Pulmonologist

A pulmonologist is a medical specialist in the lungs and airways. People also say lung doctor, chest physician or respiratory specialist; in Israel the term is rofe reot. The pulmonologist manages adults with poorly controlled asthma, chronic obstructive pulmonary disease (COPD) linked to smoking, persistent cough, unexplained breathlessness, sleep apnoea, repeated chest infections, pulmonary fibrosis and other interstitial lung diseases, a nodule found on a CT scan, or lasting breathing problems after a severe infection. The visit starts with precise questions (smoking, occupational exposures, allergies, timing of the cough, snoring, family history), listening to the chest and measuring oxygen saturation. The lung specialist then relies on lung function tests (spirometry, often done in the clinic or at the health fund's centre), a chest X-ray or CT scan, sometimes a sleep study, allergy tests or a bronchoscopy. Inhalers are adjusted, a structured stop-smoking plan is offered, night-time ventilation is prescribed for sleep apnoea, and chronic diseases are followed every three to twelve months.

• ✓A cough that has lasted more than eight weeks, especially in a current or former smoker.
• ✓Breathlessness on exertion that is getting worse over months, or that appears with efforts that used to be easy.
• ✓Asthma that needs the reliever inhaler more than twice a week, wakes you at night or has already led to an emergency visit.
• ✓Loud snoring with breathing pauses noticed by a partner, daytime sleepiness or headaches on waking.
• ✓A nodule or abnormality found on a chest X-ray or CT scan.
• ✓Bronchitis or pneumonia that comes back every winter, or a chest infection that does not clear despite antibiotics.
• ✓Coughing up blood, even a small amount, which needs prompt assessment.
• ✓Breathlessness or fatigue persisting for months after a severe respiratory infection.

In Israel, pulmonology (רפואת ריאות) is a second-tier specialty: the title specialist in lung diseases (מומחה ברפואת ריאות) is earned after a complete specialty in internal medicine (or paediatrics for paediatric pulmonology), then two to three years of accredited training and the examinations of the Scientific Council of the Israel Medical Association. It is a protected title visible in the Ministry of Health (משרד הבריאות) public licence register, so check the licence, the internal medicine specialty and the entry ריאות. Sleep apnoea in Israel is followed either by pulmonologists or by ENT specialists or neurologists trained in sleep medicine; sleep medicine is not a stand-alone specialty title, so asking where the doctor trained is reasonable. Allergists (אלרגולוגים) form a separate specialty that shares allergic asthma with pulmonologists. For a foreign qualification, the Ministry first recognises the medical degree, then the Scientific Council reviews the specialty case by case; a US pulmonary and critical care board, a UK CCT in respiratory medicine or the French DES (a direct specialty without prior internal medicine) are not transferred automatically. Respiratory physiotherapists and spirometry technicians are not pulmonologists.