What is a Paediatric Pulmonologist (Lung Specialist)?
Paediatric pulmonologists are paediatricians who specialize in treating children with lung and/or breathing problems. We are also known as respiratory or lung specialists in some countries. We treat a wide variety of diseases affecting the airways, lungs or breathing. Common conditions we treat include:
- Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy
Other less common conditions treated by a paediatric pulmonologist include:
- Apnea (Babies/children with apnea will stop breathing, or "forget" to breathe)
- Technology-dependent children, for example children with a tracheostomy who require oxygen or a ventilator to help them breathe.
- Neuromuscular respiratory diseases and muscle weakness
- Cystic fibrosis
- Congenital lung abnormalities
What education/training does a paediatric pulmonologist have?
In South Africa a paediatric pulmonologist is a paediatrician who, after receiving a medical degree (M.B.Ch.B), complete 4 years of registrar training in paediatric medicine, followed by at least two additional years of subspeciality fellowship training in paediatric pulmonology. After satisfactorily completing a fellowship in paediatric pulmonary medicine, the physician is permitted to take the board certification examination of the College of Medicine of South Africa (CMSA) in paediatric pulmonary medicine. After passing this exam, the physician is then certified as a paediatric pulmonologist.
What to expect during a paediatric pulmonology visit?
Your first visit will be at least an hour long. Follow up visits are usually 30 minutes long. The paediatric pulmonologist, >Dr Fiona Kritzinger, begins the consultation with an opportunity which allows you to express your concerns regarding your child’s health. Then she asks general questions regarding your child's birth, past medical history, growth and development as well as specific questions related to lung and breathing disorders.
She then performs a general physical examination with specific focus on the respiratory system. Once she has completed her clinical assessment she may discuss the need and reason for further investigations or procedures if it is indicated. Some of the tests and procedures which she may recommend or perform are listed below:
Common tests and procedures in paediatric pulmonology
The paediatric pulmonologist may utilise some of the following investigations to diagnose or follow on your child's lung or breathing disorder:
1. Laboratory investigation of blood (blood tests)
to exclude allergy and immune system dysfunction for example. Sometimes arterial blood gas measurements are also required to assess the function of the respiratory system.
2. Imaging studies:
For example X-ray, Computerized axial tomography (CAT or CT) scan, Magnetic resonance imaging (MRI) and Ultrasound.
3. Oxygen and carbon dioxide monitoring
4. Pulmonary function testing
Pulmonary function testing is a series of breathing tests. It measures how well your child's lungs are working. If your child takes medicine to help him breathe, pulmonary function testing can help figure out how well the medicine is working. Pulmonary function tests do not hurt.
5. Sweat test:
A sweat test measures the amount of chloride and sodium in the patient's sweat. It takes up to 30 minutes to collect the sweat in a small plastic container that is placed around the forearm (similar to a watch). A high level of chloride or sodium can be an indication of cystic fibrosis. Most children referred for a sweat test will NOT have cystic fibrosis, but the test is still necessary to rule out the possibility of cystic fibrosis in a child with a chronic lung disease.
6. Flexible fiber-optic bronchoscopy
Flexible fiber-optic bronchoscopy (FFB) allows pulmonologists to look inside the lungs with a fiber-optic scope. Using a sophisticated flexible fiber-optic instrument (flexible bronchoscope), the paediatric pulmonologist is able to explore the trachea (windpipe), main stem bronchi, and some of the small bronchi (airways). The procedure is most often used to exclude airway abnormalities and to do a bronchoalveolar lavage. This procedure may also be used to remove foreign objects that have been inhaled. It does not involve surgery, but does require sedation.
7. Bronchoalveolar lavage
This procedure helps the paediatric pulmonologist to diagnose and understand the progression of lung disease. A small, fiber-optic tube (bronchoscope) is placed into the lung, a small amount of saline is flushed into a small segment of the lung and then aspirated (sucked up) again. The sample of fluid removed contains secretions, cells, and proteins from the lungs. Doctors can analyse the sample to determine what may be occurring in the patient's lungs.
8. Polysomnography(Sleep Studies)
A polysomnography is a test performed in a hospital while the patient is asleep (usually night time) to diagnose sleep apnea. During the study we record the breathing rate, heart rate, oxygen saturation (level of oxygen in the blood), flow of air during breathing and the sleep stage of the patient by placing a variety of electrodes (stickers) and an elastic band around the chest and abdomen. This is a safe procedure and not painful.