Pediatric pulmonary medicine

Anatomy or system affected: Chest, immune system, lungs, nose, respiratory system, throat

Definition: The diagnosis and treatment of disorders of the respiratory tract in infants and children

Science and Profession

The pediatricpulmonaryspecialist is a pediatrician who has received extra training in the diagnosis and treatment of respiratory diseases. The full course of training requires a medical degree followed by three years of pediatric residency plus an additional three years of intensified study of children’s respiratory diseases. The six years of postdoctoral training are almost always conducted at a large teaching hospital.

The respiratory system has several responsibilities. Most important for life, it allows the body to take in oxygen and to eliminate carbon dioxide. It also cleans and humidifies the air that is breathed. The system contains major sensory components, particularly hearing and smell. The respiratory system is divided into two parts, the upper and lower tracts. The upper respiratory tract includes the nose, ears, paranasal sinuses, throat, and larynx. The remainder of the respiratory system, the lower respiratory tract, is within the chest and includes the trachea, lungs, and pleura (the lining between the lungs and the rib cage).

Disorders of the respiratory system are extremely common in childhood. In the first year of life, at least half of illness-related visits to the doctor are for respiratory ailments, especially ear infections and upper respiratory infections.

A child’s respiratory system is subject to a wide variety of disorders. Infections include ear infections, sinusitis, throat infections, croup, bronchitis, and pneumonia. Asthma, or reactive airway disease, is a common chronic inflammatory disease of the respiratory system that affects 5 to 10 percent of all children. The pediatric death rate from asthma rose steadily in the late twentieth century. By the late twentieth century, this ominous trend had slowed, as a result of new medications and an emphasis on patient education.

Cystic fibrosis, although much less common than asthma, is a serious inherited respiratory disorder that involves the abnormal production of mucus by the respiratory system and pancreas. Children with cystic fibrosis have a shorter-than-usual life span, although by the early twenty-first century, many of them were able to survive to young adulthood.

Pulmonary specialists often work in pediatric critical care, the provision of medical care to seriously ill or injured children. These children require careful monitoring of vital functions and management of fluids and medications. They frequently need respiratory support, such as oxygen or a ventilator. Critical care is provided in an intensive care unit.

The survival of severely premature infants has led to an increase in chronic lung disorders caused by prolonged ventilator and oxygen therapy in the intensive care nursery. Pediatric pulmonary specialists are responsible for the long-term care of these patients, along with neonatologists, specialists in newborn care.

The majority of a pediatric pulmonary specialist’s time is spent in the clinic, examining and treating children with respiratory ailments. Patient education is important in this specialty, particularly for families of children with chronic respiratory diseases such as asthma. Because pulmonary specialists hospitalize more patients than many other pediatric specialists, a substantial amount of their time is spent in the hospital. The care of critically ill children, in particular, is extremely time-consuming.

The two most severe adult respiratory diseases, lung or laryngeal cancer and chronic pulmonary disease resulting from smoking, virtually never occur in children. Nevertheless, the behaviors and habits that lead to these diseases may begin in childhood. Pediatric pulmonary specialists are active advocates of child and parent education regarding the risks of these behaviors.

Diagnostic and Treatment Techniques

A careful medical history and a thorough physical examination of the entire body, not simply of the respiratory system, are the pulmonary specialist’s most important tools. The physician augments this information with a variety of laboratory tests, radiographic studies, and special pulmonary procedures.

Pulmonary function testing involves the measurement of various volumes of air in the lungs during the cycle of inhaling and exhaling and a determination of the speed with which the patient can exhale. It helps to diagnose whether the patient suffers from restriction of lung movement or obstruction of air movement in and out of the lungs. It is most useful in evaluating chronic pulmonary disorders but is not practical for young children because of the amount of patient cooperation it requires.

Bronchoscopy is performed by using a flexible, small-diameter tube of optic fibers with an external light source in order to inspect the larynx, trachea, and larger bronchi visually. Biopsies of tissue, including lung tissue, can be obtained, as can samples of mucus for laboratory testing. Bronchoscopy is helpful in pediatric pulmonary medicine for finding and retrieving objects and particles of food that have been breathed into the lower respiratory tract. This procedure is also helpful in bronchoalveolar lavage, which is the rinsing out of a segment of chronically infected or obstructed lung tissue to remove pus, mucus, and other inflammatory products.

Respiratory infections generally respond to antibiotics and, in some cases, to antiviral agents. Asthma is treated with oral and inhaled medications that counteract the swelling and congestion of the bronchi, preferably before an attack of wheezing even begins. Cystic fibrosis requires aggressive treatment to keep mucus from obstructing the lungs, as well as occasional courses of intravenous antibiotics.

Perspective and Prospects

Pediatrics, as a medical specialty, developed in the late nineteenth century. The pediatric subspecialties, including pulmonary medicine, generally became organized in the mid-twentieth century. Major advances in the 1990s, such as the discovery of the gene responsible for the molecular defect of cystic fibrosis, promise a bright future for pediatric pulmonary medicine. In the early twentieth century, advances in the diagnosis of pulmonary tuberculosis in children and as the COVID-19 pandemic swept the globe, doctors in this specialty provided specialty care to children suffering from the consequences of the disease.

Bibliography

Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. 21st ed. Saunders/Elsevier, 2020.

Crocetti, Michael, and Michael A. Barone, eds. Oski’s Essential Pediatrics. 2nd ed. Lippincott Williams & Wilkins, 2004.

Kemper, Kathi J. The Holistic Pediatrician: A Pediatrician’s Comprehensive Guide to Safe and Effective Therapies for the Twenty-five Most Common Ailments of Infants, Children, and Adolescents. Rev. ed. Quill, 2002.

Stokes, Dennis C. Pediatric Pulmonology Asthma and Sleep Medicine: A Quick Reference Guide. American Academy of Pediatrics, 2018.

Welch, Michael J., ed. American Academy of Pediatrics Guide to Your Child’s Asthma and Allergies: Breathing Easy and Bringing up Healthy, Active Children. Villard, 2000.