Written by Dr. Dixit Kumar Thakur
13+ Years Clinical Experience
| “A day in my OPD at Pulmovista Clinics looks like a mini respiratory emergency room — not because patients arrive in crisis, but because respiratory disease is everywhere in Delhi and most of it has gone undiagnosed, undertreated, or mismanaged for years before someone finally sends the patient to a specialist. By the time people sit across from me in my clinic, they usually have one question above all others: why has no one explained this to me before?” — Dr. Dixit Kumar Thakur |
I am Dr. Dixit Kumar Thakur, Senior Pulmonologist and Respiratory Disease Specialist at Pulmovista Clinics, Delhi. Over 13 years of clinical practice in this city, I have come to understand something that surprises many of my patients: most people do not know what a respiratory disease specialist actually does. They know they have been referred to a ‘lung doctor.’ They know their GP felt the condition was beyond a general practice consultation. But beyond that — what tests will be done, what conditions will be investigated, what treatments are available, and why seeing a specialist is categorically different from seeing a general physician — most patients arrive at Pulmovista Clinics without a clear picture.
This guide changes that. Written in my own words, based on 13 years of clinical practice at Pulmovista Clinics in Delhi, this is the clearest explanation I can offer of what a respiratory disease specialist does — the conditions we manage, the tools we use, the way we think, and what you can genuinely expect when you walk through the door of a specialist respiratory clinic in Delhi.
1. What Is a Respiratory Disease Specialist? The Medical Definition
A respiratory disease specialist — also called a pulmonologist, chest physician, or thoracic medicine specialist — is a physician who has completed a medical degree, followed by postgraduate training in internal medicine, followed by subspecialty fellowship training specifically in respiratory medicine and lung disease. This training typically spans 8–10 years beyond medical school and covers the full spectrum of conditions affecting the lungs, airways, pleura (lung lining), respiratory muscles, and sleep-breathing disorders.
In India, a respiratory specialist holds an MD or DNB in Respiratory Medicine (also called Pulmonary Medicine or Chest Medicine), often followed by further subspecialty training in areas such as interventional pulmonology, sleep medicine, or critical care. At Pulmovista Clinics, I completed my postgraduate training and have spent 13 years building specialist expertise in Delhi’s specific respiratory disease landscape — COPD, asthma, ILD, sleep apnea, lung infections, and the complex interplay between Delhi’s air quality and respiratory health.
Respiratory Specialist vs. General Physician: The Critical Differences
| General Physician | Respiratory Disease Specialist (Dr. Dixit Kumar Thakur, Pulmovista Clinics) |
| Broad training across all organ systems | Deep subspecialty expertise exclusively in respiratory medicine — 8–10 years of focused training |
| Diagnoses and manages common presentations of lung conditions | Diagnoses and manages the full spectrum — from mild intermittent asthma to refractory severe asthma requiring biologic therapy; from early COPD to Stage 4 requiring pulmonary rehabilitation |
| Limited access to specialist investigations | Full lung function laboratory: spirometry, oscillometry, DLCO, body plethysmography, FeNO, CPET, 6MWT, bronchoscopy |
| Empirical antibiotic and inhaler prescribing | Microbiological-guided, phenotype-based, biomarker-informed prescribing — the right treatment for the right patient at the right dose |
| Refers for specialist opinion when uncertain | Is the specialist — the clinical endpoint for complex, unclear, or treatment-refractory respiratory disease |
| Follows basic treatment protocols | Follows and adapts the most current international guidelines — GINA 2026, GOLD 2026, ATS/ERS ILD guidelines — to the individual patient |
| No access to advanced therapies | Biologic therapy, allergen immunotherapy, long-term oxygen therapy, pulmonary rehabilitation, bronchoscopic procedures — all available at Pulmovista Clinics |
2. A Day in My OPD at Pulmovista Clinics: What I Actually See
I want to give you a real picture of what my clinical day looks like at Pulmovista Clinics — because it illustrates the breadth of what a respiratory disease specialist manages far better than any list of conditions could.
