Joe DiMaggio Children's Hospital

Evaluating and Controlling Asthma

As pediatric pulmonologists, we assist referring physicians in evaluating and confirming the diagnosis of asthma in children with recurrent symptoms. We also assist in managing asthma that is difficult to control. At the Cystic Fibrosis and Pulmonary Center at Joe DiMaggio Children’s Hospital, we help empower patients and their families by creating individualized asthma management plans that utilize pharmacologic therapies and environmental control measures.

Our evaluation involves a comprehensive history of symptoms, attempting to identify causative factors, physical examination and pulmonary function testing. Our physicians work with the patient, family and referring physician to develop a comprehensive asthma management plan, which covers controlling daily symptoms and rescue therapy for managing asthma flare-ups. We educate and demonstrate correct techniques for using inhaled medications and also provide educational materials. Our evaluation may include exercise challenge testing and methacholine testing and measurement of lung volumes, when indicated.

Our board-certified pediatric pulmonologists are assisted by respiratory therapists, nurse practitioners and allied staff.

Specialized Care for Cystic Fibrosis

The Cystic Fibrosis and Pulmonary Center at Joe DiMaggio Children’s Hospital, established in 1993, is a nationally accredited facility with more than 50 years of combined experience in providing care to patients with cystic fibrosis. Our board-certified doctors have trained in the specialty care of patients with cystic fibrosis and a board certified adult cystic fibrosis specialist directs the adult care component of our center. Our staff members provide comprehensive diagnostic and treatment services in the effort to extend the length and quality of life of the patients they serve. Furthermore, as a nationally recognized facility, we have access to some of the most recent treatment and research findings and are proud to be associated with the Cystic Fibrosis Foundation. When hospitalization is necessary, pediatric patients receive specialized care at Joe DiMaggio Children’s Hospital, the leading children’s hospital in Broward and Palm Beach counties. Adult cystic fibrosis patients receive specialized care at one of Memorial Healthcare System’s adult hospitals.

Keeping Cystic Fibrosis under Control

The Cystic Fibrosis and Pulmonary Center at Joe DiMaggio Children’s Hospital monitors patients on a regular basis and is prepared to provide prompt, aggressive outpatient treatment to minimize symptoms and complications.

If a patient shows no active symptoms, the center still provides regular monitoring and treatment, as research shows that preventative care helps maintain the child’s overall health.

Medications and Research

Cystic fibrosis patients are commonly prescribed medications that prevent infection and keep the lungs clear of mucus. Many patients also take pancreatic enzymes to help absorb the nutrients in food. Children may also receive other medications orally, through a nebulizer, intranasally, or intravenously through a central line such as a PICC line or a port a catheter, if needed.

While there is no cure for cystic fibrosis, new antibiotics, treatments and therapies are being studied. Antioxidant-boosting medications, for example, are a promising area of research in the prevention of lung inflammation. New gene therapies and therapeutic drugs are being developed in hopes of reversing the behavior of defective genes.

Nutritional Intervention Provided

Patients with cystic fibrosis may have trouble achieving normal height and weight. The Cystic Fibrosis and Pulmonary Center at Joe DiMaggio Children’s Hospital provides patients with nutritional support through the expertise of a registered dietitian. Through regular monitoring for cystic fibrosis-related digestive disorders, we will strive to help keep your child’s digestion and growth as normal as possible.

As a result of improvements in cystic fibrosis treatment, almost half of all Americans with cystic fibrosis today are adults. Adult patients also benefit from special dietary consultations to prevent or lessen the effects of cystic fibrosis-related diabetes, osteoporosis and other complications.

Treatment Plans for the Exacerbation of Symptoms

Under most circumstances, cystic fibrosis can be managed on an outpatient basis. When exacerbations of symptoms call for more aggressive treatment, including hospitalization, the Cystic Fibrosis and Pulmonary Center at Joe DiMaggio Children’s Hospital will work with you and your family to create a family-centered, multidisciplinary plan of action tailored to help meet the needs of your child and your family.

Education and Ancillary Services for the Entire Family

In addition to providing world-class medical care to our patients, the center also provides extensive patient and family education about the medical, genetic and nutritional aspects of cystic fibrosis. Our team can also assist with arranging home care, financial counseling and emotional support for patients and families. Our respiratory therapists, dietitian, nurse practitioners, social workers and other professionals will work closely with you and your child to address how a person with cystic fibrosis can live a full and happy life.

Pediatric Sleep Medicine

As one of the few dedicated pediatric sleep labs in the South Florida region – and the only Broward County sleep lab under the guidance of a pediatric pulmonologist with certification in sleep medicine – the pediatric sleep lab at Joe DiMaggio Children’s Hospital is dedicated to correctly diagnosing the sleep-related problems a child might be having.

Our Pediatric Sleep Lab is truly unique. Not only do we evaluate a child’s sleep disorder using specific pediatric criteria, we also frequently consult with the extensive pediatric subspecialty staff at Joe DiMaggio Children’s Hospital. Having access to this comprehensive network of experienced pediatric clinicians further distinguishes our services from sleep labs that are designed primarily for adult patients.

Some of the main sleep disorders investigated at the Sleep Lab at Joe DiMaggio Children’s Hospital are:

• Obstructive sleep apnea and upper airway resistance syndromes
• Disorders of respiratory rhythm (central sleep apnea, CCHS, infantile central apnea)
• Disorders of excessive sleepiness, for example, narcolepsy
• Periodic limb movement disorders
• Breathing disorders secondary to gastroesophageal reflux
• Breathing disorders secondary to neurological disorders
• Disorders of circadian rhythm and sleep-wake schedule disorders
• Parasomnias and insomnia

Our Sleep Lab professionals are specially trained to provide information to help calm the fears of children and create a comfortable environment in the effort to achieve the best diagnostic outcome.

Our Sleep Lab treats sleep-associated breathing disorders in infants, children and adolescents in a fully equipped two-bed sleep facility. Both sleep rooms include video and infrared monitoring equipment allowing direct patient observation. These soundproof rooms are designed with children in mind, and are fully equipped to perform the most complete array of testing available. Some of the latest computerized equipment is used to gather test data and analyze events. Results are carefully reviewed by an experienced technologist and interpreted by a sleep board certified physician, who is available for consultation if needed. A pediatric sleep clinic also exists, featuring professionals with extensive experience in positive airway pressure management.

Outstanding Care for Patients with Neuromuscular Diseases

The Neuromuscular Disease Clinic, which was founded in late 2010, consists of pediatric pulmonologists, a dedicated respiratory therapist, social worker, nurses and a nutritionist. Our team collaborates with both the PICU and Sleep Lab to treat and help prevent respiratory complications in children with neuromuscular diseases.

Advanced Technologies and New Protocols to Avoid Respiratory Complications

The successful management of respiratory complications of children with neuromuscular diseases includes:

• A better appreciation of the symptoms of hypoventilation during sleep (which are often subtle)
• A greater understanding of the importance of close monitoring, including serial lung function testing, by a pediatric pulmonologist
• Accepting the importance of noninvasive ventilation in treating acute and chronic hypoventilation
• Improved airway clearance techniques, such as assisted coughing via insufflator-exsufflator

New, noninvasive technologies have become available for respiratory management of these patients. In addition, respiratory care protocols for prevention of pulmonary morbidity have gained wide acceptance among respiratory specialists.