Chest X-Ray

Most new patients will need a chest x-ray. This is essential in evaluating your child's lungs. It allows our care providers to evaluate your child's lung potential problems or to identify a healthy baseline.

If you have had a recent chest x-ray, please bring the actual film to the office (this is easily requested wherever you had it performed). If you bring a print out of an interpretation or your doctor's office faxes an interpretation, it is not adequate and will have to be repeated.

We can only make an assessment based on our own interpretation of the picture and rely on trained pediatric radiologists to re-read every study as well. The radiation your child receives as a result of a chest x-ray is so minimal, it is similar to a 4 hour airplane ride.

Always arrive 45 mins prior to your initial office visit so that we can send you for a chest x-ray before your visit.

Bronchoscopy

This is a procedure performed with a "bronchoscope" which is a long thin tube with a suction port and a fiberoptic camera. There are two main reasons for a child undergoing a bronchoscopy. First, it allows the doctor to visualize the airways of the child from the nasal passage down to the small airways in the lungs. Secondly, it allows for suctioning of sputum or mucous and to take and analyze that sample for bacterial, viral, fungal growth and to look at certain cells that may be present indicating certain disease states.

It also allows us to analyze the sample for cells that may indicate that there is aspiration of food/formula from stomach contents after reflux events or from the mouth when swallowing. We are also able to use sterile saline water to "wash out" certain areas of the lung which may help in healing in certain instances.

Bronchoscopies are performed in the surgical suite and done under general anesthesia, with a pediatric anesthesiology team monitoring your child. This has been proven to be a more "patient friendly" method and allows your child to undergo this procedure with minimal pain or discomfort.

In general, this is an outpatient procedure and takes 10-15 minutes to perform but with the entire pre and post procedure monitoring will take upwards of 4-6 hours. If your child is an infant, they will need to be observed for longer due to hospital anesthesia protocol.

Your child will need to be "NPO" for this procedure, which means he/she can not eat, drink or even chew gum for a certain amount of hours before the procedure.

Pulmonary Function Testing (PFT)

These are what we frequently call "pft's" in the office. This is a test to assess the airflow in and out of the airways in your child's lungs and to measure their lung volumes during different breaths. This is the gold standard to diagnose asthma and a host of other disease states. This test is done many times with the use of a "bronchodilator" such as albuterol or Xopenex, to measure if your airflows improve with these medicines.

We have two certified respiratory therapists in our office that can do these tests. We also have a more complete lung finction lab in the hospital that can provide diagnostic testing including:

• Spirometry
• Spirometry after bronchodilation
• Flow-volume loops
• Single breath diffusion capacity (DLCO)
• Body plethysmography
• Pulse oximetry
• Cardiopulmonary exercise test- this can test whether or not there are changes in air flow in the lungs, oxygen delivery, or heart problems during strenuous exercise.
• Exercise provocation test -this can be used to identify "Exercise Induced Asthma".
  Methacholine challenge
• Maximal inspiratory/expiratory pressures

If your child is currently using a rescue inhaler of any kind, or a long acting bronchodilator such as Advair or Symbicort, please refrain from using them the day of your appointment. This will allow us to get an accurate measure of your child's baseline lung function.

Capillary blood gas (CBG)/ Arterial blood gas testing (ABG):

This is a test that is performed to measure the amount acid/base balance in the blood, oxygen content and carbon dioxide content. This is essential in assessing the function of the lungs in children with certain long term lung disease, including chronic lung disease of prematurity. It is collected using a finger prick (CBG) or a needle (ABG).