Pulmonology


U.S. News & World Report High Performing Badge - pediatric pulmonology

he pediatric pulmonology program at UF Health Shands Children’s Hospital is ranked as one of the best programs in the nation by U.S. News & World Report.

UF Health Shands Children’s Hospital is ranked among the nation’s best by U.S News & World Report, and our pediatric pulmonary program can say the same while being the highest-ranked program in Florida.

Our pediatric pulmonary team provides a broad range of clinical and diagnostic services to infants, children and adolescents with acute and chronic respiratory disorders. The division uses a team approach and partners with families to provide comprehensive care.

We are accredited by the Cystic Fibrosis Foundation as a Cystic Fibrosis Care Center. Additionally, the division hosts multiple clinical programs dealing with severe asthma, sleep disorders, pulmonary hypertension, neuromuscular diseases, ventilator dependency, and lung transplantation, among others.

Since 1979, the division has been continuously awarded one ofsixfederally funded Pediatric Pulmonary Center training grants to provide interdisciplinary training with the goal of developing leaders in the care of children with pulmonary disorders.

In addition to the pediatric medical faculty, the division is composed of pediatric nutritionists, pediatric nurses, pediatric nurse practitioners, physician assistants, pediatric social workers, pharmacists, respiratory therapists and a family partner.

The collaboration across multidisciplinary teams is one of the reasons our pediatric pulmonary program is so unique.

Conditions treated

Centers and programs

Asthma

At UF Health, the Pediatric Pulmonary Division offers the expertise of board-certified pediatric pulmonologists, along with an interdisciplinary team of nurses, respiratory therapists, clinical pharmacists, nutritionists and social workers.

Our team endeavors to provide a family-centered, culturally appropriate approach to the development of individualized asthma plans for patients referred from their primary care providers. Asthma clinics are held on the 2nd floor of the Shands Medical Plaza.

Severe Asthma

Our pediatric severe asthma patients at UF Health are treated by the first program in North Central Florida designed specifically to address the unique clinical, environmental and systemic needs of children with severe asthma.

Patients are cared for by a multidisciplinary team, which includes a pulmonologist, asthma educator, clinical pharmacist, respiratory therapist, social worker, nutrition specialist and allergist. We offer the most advanced diagnostic testing, and we base our treatments on the newest therapeutic developments.

We pride ourselves on our strong coordination and collaboration with the UF Health Shands Pediatric Emergency Department -- and other community emergency departments – as well as inpatient services, community services and school nurses. We have a relationship with the National Center for Medical Legal Partnership, which helps our clinicians, case managers and social workers address structural programs at the root of many health inequities.

Our program has the capability of offering home visits to prevent children and their families from having to come to the office for multiple appointments.

Cystic Fibrosis

The Cystic Fibrosis Center at UF Health is an accredited pediatric center by the Cystic Fibrosis Foundation. The foundation accredits and provides partial funding for interdisciplinary pediatric and adult cystic fibrosis care centers nationwide. Staffed by dedicated professionals, these centers provide specialized CF care. Each center undergoes thorough review by the Cystic Fibrosis Foundation’s Care Center Committee before it receives accreditation and funding. This review for accreditation occurs annually.

Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive systems of about 30,000 children and adults in the United States and 70,000 people worldwide. Our goal is to provide patient- and family-centered care, while providing best practices to our patients. We provide a multidisciplinary approach to our cystic fibrosis patients. Our team is composed of physicians, nurses, respiratory therapists, pediatric psychologists, pediatric pharmacologists, social workers, cystic fibrosis dietitians and a family liaison.

Care centers also participate in CF clinical research and work to educate health care professionals and families about CF, while emphasizing the care that’s required for people living with the disease. Data from people with cystic fibrosis is collected in the national CF Foundation Patient Registry, which serves as a rich resource for your CF health care providers and CF researchers to track the health of people living with the condition in the United States.

Sleep Center

The Pediatric Sleep Disorders Clinic provides comprehensive evaluation and management for children with a wide range of sleep disorders, including obstructive sleep apnea, narcolepsy, periodic leg movements, hypersomnias and congenital hypoventilation.

Care is provided under the direction of a pediatric pulmonologist who is board certified in sleep medicine by the American Board of Sleep Medicine and the American Board of Pediatrics. Scheduling is provided through the Pediatric Pulmonary Division.

Pediatric Lung Transplant Program

The UF Health Pediatric Lung Transplant Program is the only one of its kind in Florida.

At UF Health, our multidisciplinary team offers unique medical approaches, such as lung reduction surgery, to treat children with life-threatening lung disease. Our mission is simple: to enhance each patient’s quality of life through compassionate care, access to leading-edge medical treatment and ongoing research studies at UF Health.

In 2013, the UF pediatric lung transplant team performed the first heart-lung transplant in a child under the age of 2 in the state of Florida. For more information about our pediatric lung transplant care, visit here.