| “No two OPD days at Pulmovista are the same. But every day has the same texture: a mix of patients who are coming for the first time — frightened, often after years of misdiagnosis — and patients who have been with me for years, whose conditions I know intimately, and whose progress I track with the satisfaction of watching someone’s quality of life steadily improve. This is what respiratory medicine looks like from the inside.” — Dr. Dixit Kumar Thakur, Pulmovista Clinics, Delhi |
A Typical Morning at Pulmovista Clinics — Patient by Patient
| Patient | Presenting Complaint | What I Actually Do as a Respiratory Specialist |
| 58-year-old retired teacher, male, smoker | Breathlessness on climbing one flight of stairs; productive morning cough for 10 years; GP gave him a Salbutamol inhaler 3 years ago | Spirometry reveals GOLD Stage 3 COPD — never formally diagnosed. Switch to LAMA+LABA+ICS triple therapy. Refer for pulmonary rehabilitation. Smoking cessation pharmacotherapy. Influenza and pneumococcal vaccination. First formal diagnosis after 10 years of symptoms. |
| 34-year-old IT professional, female, non-smoker | Waking at night with cough and breathlessness; worse in winter; using rescue inhaler 4× per week | FeNO of 58 ppb — significant eosinophilic inflammation. Allergy panel: strongly positive for house dust mite. Diagnosis: moderate allergic asthma. Switch to SMART therapy (ICS-formoterol). Allergen immunotherapy counselling. Written asthma action plan provided. |
| 71-year-old retired government officer | Snoring reported by wife; falling asleep during daytime conversations; morning headaches | STOP-BANG score 6 — high risk. Sleep study arranged. Severe OSA confirmed (AHI 42/hour). CPAP initiated. Hypertension management reviewed in context of OSA. |
| 45-year-old housewife, progressive breathlessness over 18 months | Referred by GP as ‘asthma not responding to treatment’; two courses of oral steroids with partial response | Spirometry shows restrictive pattern. DLCO markedly reduced. HRCT shows bilateral ground-glass opacities and honeycombing. Diagnosis: Idiopathic Pulmonary Fibrosis (IPF) — not asthma. Anti-fibrotic therapy initiated. Pulmonary rehabilitation referral. Multidisciplinary team discussion. |
| 28-year-old software engineer | Recurring chest infections — 5 in the past 12 months; each treated with antibiotics by GP; ‘fully recovered’ each time | HRCT chest shows bilateral lower lobe bronchiectasis. Sputum culture grows Pseudomonas aeruginosa. Immunoglobulin panel normal. Diagnosis: post-infectious bronchiectasis. Airway clearance physiotherapy training. Sputum-guided antibiotic therapy. Long-term management plan. |
| 52-year-old diabetic patient | Referred after failed 3-drug hypertension therapy; wife reports stopping breathing at night | Suspected OSA with resistant hypertension. Home sleep test arranged. Moderate OSA confirmed. CPAP therapy significantly reduces blood pressure over 3 months — allows reduction in antihypertensive medication. |
Six patients. Six entirely different conditions. Six diagnoses that required specialist knowledge, specialist investigations, and specialist treatment that a general physician is not trained or equipped to provide. This is what a respiratory disease specialist does every day at Pulmovista Clinics.
3. The Conditions I Diagnose and Treat at Pulmovista Clinics
One of the most common misconceptions about respiratory specialists is that we only treat asthma and COPD. In reality, the scope of respiratory medicine is vast — covering every condition that affects breathing, lung function, airway structure, gas exchange, and sleep-related breathing. Here is a comprehensive overview of what I diagnose and manage at Pulmovista Clinics:
Obstructive Airway Diseases
• Asthma: All severity levels — mild intermittent to severe refractory asthma requiring biologic therapy. Allergic, non-allergic, occupational, exercise-induced, and aspirin-exacerbated variants. GINA 2026-guided management including SMART therapy, allergen immunotherapy, and all five approved biologic agents.
• COPD (Chronic Obstructive Pulmonary Disease): All GOLD stages. Emphysema, chronic bronchitis, and mixed phenotypes. Includes smoking-related and biomass fuel-related COPD — both highly prevalent in Delhi. GOLD 2026-guided triple inhaler therapy, pulmonary rehabilitation, and LTOT.
