You should consider seeing a pulmonologist when a cough, breathing difficulty, wheezing, chest tightness or recurring chest infection persists, returns frequently or interferes with sleep and daily activities. A pulmonologist is a doctor who evaluates diseases affecting the lungs, airways, breathing and, in some cases, sleep-related respiratory function.

Some symptoms can be assessed through a scheduled pulmonary consultation. Sudden or severe breathing difficulty, bluish lips, confusion, significant coughing of blood or rapidly worsening chest symptoms require emergency care instead.

This guide explains 10 warning signs that may justify a visit to a lung doctor, how pulmonologists examine the lungs and when people in Bhaktapur, Kathmandu Valley and across Nepal should seek specialist evaluation.

Content review date: July 17, 2026
Medical disclaimer: This article provides general education and cannot diagnose an individual condition.

What does a pulmonologist do?

A pulmonologist is a medical doctor who specializes in conditions affecting the respiratory system. This system includes the lungs, airways, windpipe, chest lining and the processes involved in breathing and moving oxygen into the blood.

A pulmonologist may evaluate and manage asthma, chronic obstructive pulmonary disease, recurring chest infections, pneumonia, tuberculosis, interstitial lung disease, pulmonary fibrosis, bronchiectasis, sleep-related breathing disorders and unexplained breathlessness.

A general physician can assess many common respiratory illnesses. A pulmonologist becomes particularly useful when symptoms are persistent, recurrent, severe, difficult to diagnose or not responding as expected to initial treatment.

Nagarik Hospital has a dedicated Pulmonary & Critical Care Department that publicly lists pulmonary rehabilitation, sleep-laboratory support and critical-care facilities.

What are the 10 warning signs you should see a pulmonologist?

A single symptom does not always indicate lung disease. The duration, severity, pattern, triggers, health history and effect on daily life all matter.

The following warning signs should prompt professional assessment, especially when they persist, recur or become worse.

1. A cough that lasts longer than expected

A cough commonly occurs with a cold or short-term respiratory infection. However, a cough that continues for several weeks, repeatedly returns or does not follow the expected recovery pattern needs further evaluation.

The US Centers for Disease Control and Prevention advises seeking medical care for acute bronchitis symptoms that last more than three weeks, repeated episodes of bronchitis, coughing bloody mucus or shortness of breath.

A persistent cough may be associated with:

• Asthma
• Chronic bronchitis
• COPD
• Post-infectious airway irritation
• Tuberculosis
• Bronchiectasis
• Interstitial lung disease
• Acid reflux
• Allergic or upper-airway conditions
• Certain medicines
• Occupational or environmental exposure

A pulmonologist may be appropriate when the cause remains unclear, the cough interrupts sleep, it is associated with breathlessness or wheezing, or it continues despite initial treatment.

A cough should not be assessed only by its duration. Coughing blood, severe breathing difficulty or a rapidly worsening illness requires earlier evaluation.

2. Unexplained shortness of breath

Breathlessness during strenuous exercise can be normal. Becoming unusually short of breath during routine activities such as walking on level ground, climbing a familiar staircase, bathing or speaking deserves attention.

Shortness of breath can arise from the lungs, heart, blood, muscles, physical deconditioning or anxiety-related conditions. A pulmonologist helps determine whether airflow limitation, inflammation, lung scarring, infection, low oxygen, sleep-related breathing problems or another respiratory issue is involved.

Notice changes such as:

• Needing to stop more frequently while walking
• Avoiding stairs that were previously manageable
• Becoming breathless while dressing
• Difficulty taking a satisfying deep breath
• Breathlessness that wakes you at night
• Reduced ability to work or exercise
• Recovery taking longer than usual after activity

Shortness of breath is a recognized symptom of asthma and COPD, especially when accompanied by cough, wheezing or chest tightness.

Sudden, severe or rapidly worsening breathlessness should be treated as an emergency rather than delayed for a routine appointment.

3. Recurring wheezing or chest tightness

Wheezing is a whistling or squeaking sound that commonly occurs when air moves through narrowed airways. It may be associated with asthma, COPD, infection, allergies or another airway condition.

The National Heart, Lung, and Blood Institute identifies wheezing, coughing, shortness of breath and chest tightness as common asthma symptoms. These symptoms may vary over time and can be triggered by exercise, infection, allergens, smoke, cold air or workplace exposure.

