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The Asthma Care Program provides a single source of comprehensive asthma care for children. Our pediatric pulmonologists specialize in the care of infants, children, and adolescents with asthma and work to offer a comprehensive approach to asthma management. Children with asthma or who are having problems with coughing, wheezing, shortness of breath or chest tightness are evaluated by our specialists.

Asthma is a disease that affects the lungs. It is one of the most common long-term diseases of childhood and adulthood. Asthma does not go away when symptoms go away. If your child has asthma, it needs to be cared for even if he or she is feeling good. The goal of asthma treatment is to control the disease and prevent attacks. Asthma has to be cared for all the time, not just when symptoms are present. Specific treatments for asthma will be determined by your child鈥檚 provider based on his or her age, overall health, medical history, extent of the disease, expectations for the course of the disease, and family opinion and preference

Asthma is managed by:

• Identifying and minimizing contact with asthma triggers.
• Understanding and taking medications as prescribed.
• Monitoring asthma to recognize signs when it is getting worse.
• Knowing what to do when asthma gets worse.

Asthma is treated by:

• The use of objective measures of lung function-spirometry, peak flow expiratory rate, and pulse oximetry-to diagnose the severity of asthma and to monitor the course of treatment.
• The use of medication therapy designed to reverse and prevent the airway swelling component of asthma as well as to treat the narrowing airway.
• The use of environmental control measures to avoid or eliminate factors that cause or trigger asthma flare-ups.
• Patient education that includes a partnership among the child, family members, and health care providers.

Good asthma control will:

• Prevent chronic and troublesome symptoms, such as coughing and shortness of breath.
• Reduce your need for quick-relief medicines.
• Help you maintain good lung function.
• Let you maintain your normal activity levels and sleep through the night.
• Prevent asthma attacks that could result in your going to the emergency room or being admitted to the hospital for treatment.

What is cystic fibrosis?
Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive system of about 30,000 children and adults in the United States (70,000 worldwide). A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that:

• Clogs the lungs and leads to life-threatening lung infections.
• Obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food.

In the 1950s, few children with cystic fibrosis lived to attend elementary school. Today, advances in research and medical treatments have further enhanced and extended life for children and adults with CF. Many people with the disease can now expect to live into their 30s, 40s and beyond.

Symptoms of Cystic Fibrosis
People with CF can have a variety of symptoms, including:

• Very salty-tasting skin
• Persistent coughing, at times with phlegm
• Frequent lung infections
• Wheezing or shortness of breath
• Poor growth/weight gain in spite of a good appetite
• Frequent greasy, bulky stools or difficulty in bowel movements

The Cystic Fibrosis Center at Children鈥檚 Wisconsin is accredited for care, teaching and research by the Cystic Fibrosis Foundation. Accreditation requires that our CF clinicians provide care based on the following guidelines: a recommendation for a minimum of four visits to a certified CF center annually, two pulmonary function tests each year, sputum cultures frequency and laboratory testing.

The clinic offers multidisciplinary care for newborns, children, and adolescents. The CF team includes specialists in pediatric and pulmonary medicine, nutrition, social work, genetics, nursing, and respiratory care. Children and young adults receive their care at Children鈥檚 Wisconsin. Adults patients are cared for in the CF Clinic at Froedtert Hospital.

Based on the most recent data provided by the Cystic Fibrosis Foundation Patient Data Registry, children managed at our center have lung function above the national average. More specifically, these outcomes place our center among the top 10 centers in the country for pulmonary outcomes in children. The Registry also shows a strong association between a higher body mass index percentile and better lung function in children with CF. Our goal is for children with CF to grow and develop like children without CF.

Outpatient services include:

• Pulmonary function testing
• Instruction in airway clearance
• Nutrition counseling
• Sweat testing and genetic counseling for newborns and families identified through the Wisconsin Newborn Screening Program
• Genetic counseling for individuals and families already diagnosed with CF
• Referral to other specialty services

Inpatient services include:

• Hospitalization for aggressive airway clearance and intravenous antibiotics.

Additional services:

• Research focused on improved treatments
• Educational program for families and health professionals

We see children with a wide-range of pulmonary problems including asthma, chest pain, chronic lung disease of infancy, chronic cough, recurrent pneumonia, congenital hypoventilation, infant apnea, interstitial lung disease, neuromuscular disease with breathing problems, stridor, and congenital and acquired airway lesions.

Outpatient services include:

• Pulmonary function testing as described below.
• Complex airway evaluations including bronchoscopy.
• Care for children with end-stage lung disease pre- and post-lung transplant.

The Infant Apnea and Bronchopulmonary Dysplasia (BPD) Program at Children鈥檚 Wisconsin treats infants with respiratory issues including BPD and apnea. Our specialists work closely with primary care physicians and other health care professionals throughout Wisconsin to provide comprehensive pulmonary care for every child.

