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Pediatric Pulmonary Function Testing

Diagnosing Respiratory Disease in Children

New York, NY (Oct 29, 2009)

Boy on treadmill with physician beside him

Pulmonary Function Testing (PFT), a series of breathing maneuvers that can measure lung size, velocity of airflow, as well as gas exchange are painless and non-invasive procedures that most children age 5 or older are able to perform by following some simple directions.

The Division of Pediatric Allergy, Immunology, and Pulmonology at the Phyllis and David Komansky Center for Children's Health, which is affiliated with Weill Cornell Medical College, offers comprehensive, state-of-the-art evaluation of pediatric respiratory disease in a warm and child-friendly environment. As part of that care, the Division recently opened a Pediatric Pulmonary Function Testing Laboratory that offers the latest technologies and equipment to diagnosis and treat lung diseases and disorders in children from age three through adolescence. Staffed by pediatric pulmonologists, an exercise physiologist and technicians, the lab provides a full range of non-invasive testing and procedures to measure lung function.

Joshua P. Needleman, MD, Director of the Pediatric Pulmonary Function Laboratory and Associate Professor of Clinical Pediatrics at Weill Cornell Medical College, explains the benefits and purpose of pulmonary function testing.

"In general when you are trying to diagnose or manage respiratory disease, your main tools are a medical history, physical examination, maybe an X-ray, or occasionally a bronchoscopy," he says. "However, actual objective measurements of a patient's respiratory physiology can be extremely helpful, particularly in patients who have a known entity such as asthma, but aren't fully aware of the extent of their morbidity or disability. For example, it's common for me to meet patients who tell me that they know that they have asthma but they feel fine and have no symptoms. They truly believe it. They don't complain, they say they are comfortable, and their physical exam is unremarkable. Yet I can perform a pulmonary function test and discover their lung function is 15 to 20 percent below normal or below their best."

PFTs help to establish the cause of a patient's breathing problems. "If someone has a chronic cough, we want to know if it's related to asthma or lung disease," says Dr. Needleman. "A cough can be terribly disabling and can come from anywhere from the nose to the deepest areas of the lungs. PFTs can determine if the patient has some type of lung disease or asthma and can help measure their level of control and disease progression."

Types of Pulmonary Function Tests Performed

"We do many different types of tests – it depends on what the child needs based on their clinical picture," continues Dr. Needleman. "Some tests require more cooperation than others, however, we can measure children now at about three years of age. So much respiratory disease takes place between the ages of 3 and 5. And at that age, they can't tell you a lot and can't explain what they are feeling. Until recently we haven't had many of the tools we have now to understand what's going on."

Common pulmonary function tests performed today include:

  • Spirometry – Spirometry is the most common of the PFTs, measuring lung function, specifically the measurement of the volume and/or flow of air that can be inhaled and exhaled. Spirometry is an important tool in the evaluation of obstructive lung diseases such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease. In this test, soft clips are placed on the child's nostrils to prevent air leakage from the nose. The child places his or her mouth on a comfortable mouthpiece and is instructed to breathe in deeply and blow out with as much force as possible several times. The mouthpiece is connected to flow sensors that record the effort for analysis electronically.
  • Impulse Oscillometry – This test, which only requires passive cooperation, assesses airflow obstruction in children who are not able to perform a forced exhalation maneuver. Pulses of air make a vibrating sensation on the child's cheeks and in the chest. The child wears soft nose clips and breathes through a filtered mouthpiece, breathing normally for 20 to 30 seconds, takes a short break, and then repeats the test several times. This test can be performed on children as young as 3 years old.
  • Cardiopulmonary exercise test – Cardiopulmonary exercise test results are used to determine the cause of chest pain, evaluate fitness, heart function and the effectiveness of drug therapies. The cardiopulmonary exercise test measures how well the heart and lungs work while the child exercises. This test may be prescribed for a child who is experiencing shortness of breath, chest discomfort, low energy, reduced blood oxygen levels, or heart or lung problems.
  • Total Lung Capacity (TLC) – TLC measures the total amount of air a patient's lungs can hold. The measurement is performed in a body plethysmograph, a clear Plexiglas booth – also referred to as a "body box." The child sits inside the booth and breathes into a tube in a manner similar to spirometry, and again the tube is attached to a computer that calculates the child's lung volume, collecting pressure and airflow measurements.
  • Oxygen Saturation – This test measures the amount of oxygen being carried by the red blood cells. One method uses a device that shines a light through the nail bed of a finger and measures the amount of oxygen in the blood based on the way red blood cells carrying oxygen absorb and reflect light.
  • Medication evaluation – Following the initial lung testing, the pulmonologist may give the child bronchodilators and then repeat the lung function testing to evaluate the effectiveness of the medication.

Dr. Needleman and the PFT staff make every effort to put children and their parents at ease and comfortable during the testing. Exercise Physiologist Diane Berkovits helps to administer and monitor the basic pulmonary function tests, working closely with pulmonologists and allergists.

"The most important thing for parents to know is that these tests are very safe and that during certain tests, for example, the exercise pulmonary function test, a physician is always on hand," she says. "We take every precaution beforehand, and that includes ensuring that the patient has followed all pre-testing instructions."

Ms. Berkovits also instructs patients on asthma maintenance and prevention.

"I think the children actually have fun during the tests," she says. "We do everything we can to allay the fear and apprehensions of children and their parents – these tests are very safe, non-invasive, and always done under the supervision of specialists who are skilled in the evaluation of children with lung disorders."

Contributing faculty for this article:

Joshua P. Needleman, MD, Director of the Pediatric Pulmonary Function Laboratory, Phyllis and David Komansky Center for Children's Health, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Associate Professor of Pediatrics at Weill Cornell Medical College

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