You should consider seeing a pulmonologist when wheezing:

• Happens repeatedly
• Occurs at night or early morning
• Appears during exercise
• Is triggered by dust, smoke, fumes or cold air
• Is accompanied by breathlessness
• Continues despite prescribed treatment
• Has never been properly diagnosed

Wheezing is not always asthma. A specialist assessment can help avoid repeated self-treatment without confirming the cause.

4. Repeated bronchitis, pneumonia or chest infections

Repeated episodes of bronchitis or pneumonia may indicate more than frequent exposure to seasonal infections. They can sometimes be associated with uncontrolled asthma, COPD, bronchiectasis, aspiration, immune problems, airway blockage or another underlying condition.

The CDC recommends medical assessment for repeated episodes of bronchitis and for bronchitis symptoms lasting more than three weeks.

A pulmonologist may be useful when:

• You receive repeated diagnoses of bronchitis
• A cough returns soon after treatment
• Pneumonia affects the same area repeatedly
• You regularly produce large amounts of mucus
• Infections require repeated hospital visits
• You have persistent symptoms between infections
• Imaging remains abnormal after recovery

Bring previous chest X-rays, CT scans, laboratory reports and medicine records to the consultation. Comparing current findings with older reports can help the specialist identify a recurring pattern.

5. Asthma that remains difficult to control

Asthma can often be managed through primary or general medical care. A pulmonologist may be needed when symptoms remain frequent, severe or difficult to control despite following the prescribed plan.

Warning signs include:

• Frequent use of a quick-relief inhaler
• Night-time coughing or wheezing
• Repeated emergency visits
• Activity limitation
• Symptoms that return after short improvement
• Uncertainty about the diagnosis
• Difficulty using an inhaler correctly
• Symptoms caused by several different triggers
• Repeated courses of oral steroids

A pulmonologist may review whether the diagnosis is correct, assess lung function, check inhaler technique, identify triggers and consider whether another respiratory condition is contributing.

Do not stop or change prescribed asthma medicines without consulting the treating clinician.

6. A long-term cough with mucus

A persistent cough that produces mucus may occur with chronic bronchitis, COPD, bronchiectasis, recurring infection or other airway conditions.

The National Heart, Lung, and Blood Institute lists an ongoing cough, sometimes producing significant mucus, as a common COPD symptom. Breathlessness, wheezing, chest tightness and fatigue may also develop and can worsen gradually.

People sometimes adjust their routine without recognizing the change. They may walk more slowly, stop climbing stairs or avoid activities that expose their breathing difficulty.

A pulmonary evaluation is especially important when a long-term productive cough occurs alongside:

• Current or previous smoking
• Exposure to second-hand smoke
• Indoor cooking smoke
• Dusty work
• Chemical fumes
• Repeated infections
• Reduced exercise capacity
• Unintentional weight loss
• Blood-stained mucus

The consultation should focus on both the symptom and the person’s exposure history.

7. Coughing up blood

Blood in mucus can range from small streaks to a larger amount. Possible causes include airway irritation, infection, tuberculosis, bronchiectasis, blood clots, lung tumours and other respiratory conditions.

Coughing blood should not be diagnosed at home. Even when the amount appears small, professional assessment is appropriate, particularly when it recurs.

Seek urgent or emergency care when:

• The amount is more than a few streaks
• Bleeding continues or increases
• Breathing becomes difficult
• You feel faint, weak or confused
• Chest pain is present
• Your heart is beating unusually fast
• You take blood-thinning medicine
• You have known serious lung disease

The CDC includes coughing bloody mucus among the reasons to seek medical care for bronchitis-like symptoms.

8. An abnormal chest X-ray, CT scan or breathing test

Some people are referred to a pulmonologist even when their symptoms are mild because another test has identified an unexpected finding.

Referral may follow:

• An abnormal chest X-ray
• Lung nodules
• Persistent lung shadowing
• Signs of lung scarring
• Repeated collapse of part of the lung
• Pleural fluid
• Abnormal spirometry
• Lower-than-expected oxygen levels
• Reduced oxygen during exercise or sleep
• An occupational-health screening result

An abnormal report does not automatically mean a serious disease. The significance depends on the appearance, size, pattern, symptoms, age, exposure history and comparison with previous results.

