exposed to the outside world through the air that we breathe in. So, a very common and well known factor, of course, is smoking. And patients that do have a history of either prior or current smoking will often be at risk for certain lung conditions. And if they have symptoms respiratory in nature, they should certainly seek care. And in some cases, even if they don't have symptoms, just the risk factor of smoking itself may qualify them for certain screening tests.
But in addition to that, things like the environment can come into play. For instance, certain types of work that involves the inhalation of dust or dirt or certain allergen can certainly trigger certain respiratory conditions and play a role, as well as various other things that may be encountered in the environment outside of work, either in the home or outside.
Joey Wahler: You mentioned lung disease and, of course, for years, we've heard about the dangers of smoking and the link to lung disease. But you don't have to be a smoker, am I right, to get lung disease. How common is it for someone to get lung disease without ever having smoked?
Dr. Peter Olivieri: Yeah. Well, there are a group of diseases, certainly several distinct diseases, that are directly a result of smoking. But there are also a very large number of respiratory diseases that have nothing to do with smoking. So, I guess the answer is it's fairly common actually. Many of the patients that we see in our practice have no history of smoking. So, a common example would be asthma. So, asthma is a relatively common respiratory disease that maybe exacerbated by smoking, but inherently is not due to smoking. It has more to do with allergies and things like that.
Joey Wahler: When you talk about asthma, I believe asthma in kids, especially younger kids, is somewhat common, isn't it? But I guess the good news is that oftentimes kids grow out of it pretty quickly, so to speak, right?
Dr. Peter Olivieri: That can be true. So, what I will say is asthma throughout life can change in terms of its severity. On the other hand, there are cases where patients think that they grew out of their asthma, and then it may manifest again later in life. So, many patients with asthma will first develop symptoms in early life, in childhood or young adulthood, but that's not always the case. There is an entity called adult-onset asthma, where patients may manifest asthma symptoms for the first time in adulthood. There are other cases where patients have asthma that bothers them a lot in early life, and they may be much less of an issue later on. And then, there are other cases where it may bother them during childhood, go away for a period of years and then come back. And some of that may be based on the environment, as I mentioned earlier, with regards to some of the allergens that they're exposed to or it may just have to do with the way their body's changing over time. So, we do need patients to know that, once they have asthma, they may never really, truly grow out of it.
Joey Wahler: Interesting. And so just to backtrack for a moment, asthma is defined as what? What's going on when you have that?
Dr. Peter Olivieri: Well, a short version of it is that there's muscle that surrounds the airway tubes in the lung. And when patients have asthma, that muscle is hypersensitive and can sort of spasm, which causes the airway tubes to become more narrow and can make breathing more difficult. The other thing that I've alluded to is that some patients with asthma have an allergic type of asthma where the main trigger has to do with things that they're breathing in that they may be sensitive to. And in those cases, there may also be kind of an allergic kind of swelling component in the airway as a result of breathing in certain particles from the air.
Joey Wahler: And then, earlier you mentioned COPD. Tell us exactly what that is and how common that is nowadays.
Dr. Peter Olivieri: So, it is relatively common. It is one of the most common things that we do see in the pulmonary clinic. It is, in the United States, almost exclusively due to smoking. There are in other countries, primarily in low middle income countries or in developing countries where patients burn certain types of biomass for heating and cooking, particularly inside the home, the long-term exposure to that smoke can also lead to COPD. And then, some occupations such as mining can also lead to COPD. But again, in the United States, by and large, this is a disease of patients who have either previously or currently smoked. And in some ways, it's similar to asthma in that the airways are narrow and patients have breathing trouble, but it is a little bit less intermittent than asthma. Whereas the typical asthma patient may have good days and bad days based on the exposure to various things in the environment, usually patients with COPD will have more persistent symptoms. But the treatments can be somewhat similar in the sense that inhalers are often a prominent component of the treatment for both conditions.
Joey Wahler: And both are very treatable, whether it's asthma or COPD. Am I right?
Dr. Peter Olivieri: Absolutely.
Joey Wahler: Couple other things. What would you say, doctor, are the general benefits of working with a pulmonologist on a regular long-term basis?
