WHAT IS A PEDIATRIC PULMONOLOGIST?

The person with expert skills in assessing, diagnosing and treating infants, children and teenagers who have lung diseases, lung disorders or other types of breathing problems. All types of lung diseases or breathing disorders are evaluated as such:

  • Aspiration
  • Asthma
  • Cystic fibrosis
  • Hereditary hemorrhagic telangiectasia (HHT) screening and care
  • Neurologic disease causing weakness of breathing muscles
  • Respiratory disease in congenital heart disease
  • Respiratory distress syndrome (RDS), including bronchopulmonary dysplasia (BPD), a serious breathing disorder more common in premature newborns
  • Sleep-disordered breathing, including obstructive sleep apnea
  • Other diseases with lung involvement, such as inflammatory bowel disease with pulmonary complications, or vasculitis

PULMONARY TESTS AND PROCEDURES FOR CHILDREN:

These are physical examinations that provide comprehensive diagnostic testing as well as numerous diagnostic and therapeutic procedures:

  1. Flexible fiber optic bronchoscopy - This is an important procedure for evaluating the airway, vocal cords, trachea, bronchi and bronchioles of children. This procedure will put the child under sedation while a special instrument with a tiny camera is passed through either the nose or mouth into the lungs. The camera on the bronchoscope allows the pediatric pulmonologist to view the anatomy through the scope or on a video monitor.
  2. Polysomnography (sleep study) interpretation - This is a sleep test used to diagnose sleep disorders in children. During the procedure, information is collected regarding:
    1. Brain waves
    2. Blood oxygen levels
    3. Eye and leg movements
    4. Respiratory effort or events
    5. Heart rhythm
  3. Simple exercise testing - This is evaluated through the body's response to exercise. Your child may be recommended for one of the following depending on the pulmonary condition being tested:
    1. 6-minute walk test (simple pulmonary stress test) - This will measure how far the patient can walk in 6 minutes. At the end of the test, it will be rated on the child's shortness of breath from 0-10 on a special scale.
    2. Cardio pulmonary exercise test (CPET) - This is a 12 to 15 minute test that measures breathing variations, as well as blood flow and oxygen flow to the muscles during exercise.
    3. Exercise-induced asthma challenge - This measure functionality of the lungs before and after exercise. Testing is similar to CPET, but for a shorter time period and with no resistance. It is used to identify exercise-induced asthma, to set exercise limits, or to evaluate the effectiveness of current medications.
  4. Pulse oximetry - This is a non-invasive test that is used for monitoring the oxygen saturation in the blood. A sensor device is placed on the patient's body, usually the fingertip, which transmits wavelengths of light that pass through a pulsating capillary bed to a photodetector. The photodetector measures absorbency of the wavelengths to determine blood oxygen levels. Often used overnight to determine if oxygen levels drop during sleep.
  5. Radiological imaging studies - These are several radiological imaging studies that may be used in determining pulmonary conditiosn or disorders. Thoracic (chest) imaging can be instrumental in diagnosing, as well as evaluating treatment effectiveness in conditions such as asthma, pneumonia, pulmonary embolism and cystic fibrosis. The imaging studies include:
    1. X-ray
    2. Computerized axial tomography (CAT or CT) scan
    3. Magnetic resonance imaging (MRI)
    4. Ultrasound
  6. Oxygen and carbon dioxide monitoring - This involves attaching electrode-containing sensors to the skin to measure oxygen and carbon dioxide levels in the blood. The electrodes warm the skin, which causes capillary dilation resulting in an increase in blood flow and oxygen delivery to the skin surface. The sensors are connected to a monitor where the oxygen and cabon dioxide levels are displayed. Oxygen and carbon dioxide levels may also be measured by performing an arterial blood gas (ABG) test. An ABG test uses the blood taken from an artery to measure:
    1. Partial pressure of oxygen
    2. Partial pressure of carbon dioxide
    3. Bicarbonate
    4. pH
    5. Oxygen content and saturation values
    6. ABG testing can identify how efficiently the lungs remove carbon dioxide from the blood and move oxygen into the blood.
  7. Pulmonary function testing - This is a series of breathing tests that measure lung function. PTF is used to determine hwo efficiently the lungs take in and exhale air and transfer oxygen to the blood. PFT is usually performed to:
    1. Diagnose respiratory conditions
    2. Assess lung and airway growth
    3. Monitor chronic respiratory conditions
    4. Evaluate medication effectiveness
    5. Pulmonary function testing may include:
      1. Spirometry
      2. Oscillometry
      3. Exercise testing
      4. Lung volume measurements
  8. Fraction of exhaled nitric oxide testing - This is measuring the fraction of exhaled nitric oxide (FeNO) and is a useful method of evaluating therapy in individual patients. It has proved useful as a noninvasive marker of airway inflammation, in order to guide adjustment of the dose of inhaled corticosteroids.
  9. Spirometry (lung function test) and bronchodilator response - This is the most common pulmonary function test that is used to measure lung function. During a spirometry test, the patient breathes into a mouthpiece, usually while sitting in a special booth called a body plethysmograph. The mouthpiece is connected to a spirometer that records the amount and rate of air being inhaled and exhaled. Spirometry testing is used to diagnose certain lung conditions, including:
    1. Asthma
    2. Chronic obstructive pulmonary disease (COPD)
    3. Bronchitis
    4. Emphysema
    5. Pulmonary fibrosis
  10. Sweat test - This is the most reliable method for diagnosing cystic fibrosis (CF). It involves measuring the amount of chloride and sodium (salt) present in the patient's sweat. This test is not painful and usually takes approximately 30 minutes. In general, results of the test are available the same day.