Our physicians specialize in treating respiratory issues including:

• Bronchopulmonary dysplasia
• Abnormal control of breathing
• Apnea of prematurity or infancy
• Periodic breathing
• Apparent life-threatening events
• Reflux-related respiratory events

Patients are continuously monitored and to make adjustments to their treatment that may include:

• Supplemental oxygen
• Medications such as bronchodilators, inhaled steroids and diuretics
• Nutritional support

When further diagnostic procedures are needed, our specialists utilize:

• Cardiorespiratory monitors
• Polysomnography
• Infant lung function testing
• Fiberoptic bronchoscopy

The Pulmonary Function Lab at Children's Wisconsin performs a wide range of lung function testing for infants, children, and adults in a child-friendly environment. The lab has comprehensive state-of-art facilities for performing and interpreting lung function tests. The lab is registered with the American Thoracic Society.

Pulmonary function tests for children can be a challenge. Getting accurate results can be difficult. We make special efforts to make these tests fun for our patients.

A pulmonary function test is a breathing test. It gives information about how well the lungs are working. These tests may be done when a person has shortness of breath, trouble breathing, or coughs frequently. The test results may help the provider to diagnose and treat breathing problems.

The child must be able to follow simple directions about breathing and blowing. Cooperation is very important to obtain good test results. Most 5-year-olds and some younger children can do the easier tests. Other testing will depend on the age and cooperation of the child.

Outpatient and inpatient services include:

• Spirometry
  • Pre- and post-bronchodilator spirometry
  • Positional spirometry
• Lung volumes
• Diffusion capacity
• Exhaled nitric oxide analysis
• Maximal respiratory pressures
• Six-minute walk
• Bronchial challenges
  • Methacholine challenge
  • Exercise challenge
  • Cold air challenge
• Exercise physiology study
• Infant/toddler pulmonary function test
• Metabolic study
• Education in use of MDIs/spacers, airway clearance techniques

The power of teamwork
Sleep Center team includes doctors who are board-certified sleep specialists, psychologists and nurse practitioners who specialize in treating children with sleep problems. Sometimes the skills of another specialist, like an ear, nose and throat doctor, are needed. Our team approach makes it easy, because these experts are all available in each of our convenient locations.

Children's offers the only sleep center in Wisconsin dedicated to caring for children.

What happens in the Sleep Center
Our Sleep Center is divided into two parts: sleep clinic and sleep lab. During a Sleep Clinic appointment, a specialist will talk with you and your child about his or her sleep problems. After this appointment, your child may need special tests in one of our sleep labs.

Most children first visit the sleep clinic for an evaluation that includes gathering the child's medical history and doing a physical exam. Sometimes only changes in a child's behavior or a family's bedtime activities are needed. Other times, children may need an overnight test in a sleep lab. A specific treatment plan will be provided based on the specific needs of the child.

Sleep lab
Some children will need to stay overnight in one of our state-of-the-art sleep labs for a sleep test. While some sleep centers may treat both children and adults, Children鈥檚 Wisconsin specializes in the care of children only. Throughout the night, a specially trained and registered sleep technologist will monitor your child's breathing, oxygen levels, heartbeat, brain activity, body movements and snoring. Sleep tests give doctors important information about your child's health. None of the tests are painful.

All children, even those with complex medical needs, can be monitored and safety cared for in our sleep labs. To help parents and children feel more comfortable, we offer space for one parent to stay overnight with the child during his or her sleep study. Our sleep labs are equipped with TV/videos, free WI-FI, and a family lounge with a refrigerator. Children and families can feel like they are at home.

Diagnoses/conditions treated:

• Snoring
• Obstructive sleep apnea
• Nocturnal hypoventilation
• Delayed sleep phase syndrome
• Excessive daytime sleepiness
• Narcolepsy
• Insomnia of childhood
• Insomnia of adolescence
• Parasomnias, including nightmares, night terrors, sleepwalking
• Periodic limb movement disorder
• Rhythmic movement disorder (head banging or body rocking)
• Restless legs syndrome
• All other sleep disorders

Outpatient and inpatient services include:

• Sleep clinic evaluation with follow-up care
• Overnight sleep studies
• Behavioral modifications
• Multiple sleep latency test
• Actigraphy monitoring
• Sleep studies in conjunction with EEG/seizure monitoring or esophageal pH monitoring
• CPAP/BiPAP titration
• Ventilator titration
• Mask fittings and desensitization programs
• Referral to other specialists if needed

The Tracheostomy/Home Ventilator Program assesses the needs of patients with various medical conditions requiring ventilator assistance and/or tracheostomy. Multidisciplinary clinics are held three times per month, with pulmonary, otolaryngology, respiratory therapy, nutrition, social work, and nursing case management available. The team is very involved in outcomes research to improve the quality of care that children and families receive.

Care is provided by a dedicated team from the time of the tracheostomy surgery through long-term follow-up. At each visit, the child will see his or her pulmonary and otolaryngology physician. Each child is assigned an advance practice nurse or nurse clinician who provides care coordination and case management services for the child and family.