Dr. Peter Olivieri: In general, the benefit of seeing a pulmonologist is to get an accurate diagnosis and an effective treatment plan for the respiratory problem. And as we've discussed, some respiratory issues such as asthma and COPD are chronic long-term issues, so patients with these conditions often benefit from establishing long-term followup with a pulmonologist to ensure that the condition is being effectively managed over time.
Joey Wahler: So, the important thing there, I guess, is for people to keep in mind that what may be the status of a pulmonary condition today isn't necessarily, as we've discussed, going to be the case a month or a year from now, right?
Dr. Peter Olivieri: That's absolutely true.
Joey Wahler: And then finally, that being said, in summary here, what would be your main message for our listeners about monitoring their general pulmonary health even if, as far as they know right now, it happens to be good, hopefully?
Dr. Peter Olivieri: A lot of it is common sense. Of course, if you don't smoke, please don't start. If you do smoke, please seek care to partner with your physician to try to quit. If you have a history of smoking, please do talk to your physician about it because, as I mentioned earlier, there are some tests that may need to be done even if you're not having symptoms. In addition to that, if you have a job that involves exposure to dust, particles, dirt, and other things that make you cough or make your breathing difficult when you breathe them in, please follow the local guidelines regarding the use of a mask or other respirator.
And really, what I would say is that you're experiencing any troubling symptoms related to your breathing or your chest, such as, again, shortness of breath, cough that won't go away, chest pain, chest pressure, wheezing, please get evaluated as these symptoms can sometimes indicate a serious condition. Seeing your primary doctor first is usually reasonable. And of course, if the issue is more urgent, seeking care in an urgent care or ER is appropriate and really with breathing problems and other chest symptoms, it's always better to get checked out than to wait because sometimes things can worsen if left untreated.
Joey Wahler: Absolutely. Some great advice and information. Very thorough to say the least. Folks, we trust you're now more familiar with when to see a pulmonologist. Dr. Peter Olivieri, thanks so much again.
Dr. Peter Olivieri: My pleasure. Thank you.
Joey Wahler: Thank you, and you can find more shows just like this one at umms.org/podcast. Again, umms.org/podcast. And on the University of Maryland Medical System YouTube channel, there's lots of content for you there as well. So, thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health, I'm Joey Wahler.
When to See a Pulmonologist
Joey Wahler: Pulmonary issues range from shortness of breath to chronic conditions and serious diseases. So, we're discussing when to see a pulmonologist. Welcome to the Live Greater Podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler.
Our guest, Dr. Peter Olier, a board certified pulmonary and critical care physician at, um, Baltimore, Washington Medical Center dr. Olivier, thanks for joining us.
Dr. Peter Olivieri: Good morning. Thanks for having me.
Joey Wahler: Great to have you. So, first, in a nutshell, what exactly does the area of pulmonology cover for someone like you?
Dr. Peter Olivieri: A pulmonologist is a physician who specializes in the respiratory system, which primarily consists of the lungs, but also includes things like the windpipe and the airways, as well as some other structures in the chest. So, pulmonary physicians tend to treat a variety of complaints and diseases that involve the chest.
Joey Wahler: And so that being said, what are some of the more common conditions or diseases that would require seeing someone such as yourself?
Dr. Peter Olivieri: Sure. So, some common things would be diseases such as asthma, COPD or chronic obstructive pulmonary disease, as well as some other just common undifferentiated complaints such as trouble breathing or shortness of breath or a longstanding cough.
Joey Wahler: So, let's take something like a cough for instance. At what point does a cough go from being something that's just annoying to being something where you might want to see a specialist?
Dr. Peter Olivieri: Yeah, that's a great question. I think for those types of symptoms, often patients will initially see a frontline provider such as their primary care physician or PCP or may even seek care at something like an urgent care facility. And those are quite reasonable because most coughs are short-lived and maybe due to things like viral infection such as a cold or even allergies. But when a cough lasts for a longer period of time, and by that I mean typically several weeks or the cough is not responding to the initial measures that have been tried or even just time, that would be a time when it would be reasonable to consider seeing a pulmonary physician. And this is often done under the guidance of a patient's primary care provider.