• Bronchiectasis: All causes — post-infectious, post-TB, allergic bronchopulmonary aspergillosis, immune deficiency-related, primary ciliary dyskinesia. Airway clearance therapy, sputum-guided antibiotic protocols, and long-term management.
• Tracheal and large airway disorders: Tracheal stenosis, tracheobronchomalacia, and endobronchial lesions — investigated by bronchoscopy and managed with bronchoscopic or surgical referral.
Restrictive and Interstitial Lung Diseases
• Idiopathic Pulmonary Fibrosis (IPF): Diagnosis by HRCT and multidisciplinary discussion; anti-fibrotic therapy (nintedanib, pirfenidone); pulmonary rehabilitation; oxygen therapy; transplant referral.
• Other ILDs: Hypersensitivity pneumonitis (pigeon-keeper’s lung, farmer’s lung, humidifier lung), connective tissue disease-ILD (RA-ILD, SSc-ILD, myositis-ILD), sarcoidosis, cryptogenic organising pneumonia (COP), drug-induced ILD.
• Occupational lung diseases: Silicosis, asbestosis, coal workers’ pneumoconiosis, occupational asthma — highly relevant in Delhi’s construction, stone-cutting, and manufacturing workforce.
Respiratory Infections
• Pneumonia: Community-acquired, hospital-acquired, aspiration, and opportunistic pneumonia. Microbiological-guided antibiotic selection. Management of severe pneumonia and parapneumonic effusions.
• Pulmonary tuberculosis: Diagnosis, DOTS therapy initiation, drug-resistant TB management, and long-term post-TB lung disease management.
• Non-tuberculous mycobacteria (NTM): MAC, M. abscessus, M. kansasii — increasingly important in Delhi patients with structural lung disease.
• Fungal lung infections: Invasive aspergillosis, ABPA, cryptococcal pneumonia, Pneumocystis jirovecii (PCP) in immunocompromised patients.
• Recurrent respiratory infections: Investigation for the underlying predisposing cause — bronchiectasis, immune deficiency, GERD with aspiration, structural abnormalities.
Sleep-Related Breathing Disorders
• Obstructive sleep apnea (OSA): Diagnosis by home sleep test or polysomnography; CPAP and BiPAP therapy; dental appliance referral; weight management.
• Central sleep apnea: Including Cheyne-Stokes respiration in heart failure and opioid-induced central apnea — BiPAP or ASV (adaptive servo-ventilation).
• Obesity Hypoventilation Syndrome (OHS): High-pressure BiPAP or non-invasive ventilation with careful monitoring.
• Overlap syndrome: COPD plus OSA — one of the most clinically significant and underdiagnosed combinations I manage at Pulmovista.
Pleural Diseases
• Pleural effusion: Diagnostic and therapeutic thoracentesis; analysis of pleural fluid to determine cause (transudate vs exudate, malignant vs benign).
• Pneumothorax: Management of spontaneous and secondary pneumothorax.
• Pleural thickening and mesothelioma: Investigation and oncology referral.
Pulmonary Vascular Disease
• Pulmonary hypertension: Echocardiography and right heart catheterisation referral; management of Group 3 PH (due to lung disease); collaboration with cardiology for Group 1 PAH.
• Pulmonary embolism: Diagnosis by CTPA; anticoagulation management; long-term follow-up for chronic thromboembolic disease.
Other Respiratory Conditions I Manage at Pulmovista
• Post-COVID lung syndrome: Small airway disease, persistent breathlessness, exercise intolerance, and pulmonary fibrosis — assessed with oscillometry, DLCO, and FeNO.
• Dysfunctional breathing: Hyperventilation syndrome and vocal cord dysfunction — conditions that mimic asthma and are dramatically over-treated with inhalers.
• Lung cancer screening: Low-dose CT screening for high-risk patients (heavy smokers, occupational exposures); referral and liaison with oncology for diagnosed cases.
• Cough: Chronic cough assessment — identifying the cause (post-nasal drip, GERD, asthma, ACE inhibitor, eosinophilic bronchitis) and treating it specifically.