A pulmonologist can decide whether the finding requires monitoring, repeat imaging, pulmonary function testing, laboratory investigation, bronchoscopy or another assessment.

9. Breathing problems during sleep

Loud snoring alone does not always require a pulmonologist, but repeated breathing pauses, choking during sleep, morning headaches, unexplained daytime sleepiness or poor concentration may indicate a sleep-related breathing disorder.

Sleep apnoea can repeatedly interrupt breathing during sleep and affect oxygen levels and sleep quality.

Consider a pulmonary or sleep-medicine assessment when someone notices:

• Pauses in your breathing during sleep
• Gasping or choking episodes
• Very loud, persistent snoring
• Severe daytime sleepiness
• Morning headaches
• Poor concentration
• Falling asleep during routine activities
• Difficult-to-control blood pressure alongside sleep symptoms

Nagarik Hospital lists sleep-laboratory support within its Pulmonary & Critical Care Department. Its website also lists Dr. Raju Pangeni as a pulmonary, intensive-care and sleep physician with an interest in airway disease and sleep medicine.

10. Persistent symptoms after smoke, dust or workplace exposure

Long-term exposure to smoke, dust, chemicals or fumes can affect the airways and lung tissue. Symptoms may develop gradually, and the relationship with work or the environment may not be immediately obvious.

A specialist evaluation may be appropriate when:

• Symptoms are worse during workdays
• Breathing improves during holidays
• Coworkers report similar respiratory problems
• Your job involves silica, construction dust, textile dust, welding fumes, chemicals or smoke
• You have a significant smoking history
• Symptoms began after a major inhalation exposure
• Breathlessness continues after leaving the exposure

Prepare a timeline of your work history, substances handled, protective equipment used and when symptoms improve or worsen.

A pulmonologist may combine the exposure history with spirometry, imaging or other tests. The goal is not only to identify disease but also to reduce continued exposure where possible.

When are breathing symptoms an emergency?

A routine pulmonology appointment is not appropriate when breathing is severely or suddenly compromised.

Seek emergency medical care for:

• Severe or rapidly worsening breathlessness
• Inability to speak normally because of breathlessness
• Bluish or grey lips or face
• Confusion, fainting or unusual drowsiness
• Severe chest pain
• Significant coughing of blood
• Very low oxygen readings with symptoms
• A severe asthma attack not responding to the prescribed rescue plan
• Choking or suspected airway blockage
• Breathing difficulty after a serious allergic reaction
• Breathing difficulty after chest trauma

Nagarik Hospital states that it provides 24-hour emergency and ambulance services. Its website lists the emergency and ambulance number as +977-9801904640.

Should you see a general physician, pulmonologist or emergency department?

The appropriate choice depends on symptom severity, duration and complexity.

The table is a general guide, not a substitute for clinical triage. When symptoms feel severe or concerning, seek timely medical care rather than trying to select the perfect specialty first.

Should I see a pulmonologist for bronchitis?

You do not necessarily need a pulmonologist for a first, uncomplicated episode of acute bronchitis. Acute bronchitis is commonly managed by a general physician, especially when symptoms are mild and gradually improving.

A pulmonologist becomes more relevant when:

• Bronchitis keeps returning
• The cough lasts more than three weeks
• You have underlying asthma or COPD
• You experience breathlessness or recurrent wheezing
• Chest infections repeatedly require hospital care
• You produce large amounts of mucus
• Imaging remains abnormal
• There is blood in the mucus
• The diagnosis is uncertain
• Treatment is not producing the expected improvement

Acute bronchitis is usually caused by a virus, and antibiotics are not automatically appropriate. A clinician should determine whether pneumonia, asthma, COPD, tuberculosis or another condition is present.

What conditions does a pulmonologist treat?

Pulmonologists evaluate a broad range of lung, airway, chest-lining and sleep-related respiratory conditions.

Asthma

Asthma causes variable airway inflammation and narrowing. Symptoms may include coughing, wheezing, shortness of breath and chest tightness.

Chronic obstructive pulmonary disease

COPD includes persistent airflow obstruction associated with chronic bronchitis, emphysema or both. Common symptoms include ongoing cough, mucus, breathlessness, wheezing, chest tightness and fatigue.