Joey Wahler: And so just to clarify that, typically patients are referred to a pulmonologist from a primary care doctor, right?
Dr. Peter Olivieri: Often that is the case, and some of that depends on the type of insurance that the patient has. Often patients will see their primary physician first, which is quite appropriate for many of these types of symptoms. And when necessary, the primary will refer a patient to see a specialist such as a pulmonologist. Some patients do have a type of insurance though that allows them to seek care with a specialist directly without a referral. And in those cases, sometimes patients will do research on their own about their symptoms or may be referred by a friend, family member, or colleague to see a pulmonologist directly.
Joey Wahler: Gotcha. So, always good for people to check with their insurance carrier first to make sure they're doing what they need to to be covered if they can be, right?
Dr. Peter Olivieri: Yeah, I think that's reasonable. If you call a pulmonology office, you're going to find out on the phone whether or not that's the case. But I think, again, seeing your primary is always a reasonable starting point if you can get in with them in a timely fashion.
Joey Wahler: Okay. So generally speaking, what happens during an initial consultation? What kinds of tests are performed, et cetera?
Dr. Peter Olivieri: Typically, the pulmonologist will take a detailed history pertinent to whatever the issue is at hand, and will perform a physical examination with an emphasis on evaluating the throat and upper airway, as well as listening to the chest with a stethoscope. They would review any pertinent tests that may have been done prior to the consultation. And based on their assessment, they may prescribe medications or, in some cases, order additional tests or procedures.
Joey Wahler: What are some of the factors in everyday life, doctor, that affect pulmonary health, be it pro or con?
Dr. Peter Olivieri: There are lots of things because, like some other organs, the lungs are exposed to the outside world through the air that we breathe in. So, a very common and well known factor, of course, is smoking. And patients that do have a history of either prior or current smoking will often be at risk for certain lung conditions. And if they have symptoms respiratory in nature, they should certainly seek care. And in some cases, even if they don't have symptoms, just the risk factor of smoking itself may qualify them for certain screening tests.
But in addition to that, things like the environment can come into play. For instance, certain types of work that involves the inhalation of dust or dirt or certain allergen can certainly trigger certain respiratory conditions and play a role, as well as various other things that may be encountered in the environment outside of work, either in the home or outside.
Joey Wahler: You mentioned lung disease and, of course, for years, we've heard about the dangers of smoking and the link to lung disease. But you don't have to be a smoker, am I right, to get lung disease. How common is it for someone to get lung disease without ever having smoked?
Dr. Peter Olivieri: Yeah. Well, there are a group of diseases, certainly several distinct diseases, that are directly a result of smoking. But there are also a very large number of respiratory diseases that have nothing to do with smoking. So, I guess the answer is it's fairly common actually. Many of the patients that we see in our practice have no history of smoking. So, a common example would be asthma. So, asthma is a relatively common respiratory disease that maybe exacerbated by smoking, but inherently is not due to smoking. It has more to do with allergies and things like that.
Joey Wahler: When you talk about asthma, I believe asthma in kids, especially younger kids, is somewhat common, isn't it? But I guess the good news is that oftentimes kids grow out of it pretty quickly, so to speak, right?
Dr. Peter Olivieri: That can be true. So, what I will say is asthma throughout life can change in terms of its severity. On the other hand, there are cases where patients think that they grew out of their asthma, and then it may manifest again later in life. So, many patients with asthma will first develop symptoms in early life, in childhood or young adulthood, but that's not always the case. There is an entity called adult-onset asthma, where patients may manifest asthma symptoms for the first time in adulthood. There are other cases where patients have asthma that bothers them a lot in early life, and they may be much less of an issue later on. And then, there are other cases where it may bother them during childhood, go away for a period of years and then come back. And some of that may be based on the environment, as I mentioned earlier, with regards to some of the allergens that they're exposed to or it may just have to do with the way their body's changing over time. So, we do need patients to know that, once they have asthma, they may never really, truly grow out of it.