4. The Tools I Use: What Investigations a Respiratory Specialist Performs
Part of what distinguishes a respiratory disease specialist from a general physician is access to — and expertise in interpreting — a comprehensive range of specialist investigations. At Pulmovista Clinics, the following diagnostic tools are available or accessible through our established referral network:
Lung Function Laboratory at Pulmovista Clinics
| Test | What It Tells Me |
| Spirometry + bronchodilator reversibility | Confirms airflow obstruction; distinguishes asthma from COPD; classifies GOLD stage |
| Oscillometry (IOS/FOT) | Detects small airway disease before spirometry is abnormal; maps peripheral airway resistance |
| DLCO (Diffusing Capacity) | Measures oxygen transfer efficiency — essential for ILD and emphysema assessment |
| Body Plethysmography (Lung Volumes) | Measures TLC, RV, FRC — confirms restriction; quantifies hyperinflation and gas trapping |
| FeNO (Fractional Exhaled Nitric Oxide) | Quantifies eosinophilic airway inflammation — guides ICS dosing and biologic selection |
| 6-Minute Walk Test with oximetry | Measures functional exercise capacity; identifies exertional desaturation |
| CPET (Cardiopulmonary Exercise Testing) | Gold standard for unexplained breathlessness — separates respiratory, cardiac, and deconditioning causes |
| Peak Flow Monitoring | Home-based asthma monitoring — variability pattern helps diagnose and assess control |
Imaging I Interpret and Order
• HRCT Chest: High-resolution CT — essential for bronchiectasis, ILD, and complex infection diagnosis. A chest X-ray is not sufficient for these conditions.
• CTPA (CT Pulmonary Angiography): For suspected pulmonary embolism.
• Low-dose CT Chest: Lung cancer screening in high-risk patients.
• Chest X-ray: Baseline assessment, monitoring, and acute presentation review.
• Echocardiography: For pulmonary hypertension assessment and cardiac contribution to breathlessness.
Procedures Performed by Respiratory Specialists
• Bronchoscopy: A flexible camera passed through the nose or mouth into the airways — for visualising airway anatomy, taking biopsy samples, retrieving foreign bodies, and obtaining BAL (bronchoalveolar lavage) samples for microbiological and cytological analysis.
• Thoracentesis: Draining fluid from around the lung (pleural effusion) — both for diagnosis (analysing the fluid) and treatment (relieving breathlessness from large effusions).
• Endobronchial Ultrasound (EBUS): A bronchoscopic technique that uses ultrasound to sample lymph nodes adjacent to the airways — used for staging lung cancer and diagnosing sarcoidosis without open surgery.
• Sleep Study (Polysomnography): Overnight monitoring of sleep, breathing, oxygen levels, heart rhythm, and muscle activity — the gold standard for OSA diagnosis.
• CPAP and BiPAP Initiation: Prescribing, titrating, and monitoring positive airway pressure therapy for sleep-related breathing disorders.