Pneumonia and recurring respiratory infections

Pulmonologists may evaluate severe, unusual, repeated or slow-to-resolve infections, particularly when another lung condition is suspected.

Tuberculosis

Tuberculosis can affect the lungs and may cause prolonged cough, fever, night sweats, weight loss or coughing blood. Testing and treatment must follow qualified medical and public-health guidance.

Interstitial lung disease and pulmonary fibrosis

Interstitial lung diseases affect the tissues surrounding the lung’s air sacs and may cause progressive breathlessness, dry cough and abnormal imaging.

Nagarik Hospital identifies Dr. Rakshya Pandey as a Pulmonology, Critical Care and ILD Specialist with an interest in interstitial lung disease, airway disease and advanced bronchoscopy.

Bronchiectasis

Bronchiectasis involves damaged and widened airways that may collect mucus and contribute to repeated infection, chronic cough and sputum production.

Pleural conditions

The pleura are thin layers around the lungs. Pulmonologists may evaluate pleural fluid, inflammation or air around the lung.

Sleep-related breathing disorders

Pulmonary and sleep physicians may assess sleep apnoea, night-time oxygen problems and breathing disturbances during sleep.

Occupational and environmental lung disease

Exposure to dust, smoke, fibres, chemicals and fumes can affect the lungs. Diagnosis often requires a detailed work history alongside lung-function tests and imaging.

Critical respiratory illness

Pulmonary critical-care specialists also manage severe pneumonia, respiratory failure, serious asthma or COPD attacks and other conditions requiring close monitoring.

For a broader overview, see Nagarik Hospital’s guide to pulmonology and critical care in Nepal.

How does a pulmonologist check your lungs?

A pulmonologist does not rely on one test. Evaluation typically combines the symptom history, physical examination and selected investigations.

Not every patient needs every test.

Medical and exposure history

The doctor may ask:

• When the symptom started
• Whether it is improving or worsening
• What triggers it
• Whether symptoms occur at night
• How symptoms affect exercise and sleep
• Whether mucus or blood is present
• Previous infections or hospital admissions
• Smoking and second-hand smoke exposure
• Work-related dust, smoke or chemical exposure
• Household cooking-smoke exposure
• Previous tuberculosis exposure
• Current medicines and inhalers
• Family history
• Previous imaging and test results

The pattern may be as important as the symptom itself.

Physical examination

The pulmonologist may:

• Observe breathing rate and effort
• Listen for wheezing, crackles or reduced air entry
• Check the chest and upper airway
• Look for signs of low oxygen
• Assess swelling or other findings that could suggest heart or systemic disease

A normal examination does not always exclude asthma or another intermittent condition.

Pulse oximetry

A pulse oximeter estimates oxygen saturation through a sensor placed on a finger.

The result must be interpreted with the person’s symptoms, circulation, altitude, device quality and clinical condition. A normal reading does not rule out every lung disease.

Spirometry

Spirometry measures how much air a person can breathe out and how quickly it can be exhaled.

It is commonly used when asthma or COPD is suspected and can help assess airflow obstruction. The American Thoracic Society describes spirometry, diffusion studies and body plethysmography as common pulmonary function tests.

Full pulmonary function testing

Additional breathing tests may measure:

• Lung volumes
• Air trapping
• Gas transfer between the lungs and blood
• Response to a bronchodilator
• Changes during exercise

The specialist chooses tests according to the suspected condition.

Chest X-ray

A chest X-ray may help identify pneumonia, fluid, lung collapse, a mass or another structural change.

A normal X-ray does not exclude asthma, early COPD or every pulmonary disorder.

CT scan

A CT scan provides more detailed cross-sectional images than a standard X-ray. It may be considered for:

• Lung nodules
• Interstitial lung disease
• Bronchiectasis
• Pulmonary fibrosis
• Repeated pneumonia
• Pleural disease
• Unexplained abnormal X-rays
• Selected vascular conditions

CT involves radiation and should be used when the expected clinical value justifies it.

Laboratory and sputum tests

Blood and sputum tests may help investigate:

• Infection
• Tuberculosis
• Allergy-related inflammation
• Anaemia
• Immune conditions
• Other causes of breathlessness

Tests should be selected according to the clinical question rather than ordered as an unrestricted package.

