Issue link: https://viewer.e-digitaledition.com/i/894235
Dr. Starla Martinez is Director of Akron Children's Robert T. Stone, MD, Respiratory Center. She is shown here with Suzanne Felter, Nurse Program Coordinator. bronchoconstriction (EIB)," Dr. Bhatia says. "Exercise challenge tests (which only assess for EIB) are routinely ordered to evaluate EID. However, the test is often negative, providing no guidance to the provider regarding the cause of EID and further management." In fact, according to Dr. Bhatia, EIB is only present in 8-23 percent of otherwise hea lthy children complaining of EID. There are many other clinical entities that mimic EIB (deconditioning, physiological limitation, vocal cord dysfunction, hyper- ventilation, chest wa ll abnorma lities, cardiac abnormalities, etc.). CPETs can help physicians correctly assess and diag- nose these patients, providing e€ective care that addresses the specific issues each patient is facing. CPETs also help physicians estimate the prognosis in cystic fibrosis patients, giving patients and their families a clearer picture of the timeline of the disease and how it will a€ect them a long the way. The tests can a lso help diagnose and treat mitochondrial myopathy, and for patients who have had congenital heart defects repaired, CPETs allow physicians to di€erentiate between limitations of the heart and lungs. Physicians should consider referring patients for a CPET if they have EID with symptoms that are inconsistent with EIB, especially if asthma treatment isn't working. Asthmatic patients can also be referred if they have exercise symptoms despite asthma treatment to assess for EIB, as more e€ective treatment may be available or they may have an additional cause of exercise intolerance (e.g. vocal cord dysfunction). Physicians can also refer patients to help di€erentiate EIB from other causes of dyspnea, such as deconditioning, a ca rdiac condition or physiolog ica l limitation. Patients with a certain clinica l condition (e.g. chest deformity) and exercise intoler- ance, who are considering surgery, may have a CPET to help them make a more informed decision. VENTILATOR & RESPIRATORY TECHNOLOGY PROGRAM For Starla Martinez, MD, a pediatric pulmonologist and Director of A kron C h i l d r e n 's R o b e r t T. S t o n e , M D, Respiratory Center, growth in ventilator technolog y has been a consta nt over the last decade. New technologies and procedures have significantly increased the hospital's Ventilator & Respiratory Technolog y Program — the population of patients in this program has grown by 94 percent since 2008. There are at least two factors driv- ing this g row th. Firstly, technolog y i mprovement s h ave a l lowed m a ny children to receive home ca re, when previously they would have required hospita l care. "The ventilators now available for home use are much more sophisticated than they were 10 years ago. They are able to provide the types of ventilation previ- ously available exclusively in intensive care units," says Dr. Martinez. Other respiratory supports, such as non-invasive ventilation that has been commonly used in the adult popula- tion for years, have only fairly recently become adaptable for use in sma ller pediatric patients. Secondly, there are new treatments and procedures available for conditions that previously resulted in early mortal- ity. For example, infants with so-called "asphyxiating thoracic dystrophy," or small chests that don't grow well, can be treated with rib-expansion devices a llowing lung grow th a nd leading to significant lengthening of life. Akron Children's Robert T. Stone, MD, Respiratory Center o€ers a wide spec- trum of services for those with pulmonary and sleep conditions. At the Center, a combination of specia lists prov ides comprehensive care. "Our multidisciplina r y tea m con- sists of pediatric pulmonologists, sleep physicians, nurse practitioners and psy- chologists, as well as dieticians, genetic counselors, nurses, physical therapists, respiratory therapists and technicians, and socia l workers, in addition to our o¨ce sta€," says Dr. Martinez. Together, the center's tea m treats patients w it h a st hma , chronic lung disease of prematurity, cystic fibrosis, cilia r y dyskinesia , impa ired a ir way clearance, neuromuscular wea kness and even pulmonary complications from cardiac issues. They also address acute illnesses like pneumonia, bronchiolitis, chronic cough and more at six locations: A k r on , B oa r d m a n , Nor t h Ca nt on , Norwalk, Twinsburg and Warren. Despite the condition, Akron Children's experienced pulmonary medicine team and expanded facilities can help find the right solution to improve the patient's health and overall quality of life. To learn more about Akron Children's Robert T. Stone, MD, Respiratory Center and the programs and treatment options o‡ered, go to akronchildrens.org. To refer a patient, call 330-543-8885. ■ 0 8❱❱❱❱❱ C O V E R S T O R Y