Biomarker Tests I Use Regularly
| Biomarker | Clinical Use at Pulmovista Clinics |
| Blood eosinophil count | Guides ICS therapy in COPD; key eligibility criterion for anti-IL-5 biologic therapy in asthma |
| Total serum IgE + allergen-specific IgE | Confirms allergic sensitisation; guides Omalizumab biologic therapy eligibility |
| Serum immunoglobulins (IgG, IgA, IgM) | Screens for primary immune deficiency in recurrent infection patients |
| Anti-nuclear antibody (ANA), RF, anti-CCP, ANCA | Screens for connective tissue disease-associated ILD |
| Serum ACE | Elevated in sarcoidosis — supports diagnosis alongside HRCT and biopsy |
| Aspergillus IgE + precipitins + galactomannan | ABPA diagnosis and monitoring; invasive aspergillosis detection |
| Sputum microbiology (culture & sensitivity) | Guides antibiotic selection in COPD exacerbations, bronchiectasis, and pneumonia |
| AFB smear and culture | Tuberculosis diagnosis and monitoring |
5. The Treatments I Provide: Advanced Therapies Available at Pulmovista Clinics
A respiratory disease specialist does not just diagnose — we treat. And the treatment options available to a specialist are fundamentally different from what a general physician can prescribe. Here is what I can offer patients at Pulmovista Clinics that is not available in general practice:
Biologic Therapy for Severe Asthma
Biologic therapies are precision-medicine injections that target specific molecular pathways driving severe airway inflammation. At Pulmovista Clinics, I prescribe all five currently approved biologics for severe asthma:
• Omalizumab (Xolair): Anti-IgE — for severe allergic asthma with elevated total IgE
• Mepolizumab (Nucala): Anti-IL-5 — for severe eosinophilic asthma
• Benralizumab (Fasenra): Anti-IL-5Rα — rapid eosinophil depletion; 8-weekly maintenance
• Dupilumab (Dupixent): Anti-IL-4/IL-13 — dual pathway; also treats atopic dermatitis and CRSwNP
• Tezepelumab (Tezspire): Anti-TSLP — broadest eligibility; effective across all severe asthma phenotypes
SMART Therapy for Asthma
GINA 2026-preferred treatment strategy — a single ICS-formoterol inhaler used as both daily maintenance and as-needed rescue. Dramatically superior to traditional SABA-only rescue in reducing exacerbations. Standard prescribing at Pulmovista Clinics for eligible patients.
Pulmonary Rehabilitation
A comprehensive, medically supervised programme of exercise training, breathing techniques, nutrition support, and psychological care — the most evidence-based intervention for COPD, ILD, and post-COVID lung syndrome. The Pulmovista Clinics pulmonary rehabilitation programme is personally designed and supervised by me, adapted to the individual patient’s lung function, exercise capacity, and clinical profile.
Long-Term Oxygen Therapy (LTOT)
Prescribed for patients with Stage 4 COPD and chronic resting hypoxaemia — the only pharmacological intervention proven to improve survival in very severe COPD. At Pulmovista Clinics, LTOT is prescribed after formal arterial blood gas assessment, with regular monitoring and titration.
Allergen Immunotherapy
For patients with confirmed allergic sensitisation driving asthma or allergic rhinitis — subcutaneous injections (SCIT) or sublingual drops/tablets (SLIT) that progressively modify the immune response to specific allergens over 3–5 years. Available at Pulmovista Clinics for Delhi-relevant allergens including house dust mite, Prosopis pollen, Aspergillus, and grass pollens.
Anti-Fibrotic Therapy for ILD
Nintedanib (Ofev) and pirfenidone (Esbriet) — the two approved anti-fibrotic medications for Idiopathic Pulmonary Fibrosis. These slow the rate of lung function decline and are prescribed and monitored at Pulmovista Clinics with regular spirometry, DLCO, and liver function monitoring.
CPAP and BiPAP Therapy
Full positive airway pressure service at Pulmovista Clinics — from initial titration study through mask selection, compliance monitoring, and long-term follow-up. BiPAP for complex sleep apnea, overlap syndrome, and obesity hypoventilation.
6. When Should You See a Respiratory Disease Specialist in Delhi? Dr. Dixit Kumar Thakur’s Referral Guide
One of the most important pieces of awareness content I can provide as a respiratory disease specialist in Delhi is a clear guide to when a general physician consultation is sufficient — and when specialist review at Pulmovista Clinics is necessary. Many patients wait far too long before seeing a specialist, often because they do not realise that what they are experiencing warrants one.
