Pediatric Pulmonology

Diagnosis often begins with a detailed medical history that covers when symptoms started, what makes them better or worse and whether there is a family history of asthma or allergies. A physical exam follows, focusing on breath sounds, airway structure and signs of chronic breathing effort. Testing may include pulmonary function studies, imaging or airway evaluations. For younger children, diagnosis may rely more on observed breathing patterns, feeding issues and growth. Once results are reviewed, the pulmonologist creates a treatment plan that may include medication, home strategies or follow-up testing. The goal is early, accurate diagnosis and clear guidance for families.

Specialty care is recommended when breathing symptoms are frequent, severe or not responding to standard treatments. Children may benefit from a pulmonology referral if they have recurrent wheezing, repeated pneumonias, chronic cough, unusual breathing noises or poor feeding tied to breathing effort. Referral is also appropriate for infants with persistent oxygen needs, children with suspected structural airway issues or those with complex medical conditions affecting lung function. Pediatric pulmonology offers focused testing, long‑term management and coordinated care across multiple specialties when needed. Early referral ensures timely diagnosis and helps prevent complications—supporting children in breathing comfortably, staying active and continuing to grow and thrive.
Talk with your pediatrician about a referral if your child experiences any of the following:

These signs can be related to the reactive airway diseases and respiratory disorders treated by pediatric pulmonology

Asthma management focuses on controlling symptoms, preventing flare-ups and helping children stay active. Care often begins with assessing severity using tools such as the Respiratory Severity Score and reviewing recent symptoms, triggers and medication use. Treatment typically includes inhaled medicines. Rescue inhalers help open the airways during flare-ups, while daily controller medications may reduce inflammation in children with frequent symptoms. Your child’s clinician may adjust doses based on age, severity and response.

Families may also receive education on proper inhaler and spacer technique, since correct use improves how well medicine reaches the lungs. A pediatric asthma action plan outlines steps to take when symptoms appear, when to increase treatment and when to seek urgent care. Parents are encouraged to watch for common triggers, such as respiratory infections, allergens or exercise and work with the care team to reduce exposure where possible. During more serious episodes, treatments may include repeated albuterol doses, steroids or oxygen support, depending on a child’s needs. Discharge guidance usually includes continued inhaler use, hydration and a follow-up visit within one or two days. Clear education and regular check-ins help ensure children breathe comfortably and maintain long-term control of their asthma.

An inhaler is a handheld device that sends medicine straight into the lungs when used correctly. It treats asthma where it starts — the lower airways — by helping open them and reduce swelling.

Rescue inhalers
Used when symptoms appear, such as coughing, trouble breathing or chest tightness. These provide quick relief.

Controller inhalers
Used once or twice a day to help prevent symptoms, especially when a child is exposed to triggers like allergies, illness or exercise.

Controller medicines come in different devices, and each has its own technique. Be sure to follow instructions for the specific inhaler your child uses.

After using a controller inhaler, children should rinse their mouth, brush their teeth or drink water. This helps prevent irritation and thrush, a mild mouth infection.

Common medicines include albuterol (ProAir, Proventil, Ventolin), levalbuterol (Xopenex), fluticasone (Flovent), mometasone (Asmanex HFA), fluticasone/salmeterol (Advair HFA), budesonide/formoterol (Symbicort) and mometasone/formoterol (Dulera).

This method is often used for children 5 and younger.

Used mostly by children 6 and older with the same medicines listed above.

An MDI sprays medicine out quickly. Without a spacer, much of it hits the back of the throat instead of reaching the lungs. A spacer slows the spray so more medicine gets where it’s needed.

If your child needs their rescue inhaler, use it — even without a spacer. Techniques can help improve medicine delivery, and video instructions can be useful. Still, a spacer is recommended whenever possible.

Most insurance plans cover one spacer per year with a prescription. Replacement options include:

Disposable spacers:
These cardboard versions can be flattened for travel and used up to about 10 times if kept clean and dry.

Below are common devices and the ages they’re typically used for:

Ellipta: Arnuity, Breo, Trelegy — ages 10+; not for children with severe milk allergy.
Respimat: Spiriva — ages 5+.
Twisthaler: Asmanex — ages 10+; avoid with severe milk allergy.
Diskus/Inhub: Advair, Wixela — ages 10+; avoid with severe milk allergy.
Flexhaler: Pulmicort — ages 10+; avoid with severe milk allergy.
RediHaler: Qvar — ages 8+.

Nebulizers turn liquid medicine into a mist. Common medications include albuterol, levalbuterol (Xopenex) and budesonide (Pulmicort Respules). Follow instructions for setup, breathing technique and cleaning to get the full benefit.

Flexible bronchoscopy is a hospital procedure that lets a pediatric pulmonologist look inside a child’s major airways and collect fluid from the lungs. It is done under anesthesia, and most children go home a few hours later.

Because children cannot eat or drink beforehand, most outpatient bronchoscopies are scheduled early in the morning. After reviewing the plan and signing consent forms, anesthesia is given to help the child fall asleep.

The doctor then guides a thin, flexible tube called a bronchoscope through the nose or mouth. The vocal cords and larger airways are numbed with a small amount of medication. The airways are examined for redness, swelling, abnormal tissue or excess mucus.

Many children also receive a bronchoalveolar lavage, or BAL. A small amount of saline is placed into part of the lung and then suctioned back out. This fluid helps identify infection, inflammation or other causes of symptoms.

After the procedure, the child rests in recovery until the anesthesia wears off. Because of the numbing medicine, they cannot eat or drink for about an hour.

Doctors may use bronchoscopy when they need more information about:

A bronchoscope is a small, flexible tube with a camera, light source and a channel that allows oxygen, suction or small tools to pass through.

Although complications are rare, potential risks include:

More common short-term effects include coughing, low‑grade fever, mild wheezing or small streaks of blood in mucus.

Spirometry is a breathing test we can do in the office to measure how much air your child can exhale and how quickly. This helps us understand how well the airways are working.

Because the test requires following instructions, it’s usually done for children age 5 and older. Your child will take normal breaths, then a deep breath and blow out as hard and as long as possible. This is repeated at least three times to confirm accuracy. Results are typically reviewed during the visit.

This test measures nitric oxide, a gas linked to allergic inflammation in the airways. Like spirometry, it requires coordination, so we generally perform it only in children age 5 and older.

In rare cases, more detailed lung tests are needed. These require specialized hospital equipment and are called body plethysmography. If your child needs this test, we will explain why and how it works before scheduling.