Bronchoscopy

Bronchoscopy uses a thin flexible instrument to examine the airways.

It may help investigate:

• Persistent bleeding
• Airway blockage
• Unexplained imaging changes
• A foreign object
• Certain infections
• Lung or airway masses
• The need for tissue or fluid samples

Bronchoscopy is not a routine test for every cough.

Sleep study

A sleep study records breathing, oxygen and other body signals during sleep. It may be recommended when sleep apnoea or another sleep-related respiratory problem is suspected.

Exercise testing

Exercise-related tests can help determine how the lungs, heart and oxygen systems respond to physical activity when breathlessness is not explained by resting tests.

What happens during your first pulmonology appointment?

The first consultation usually begins with a detailed discussion rather than an immediate procedure.

The pulmonologist may:

1. Review the main symptom and its duration.
2. Ask about smoking, work and household exposures.
3. Review previous illnesses and hospital admissions.
4. Examine your current medicines and inhaler technique.
5. Review previous X-rays, CT scans and laboratory reports.
6. Perform a chest and breathing examination.
7. Check oxygen saturation.
8. Decide whether lung-function tests, imaging or laboratory tests are needed.
9. Explain possible causes without claiming certainty before evidence is available.
10. Create a treatment, testing or follow-up plan.

Some patients receive a working diagnosis at the first visit. Others need further testing because several conditions can cause similar symptoms.

How should you prepare for a pulmonology consultation?

Bringing organized information can make the appointment more useful.

Prepare a symptom timeline

Record:

• When symptoms began
• What makes them better or worse
• Whether they occur during sleep or exercise
• How far you can walk before becoming breathless
• Whether mucus or blood is present
• Any fever, weight change or night sweats

Bring previous reports

Bring available:

• Chest X-rays
• CT scans
• Pulmonary function results
• Blood reports
• Sputum or tuberculosis reports
• Hospital discharge papers
• Previous prescriptions

Images on a CD, digital portal or film may provide information not included in the written report.

Bring your medicines and inhalers

A list is helpful, but bringing the inhaler devices allows the clinician to check technique.

Include medicines used regularly, occasionally and without prescription.

Document exposure history

Prepare information about:

• Current and previous smoking
• Second-hand smoke
• Cooking fuels and indoor smoke
• Workplace dust
• Chemical or industrial exposure
• Birds, mould or other possible environmental triggers
• Previous tuberculosis exposure

Write down your questions

Patients often forget important questions during a medical consultation. A short written list helps keep the discussion focused.

Pulmonary care in Bhaktapur near Kathmandu

Nagarik Community Teaching Hospital is located in Gatthaghar, Bhaktapur, within the wider Kathmandu Valley. This location allows the hospital to serve patients from Bhaktapur as well as nearby areas of Kathmandu and other parts of Nepal without inaccurately claiming a Kathmandu city address.

The hospital publicly lists:

• A Pulmonary & Critical Care Department
• Pulmonary rehabilitation
• Sleep-laboratory support
• Critical-care facilities
• Specialist pulmonologists
• An online appointment pathway
• 24-hour emergency and ambulance contact information

Relevant listed specialists include:

• Dr. Kundan Singh Karki, Senior Consultant Physician and Pulmonologist
• Dr. Rakshya Pandey, Pulmonology, Critical Care and ILD Specialist
• Dr. Raju Pangeni, Pulmonary, Critical Care and Sleep Physician

Patients should confirm the doctor’s current schedule and service availability when booking.

Questions to ask your pulmonologist

Consider asking:

1. What are the most likely causes of my symptoms?
2. Which serious causes need to be excluded?
3. Do I need spirometry or another lung-function test?
4. Is chest imaging necessary?
5. Could my work or environment be contributing?
6. Am I using my inhaler correctly?
7. Which symptoms should make me seek emergency care?
8. When should I return for follow-up?
9. What changes should I track at home?
10. Would pulmonary rehabilitation help me?
11. Do I need a sleep assessment?
12. Should another specialist also be involved?

Clear questions support shared decision-making and help the patient understand why each test or treatment is recommended.

