ENBreathlessness, a cough in its third month, a nodule found by chance on a scan taken for something else: three very different stories leading in Germany to one specialist, the pulmonologist. Pulmonology covers not just the lungs but the whole airway from throat to alveoli, and its links with heart and vessels.
This page explains pulmonology in Germany for patients from abroad: which lung diseases a German pulmonologist manages, what the work-up involves, who else shares the decision and what to bring. See also lung treatment in Germany.
What a pulmonologist does and when patients are referred
A pulmonologist is an internist with additional specialist training in respiratory medicine (in German, «Facharzt für Innere Medizin und Pneumologie»). Pulmonologists work in practices and hospital departments alike and assemble the picture from symptoms, function tests and images.
Typical reasons for referral: breathlessness on exertion that used not to be a problem; a cough lasting over eight weeks; repeated bronchitis and pneumonia; wheezing and night-time attacks; blood in the sputum; a change on a chest X-ray or CT taken for another reason.
The border with other specialties lies where symptoms have another source: cardiology for breathlessness from the heart, allergy medicine, ENT for the upper airway, thoracic surgery once an operation is discussed. Breathlessness is not always lung disease; the first task is finding its source.
The lung diseases patients most often travel with
COPD (chronic obstructive pulmonary disease) and asthma form the largest group. Both narrow the airways: in asthma the narrowing varies and often reverses fully; in COPD it is always there and never fully reverses, even after a bronchodilator. See asthma treatment in Germany.
The second group is interstitial lung disease, which affects the lung tissue itself, including pulmonary fibrosis and sarcoidosis; here a German work-up adds value because a board of pulmonologist, radiologist and pathologist, not one doctor, makes the diagnosis. Others come with bronchiectasis (permanently widened airways), after-effects of severe pneumonia, or pulmonary hypertension, raised pressure in the lung vessels that needs its own work-up.
Nodules and shadows found by chance are the commonest reason for a second opinion; their work-up is covered under lung cancer diagnosis in Germany. Sleep-disordered breathing such as sleep apnoea belongs here too and is investigated in German sleep laboratories: see treatment of sleep disorders in Germany.
How the work-up is built
The work-up is a sequence, not a list of procedures: each step depends on the last. After the conversation and examination comes lung function: spirometry, body plethysmography in a closed cabin, diffusion capacity (how well gases reach the blood) and, if needed, a bronchodilator test that separates asthma from COPD and an exercise test, plus blood gas analysis.
Then imaging — chest X-ray, high-resolution CT and, if a tumour is suspected, further methods such as PET-CT — and endoscopy: bronchoscopy with lavage, biopsy and endobronchial ultrasound of the lymph nodes. If a scan shows a mass, see lung cancer diagnosis in Germany.
One trip usually covers lung function, CT and, if needed, bronchoscopy, in a programme of three to five working days. Bring previous scans on a disc, not just written reports: only the images show whether a nodule has changed. Blood tests on the clinic’s list are best done at home. On organising such a programme, see diagnostics in Germany; for an overview, the WHO page on chronic respiratory diseases.
What treatment looks like and who takes part
Therapy follows the diagnosis, not the symptom: inhalers with correct technique in asthma and COPD; biological antibody therapy in severe allergic asthma uncontrolled by maximal inhaled treatment; culture-guided treatment of infections; drugs slowing fibrosis, such as nintedanib and pirfenidone. Smoking cessation and flu and pneumonia vaccines are topics in their own right, taken seriously in Germany.
The non-drug part — breathing exercises, airway clearance, oxygen therapy and pulmonary rehabilitation, which teaches exercises that ease breathing — is part of the treatment, not an add-on.
A surgeon joins to remove a mass, or to take tissue when bronchoscopy has given no answer. With a suspected tumour, the tumour board of pulmonologist, surgeon, radiologist and pathologist decides on surgery. In chronic lung disease the aim is control of the disease and quality of breathing, not cure. A tumour leads into oncology: see lung cancer treatment in Germany.
What to prepare before the trip
Documents come first: discharge letters, spirometry results with their dates, scans on a disc, a list of medication with doses, the smoking and occupational history, and any previous pneumonia or tuberculosis.
The programme usually takes three to five working days. A companion is optional but helps, especially with severe breathlessness or after bronchoscopy under sedation. In flight, lower cabin pressure reduces blood oxygen: if yours is already low, ask your doctor before departure about oxygen on board or an altitude test, and arrange oxygen with the airline in advance.
Frequently asked questions
How many days does a pulmonology work-up in Germany take?
Usually three to five working days: consultation, lung function tests and CT first, then bronchoscopy if needed. A biopsy can add time, because the pathologist’s final report sometimes arrives after the patient is home; it is then sent on and discussed remotely.
Should inhalers be stopped before lung function tests?
Sometimes, but only on the doctor’s instructions. To test whether narrowed airways reopen, bronchodilators are paused beforehand; timings vary by drug, and the clinic gives them at booking. Never stop treatment on your own. Shortly before testing, avoid smoking and vaping, hard exercise and clothing that restricts the chest.
Can COPD or pulmonary fibrosis be cured?
No: neither COPD nor idiopathic pulmonary fibrosis can be cured today, but treatment helps to keep them under control. In COPD, quitting smoking, inhalers, oxygen and rehabilitation ease symptoms; in fibrosis, antifibrotic drugs slow progression. Individual prospects become clear only after the work-up.
How AlenMed arranges an appointment with a pulmonologist in Germany
AlenMed starts with the records: letters and scans are translated and sent to partner clinics, which reply with a programme of examinations and dates, not a general price list. Then come the appointment, the visa invitation and an interpreter at the examination and the results discussion.
Plan for three things: how the report reaches your own doctor, how to ask the German doctor questions after you return, and what happens if test results change the plan mid-trip: new dates are agreed on the spot, and the stay may be extended.
This material is for information and is not an offer; the approach is decided by a doctor in person.