See a Respiratory Disease Specialist Urgently if You Have:
| ⚠ Urgent Indications for Specialist Referral to Pulmovista Clinics ⚠ 2 or more severe asthma attacks in the past 12 months requiring oral steroids, ER visits, or hospitalisation ⚠ Breathlessness at rest or on minimal exertion — unable to walk across a room without stopping ⚠ Coughing up blood (haemoptysis) — even a single episode ⚠ Suspected lung cancer — unexplained weight loss, persistent cough, voice change, or smoking history with new respiratory symptoms ⚠ 2 or more pneumonias in 12 months — recurrent pneumonia is almost always a sign of underlying disease ⚠ Progressive breathlessness over weeks to months — particularly with dry cough and no wheeze (possible ILD) ⚠ SpO₂ below 94% at rest — measured on a pulse oximeter ⚠ Severe sleep apnea symptoms — witnessed breathing pauses, waking gasping, excessive daytime sleepiness affecting driving safety |
See a Respiratory Disease Specialist for Planned Review if You Have:
| ✔ Non-Urgent Indications for Specialist Assessment at Pulmovista Clinics ✔ Asthma using rescue inhaler more than twice per week — indicates uncontrolled disease ✔ COPD diagnosis without formal spirometry confirmation — many patients have been labelled COPD incorrectly ✔ Chronic cough lasting more than 8 weeks — needs systematic investigation ✔ Spirometry report showing abnormality that has not been fully explained or treated ✔ Breathlessness disproportionate to apparent fitness level or lung function ✔ 3 or more chest infections in 12 months — hidden cause investigation needed ✔ Sleep symptoms — loud snoring, witnessed apneas, unexplained daytime fatigue ✔ Occupational exposure to dust, fumes, or chemicals with respiratory symptoms ✔ Family history of pulmonary fibrosis, alpha-1 antitrypsin deficiency, or cystic fibrosis with any respiratory symptoms ✔ Asthma or COPD in a patient who is pregnant or planning pregnancy — specialist management required |
7. My First Appointment at Pulmovista Clinics: What Happens, Step by Step
For patients coming to Pulmovista Clinics for the first time, uncertainty about what to expect is completely natural. Let me walk you through exactly what a new patient consultation with me involves — so you arrive prepared and leave with answers.
| 📋 What Happens at Your First Appointment with Dr. Dixit Kumar Thakur at Pulmovista Clinics STEP 1 — Detailed History (20–30 minutes): I take a thorough history covering your symptoms, their duration and pattern, what makes them better or worse, your smoking history, occupational and domestic exposures, family history, medication history, and previous investigations. I ask questions that general physicians often do not — about sleep quality, nocturnal symptoms, exercise capacity, seasonal variation, and psychological impact. STEP 2 — Physical Examination: Respiratory examination including auscultation (listening) of all lung fields, assessment of respiratory rate and effort, oxygen saturation measurement, examination of the upper airway and nose, and relevant systemic examination (clubbing, lymph nodes, signs of connective tissue disease). STEP 3 — On-Site Investigations (same day where appropriate): Spirometry with bronchodilator reversibility is performed during the first appointment for almost all new patients. FeNO is added for suspected asthma. Blood tests are arranged the same day. STEP 4 — Review of Previous Investigations: I personally review all previous X-rays, CT scans, spirometry reports, and blood results — often finding diagnostic information that was overlooked or misinterpreted. STEP 5 — Diagnosis and Treatment Discussion: I explain my clinical assessment, the likely diagnosis (or differential diagnoses if further testing is needed), and the proposed investigation and treatment plan in clear, accessible language. I do not use unexplained jargon. I encourage questions. STEP 6 — Written Plan and Follow-Up: Every Pulmovista patient leaves with a written prescription, a written action plan for their condition, and a scheduled follow-up appointment. You are never left without a clear next step. |
Conclusion: Respiratory Medicine in Delhi Is Different — And You Deserve a Specialist Who Knows It
After 13 years of practice as a respiratory disease specialist in Delhi, the question I am asked most often — in different forms, by different patients — is some version of: ‘Why did it take so long for someone to find this?’ The answer, almost always, is that respiratory disease is complex, that general practice does not have the tools or the time to fully investigate it, and that specialist care — the kind available at Pulmovista Clinics — makes a categorically different level of diagnosis and treatment possible.
If you have been living with breathlessness, cough, recurrent infections, poor sleep, or any respiratory symptom that has not been fully explained or effectively treated — you deserve a thorough specialist assessment. Not another antibiotic course. Not another blue inhaler. A proper, comprehensive evaluation by a pulmonologist who has the training, the tools, and the clinical experience to find the answer and treat it correctly.
That is what I do at Pulmovista Clinics every day. And it is what I would like to do for you.