Joey Wahler: Interesting. And so just to backtrack for a moment, asthma is defined as what? What's going on when you have that?
Dr. Peter Olivieri: Well, a short version of it is that there's muscle that surrounds the airway tubes in the lung. And when patients have asthma, that muscle is hypersensitive and can sort of spasm, which causes the airway tubes to become more narrow and can make breathing more difficult. The other thing that I've alluded to is that some patients with asthma have an allergic type of asthma where the main trigger has to do with things that they're breathing in that they may be sensitive to. And in those cases, there may also be kind of an allergic kind of swelling component in the airway as a result of breathing in certain particles from the air.
Joey Wahler: And then, earlier you mentioned COPD. Tell us exactly what that is and how common that is nowadays.
Dr. Peter Olivieri: So, it is relatively common. It is one of the most common things that we do see in the pulmonary clinic. It is, in the United States, almost exclusively due to smoking. There are in other countries, primarily in low middle income countries or in developing countries where patients burn certain types of biomass for heating and cooking, particularly inside the home, the long-term exposure to that smoke can also lead to COPD. And then, some occupations such as mining can also lead to COPD. But again, in the United States, by and large, this is a disease of patients who have either previously or currently smoked. And in some ways, it's similar to asthma in that the airways are narrow and patients have breathing trouble, but it is a little bit less intermittent than asthma. Whereas the typical asthma patient may have good days and bad days based on the exposure to various things in the environment, usually patients with COPD will have more persistent symptoms. But the treatments can be somewhat similar in the sense that inhalers are often a prominent component of the treatment for both conditions.
Joey Wahler: And both are very treatable, whether it's asthma or COPD. Am I right?
Dr. Peter Olivieri: Absolutely.
Joey Wahler: Couple other things. What would you say, doctor, are the general benefits of working with a pulmonologist on a regular long-term basis?
Dr. Peter Olivieri: In general, the benefit of seeing a pulmonologist is to get an accurate diagnosis and an effective treatment plan for the respiratory problem. And as we've discussed, some respiratory issues such as asthma and COPD are chronic long-term issues, so patients with these conditions often benefit from establishing long-term followup with a pulmonologist to ensure that the condition is being effectively managed over time.
Joey Wahler: So, the important thing there, I guess, is for people to keep in mind that what may be the status of a pulmonary condition today isn't necessarily, as we've discussed, going to be the case a month or a year from now, right?
Dr. Peter Olivieri: That's absolutely true.
Joey Wahler: And then finally, that being said, in summary here, what would be your main message for our listeners about monitoring their general pulmonary health even if, as far as they know right now, it happens to be good, hopefully?
Dr. Peter Olivieri: A lot of it is common sense. Of course, if you don't smoke, please don't start. If you do smoke, please seek care to partner with your physician to try to quit. If you have a history of smoking, please do talk to your physician about it because, as I mentioned earlier, there are some tests that may need to be done even if you're not having symptoms. In addition to that, if you have a job that involves exposure to dust, particles, dirt, and other things that make you cough or make your breathing difficult when you breathe them in, please follow the local guidelines regarding the use of a mask or other respirator.
And really, what I would say is that you're experiencing any troubling symptoms related to your breathing or your chest, such as, again, shortness of breath, cough that won't go away, chest pain, chest pressure, wheezing, please get evaluated as these symptoms can sometimes indicate a serious condition. Seeing your primary doctor first is usually reasonable. And of course, if the issue is more urgent, seeking care in an urgent care or ER is appropriate and really with breathing problems and other chest symptoms, it's always better to get checked out than to wait because sometimes things can worsen if left untreated.
Joey Wahler: Absolutely. Some great advice and information. Very thorough to say the least. Folks, we trust you're now more familiar with when to see a pulmonologist. Dr. Peter Olivieri, thanks so much again.
Dr. Peter Olivieri: My pleasure. Thank you.
Joey Wahler: Thank you, and you can find more shows just like this one at umms.org/podcast. Again, umms.org/podcast. And on the University of Maryland Medical System YouTube channel, there's lots of content for you there as well. So, thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health, I'm Joey Wahler.