Key takeaways

• A pulmonologist specializes in lung, airway and breathing conditions.
• Persistent cough, unexplained breathlessness, recurring wheezing and repeated chest infections are common reasons to request a pulmonary assessment.
• Asthma that remains difficult to control may need specialist evaluation.
• Coughing blood, abnormal imaging and sleep-related breathing pauses should not be ignored.
• Sudden severe breathlessness, bluish lips, confusion or significant bleeding requires emergency care.
• Pulmonologists may use spirometry, oxygen measurement, imaging, sputum testing, bronchoscopy or sleep studies.
• Not every person needs every pulmonary test.
• Nagarik Hospital is located in Gatthaghar, Bhaktapur, near Kathmandu and serves patients from the wider Kathmandu Valley and Nepal.
• Medical content should support not replace an individualized consultation.

FAQs

What are the signs you need to see a pulmonologist?

Consider seeing a pulmonologist for a cough lasting several weeks, unexplained shortness of breath, repeated wheezing, difficult-to-control asthma, recurring bronchitis or pneumonia, long-term mucus production, abnormal chest imaging or breathing problems during sleep. Sudden severe breathlessness, bluish lips, confusion or significant coughing of blood requires emergency care rather than a routine appointment.

What are three conditions treated by a pulmonologist?

Three common conditions treated by pulmonologists are asthma, chronic obstructive pulmonary disease and pneumonia or recurring lung infections. Pulmonologists also manage interstitial lung disease, pulmonary fibrosis, bronchiectasis, pleural disease, occupational lung conditions and sleep-related breathing disorders. The appropriate specialist may depend on the condition’s complexity and the tests or procedures required.

Should I see a pulmonologist for bronchitis?

A first uncomplicated episode of acute bronchitis can usually be assessed by a general physician. Consider a pulmonologist when bronchitis repeatedly returns, the cough lasts longer than three weeks, breathing becomes difficult, wheezing continues, imaging is abnormal or you have asthma, COPD or another existing lung disease.

What are the early warning signs of lung disease?

Early warning signs may include a persistent cough, increasing breathlessness during routine activities, recurring wheezing, excess mucus, repeated chest infections, chest tightness and reduced exercise tolerance. These symptoms have several possible causes and do not confirm lung disease by themselves. A professional assessment is appropriate when symptoms persist, recur or become progressively worse.

How do pulmonologists check the lungs?

Pulmonologists assess the symptom history, listen to the chest and may measure oxygen saturation. Depending on the clinical question, they may recommend spirometry, full pulmonary function tests, chest X-ray, CT, sputum or blood tests, bronchoscopy, sleep testing or exercise assessment. Not every patient requires every investigation.

How do I know if I have pulmonary disease?

Symptoms alone cannot reliably confirm pulmonary disease because heart conditions, anaemia, infections, physical deconditioning and other problems can cause similar symptoms. A diagnosis generally requires medical history, examination and selected tests. Seek assessment when cough, wheezing, breathlessness or recurring infections persist or interfere with normal activities.

Should I see a general physician or pulmonologist first?

A general physician is a reasonable starting point for a new, mild respiratory illness. A pulmonologist may be more appropriate for persistent or recurring symptoms, abnormal imaging, uncertain diagnosis, difficult-to-control asthma, COPD, interstitial lung disease or sleep-related breathing problems. Severe or sudden symptoms should be assessed through emergency care.

Can I see a pulmonologist for shortness of breath?

Yes. A pulmonologist can investigate whether shortness of breath is related to asthma, COPD, lung infection, airway disease, pulmonary fibrosis, low oxygen or another respiratory condition. Because heart disease, anaemia and other conditions can also cause breathlessness, evaluation may involve coordination with a general physician, cardiologist or another specialist.

Do pulmonologists treat sleep apnoea?

Some pulmonologists have additional expertise in sleep medicine and assess sleep apnoea and other sleep-related breathing disorders. Evaluation may include symptoms, physical examination and an overnight sleep study. Nagarik Hospital publicly lists sleep-laboratory support and a pulmonary, critical-care and sleep physician.

Where can I find a pulmonologist near Kathmandu?

Nagarik Community Teaching Hospital is located in Gatthaghar, Bhaktapur, within the wider Kathmandu Valley and near Kathmandu. Its website lists pulmonary and critical-care services and several pulmonary specialists. Patients should review current doctor availability and request an appointment before travelling.