Diffuse Lung Disease

UF Health’s pediatric diffuse lung disease, or DLD, program is the first in Florida devoted to caring for children with this classification of conditions. DLD, which is sometimes referred to as interstitial lung disease, or ILD, is an umbrella term used for a group of rare, but potentially severe and even fatal, lung diseases that can affect infants and children.

Management of these patients requires unique clinical expertise and a top-notch diagnostic and therapeutic approach.

Bronchopulmonary Dysplasia

The pediatric bronchopulmonary dysplasia, or BPD, program at UF Health is making great strides to create continuity of care for infants suffering from chronic lung disease. The pediatric BPD team is focused on diagnosing BPD and treating premature babies who have the condition, which can affect their growth, development and social functioning. BPD is a long-term (chronic) lung condition that affects newborn babies who were either put on a breathing machine after birth or were born very early (prematurely).

Our board-certified pulmonologists first encounter these babies in the neonatal ICU at UF Health Shands Children’s Hospital prior to their discharge, and they work with our NICU BPD team. The NICU team, in collaboration with the pulmonary division, are working on a multidisciplinary approach to babies diagnosed with BPD. The goal is to help BPD babies transition to home in the best settings and to provide good follow-up as outpatients.

Pulmonary Hypertension

Our pediatric pulmonary hypertension program at UF Health consists of a multidisciplinary team of experienced pediatric cardiologists and pediatric pulmonologists who work closely with the Congenital Heart Center and the Pediatric Cardiac Intensive Care Unit to provide clinical care for children with pulmonary hypertension, as either a primary diagnosis or secondary to heart or lung disease. Pulmonary hypertension is characterized by high blood pressure in the arteries of the lungs, forcing the right side of the heart to work harder than normal.

This program is one of the best programs for pediatric pulmonary hypertension in Florida. The pediatric pulmonology, cardiology and heart surgery programs at UF Health Shands Children’s Hospital are the highest-ranked programs in Florida for their specialties, as noted by the 2018-19 U.S. News & World Report rankings.

Pulmonary-Sickle Cell

UF Health’s pediatric pulmonary-sickle cell program is a multidisciplinary practice, established to provide a comprehensive approach for children with sickle cell disease who suffer from pulmonary complications. It is the first combined program in Florida and is one of just a few centers in the United States that offers this multidisciplinary clinical service for patients with sickle cell disease.

Sickle cell anemia is marked by red blood cells that are abnormally shaped like a sickle or crescent. These cells are fragile and are not as efficient in transporting oxygen to the body’s tissues.

Neuromuscular Disease

The UF Health Center of Pediatric Neuromuscular and Rare Diseases is a multidisciplinary program with collaboration of specialists in cardiology, neurology, pulmonology, general pediatrics, and occupational and physical therapies.

Because progressive weakness results in alterations in airway clearance, ineffective cough and difficulty breathing, the pediatric pulmonary component is essential. The prevention and treatment of the respiratory aspects of these diseases have dramatically impacted the survival of patients with neuromuscular conditions.

The UF Health Center of Pediatric Neuromuscular and Rare Diseases is a partner with the Muscular Dystrophy Association. The center operates weekly in the UF Health Medical Plaza building located in Gainesville. For more information about our center, visit us here (https://ufhealth.org/center-pediatric-neuromuscular-and-orphan-diseases-university-florida).

Ventilated Tracheostomy

Patients with chronic respiratory failure and major airway problems are likely to be technology-dependent. Our program at UF Health assists families with children who may require specialized medical equipment for their day-to-day respiratory care.

The pulmonary team is often introduced to patients and their families when they are in the newborn or pediatric intensive care units, and our providers assist in the transition to the home environment. Multiple resources are often needed, as well as nursing, respiratory therapy and medical expertise.

The goal is to optimize the quality of life of our patients and assist caregivers in managing their complex care needs. We work with home care companies and local providers to provide the best care for these children.

Diagnostics

The Pediatric Pulmonary Diagnostics Laboratory at UF Health Shands Hospital is a leading-edge facility that provides a wide spectrum of diagnostic testing for children of different age groups in order to diagnose different lung and airway diseases, while also measuring response to therapy.

The lab can perform all of the following:

Spirometry

Spirometry measures airflow and air volume as patients breathe in and out (inhales and exhales). During the test, the patient is asked to perform a series of breathing maneuvers that include taking a deep breath and exhaling very rapidly for at least six seconds. Parameters obtained during the test are then used for diagnosisof obstructive lung diseaseand suspected restrictive lung disease in children 5 years of age and older. Spirometry is also used for follow up with regards to disease progression and to demonstrate response to therapy.

Plethysmography

Plethysmographyis a test used to determine different lung volumes, including volumes of air that are not exhaled by the patient. During this test, the patient is placed inside an airtight glass chamber, also called the body box, while breathing through a tube that passes through the wall to the chamber. Differences in chamber pressures and mouth pressures are measured to calculate gas volumes inside the patient’s lungs.

This method of testing is used to evaluate for possible air trapping in the lungs due to severe airway obstruction and to diagnose restrictive lung diseases.

Lung diffusion testing

Lung diffusion testing is used to measure the transfer of gas from the lung’s air sacs to the blood. During the procedure, patients are asked to inhale a harmless amount of carbon monoxide. The difference between the amount of the inhaled carbon monoxide and the exhaled carbon monoxide is used to calculate lung diffusion capacity.

Low diffusion capacity is indicative of the presence of interstitial lung diseases (diseases that primarily affect the thin space that separates the lung air sacs from the lung blood vessels).

Infant pulmonary function

Testing of pulmonary function in infantsincludes spirometry, as well as lung volumes and airway resistance measurements, which can be performed in infants by specialized instruments and by specially trained individuals. Since infants are unable to perform most breathing maneuvers required for pulmonary function testing, such maneuvers are performed by air pumps that passively inflate the infant’s lung at safe pressures applied at the patient’s mouth and nose, and then rapidly deflate the lungs using an inflatable jacket that applies rapid compression at the infant’s chest.

The procedure is performed while the infant is sedated. The test helps diagnose infants with obstructive or restrictive lung diseases. More importantly, it helps evaluate the degree of airway obstruction caused by chronic lung diseases such as cystic fibrosis and chronic lung disease of prematurity. It also helps measure the degree of response to therapy.

Exercise challenge

Patients with suspected exercise-induced asthma may need an exercise challenge to confirm the diagnosis. The test involves performing spirometry before and after exercising for at least six minutes on a bicycle or a treadmill. A certain drop in lung function after exercise is suggestive of exercise-induced bronchospasm, which supports the diagnosis of exercise-induced asthma.

Exercise challenge with laryngoscopy

Besides performing spirometry before and after an exercise challenge, laryngoscopy may need to be performed in certain patients suspected to have exercise-induced upper airway obstruction due to vocal cord dysfunction (VCD) or laryngomalacia (floppy upper airway).

Laryngoscopy is typically performed right after exercising. A small, flexible scope is passed through one of the nasal passages to visualize the vocal cords. A numbing medicine could be placed in the nose before exercising or right before introducing the scope.

Cardiopulmonary exercise test

This test is a highly complex form of exercise testing in which patients exercise at increasing intensity until maximal capacity is reached or symptoms are reproduced. During the exercise, patients are extensively monitored by EKG, oxygen saturation and blood pressure. Cardiac and pulmonary responses to increasing exercise intensity are then determined by analyzing a few factors: the airflow and volume in and out of the patients’ lungs; the amount of oxygen being consumed; and the amount of carbon dioxide being produced with each breath.

The extensive information obtained from the patient during the test is then used to determine the patient’s overall capacity for exercise, the cause of any exercise limitation and the patient’s level of exercise conditioning.

Impulse oscillometry

Impulse Oscillometry (IOS) technique is a method of measuring airway resistance and lung compliance in children between 3 and 5 years of age, because it requires only minimal patient cooperation. It utilizes soundwaves applied at the patient’s mouth for only a few seconds while the patient is normally breathing. Upper and lower airway resistance and lung compliance are then deduced from the differences between soundwaves going to and soundwaves returning from the patient.

Exhaled nitric oxide testing

Nitric oxide is normally present in the exhaled breath but at very minute concentration. However, the concentration of exhaled nitric oxide can significantly increase when allergic inflammation of the airways is present, as is the case when a patient has asthma. Therefore, measuring the concentration of nitric oxide in the exhaled breath provides a non-invasive method to evaluate airway inflammation in asthma patients.

Bronchoscopy

Flexible bronchoscopy can be performed at UF Health Shands Hospital in children of all age groups. The procedure requires sedation and continuous monitoring. It is conducted by a team consisting of a pediatric pulmonologist, an anesthesiologist, a respiratory therapist and a nurse. A small, flexible scope is typically passed through the nose to the back of the throat, and then passed into the patients’ airways.

Besides visualizing the airways to detect possible abnormalities, flexible bronchoscopy can be used to remove secretions and foreign bodies, and also to obtain cultures and small lung biopsies.

Sleep study

A sleep study, or a polysomnogram, is a non-invasive, pain-free procedure that requires spending a night in a sleep facility. Prior to the sleep study, a sleep technician will attach monitoring leads to your body. Your breathing will be monitored by placing belts on your chest and abdomen. Any unusual body movements will also be recorded by video. A cannula will also be placed under your nose to monitor airflow and levels of carbon dioxide.

For more information, view the Sleep Study Resources.