When big breathing problems trouble little ones – Pediatric pulmonologists provide expert care

Asthma- when to see the pediatric pulmonologistStruggling to breathe can be terrifying, especially for children – and their parents. Acute and chronic respiratory challenges including asthma need specialized care to keep airways open – enter the pediatric pulmonologist.

Chiarina Galvez, M.D., explains when a child with asthma symptoms should see a pediatric pulmonology specialist.

What is pediatric pulmonology?

Pediatric pulmonology is a medical specialty that focuses on the care of infants, children and teenagers with disorders of the lung and airways, and those with sleep-related breathing problems.

If a child has moderate-to-severe asthma, should the child see a pediatric pulmonologist?

Children with moderate-to-severe persistent asthma may benefit from a consultation with a pulmonologist. Asthma guidelines recommend seeing a specialist for children ages 0 to 4 years who need daily controller therapy.

These recommendations are made because several studies have shown that patients who received specialized care had better outcomes, which included improvements in asthma symptoms, as well as fewer hospitalizations and emergency department visits.

If the asthma diagnosis is uncertain, or if there are difficulties maintaining asthma control, then pulmonology referral should be strongly considered.

Asthma is not as common in Arizona because the climate is hot and dry – right?

Unfortunately, we’ve learned over the years that asthma is prevalent in the state. In 2014, it was estimated that the prevalence of asthma in Arizona children aged 17 years and younger was higher than the national average (10.9 percent vs 9.2 percent).

Asthma is a complex condition, and it is likely that genetics and multiple environmental factors interact to trigger the disease.

The right environment depends on the individual’s triggers. A climate that might be good for one child’s asthma, might be terrible for another. Achieving good asthma control requires working with a specialist to identify and avoid triggers, medication adherence and regular follow-up visits to optimize therapy.

What respiratory symptoms should a parent of a child with asthma be mindful of?

In children, symptoms of respiratory problems are often varied and may be subtle. If a child is experiencing any of the following symptoms, a pediatric pulmonologist may be able to help.

  • Cough for more than four weeks and is not improving
  • Two (or more) episodes of pneumonia in one year
  • Chronic wet cough
  • Pauses or stops breathing while awake or asleep
  • Fast or labored breathing on a frequent basis
  • Frequent or recurrent brassy or honking cough
  • Gets a cough after he or she choked on food or another object, even if he or she choked on the object days or weeks ago

It may also be helpful to see a pediatric pulmonologist if a child has received treatment due to a respiratory illness.

  • Hospitalization
  • More than one visit to an emergency department
  • Received more than two courses of oral steroids in the past year
  • Has complicating conditions (e.g., chronic lung disease of prematurity)

Dr. Galvez - pediatric pulmonologistWhat motivated Dr. Galvez to become a pediatric pulmonologist?

It has been my life’s calling to care for children who are acutely ill and admitted to the hospital. But what makes pediatric pulmonology so special to me is the opportunity to see patients over the long term – I build relationships with the children and their families. It’s why I chose this field.

In addition to completing medical school and a pediatric residency, Dr. Chiarina Galvez completed her pediatric pulmonary fellowship – a three-year, specialized training in the treatment and management of pediatric, respiratory illnesses.

What are the most common illnesses you treat?

Conditions we frequently treat include asthma, bronchopulmonary dysplasia (breathing problems related to prematurity), chronic cough, recurrent pneumonia and sleep apnea. We also take care of patients who are technology dependent, such as those with tracheostomies and on home ventilators and oxygen.

Dr. Galvez is a pediatric pulmonologist at TMCOne. Call (520) 324-7200 for more information.






COPD: Sorting out misconceptions and medication mismanagement

“It’s like breathing through a straw.”

“Most days, I feel like a fish out of water gasping for air.”

“It takes me three times longer to accomplish everything due to shortness of breath and lack of stamina.”

Dr. William Abraham Board-Certified, Internal Medicine TMC One

Dr. William Abraham
Board-Certified, Internal Medicine

That’s how some patients with chronic obstructive pulmonary disease, or COPD, describe life with their condition. It’s one of the most common lung diseases and it makes it difficult to breathe. According to the COPD Foundation, more than 24 million Americans, including more than 343,000 Arizonans, have been diagnosed with it. There are two main forms of COPD: chronic bronchitis, which involves a long-term cough with mucus, and emphysema, which involves damage to the lungs over time. Most people with COPD have a combination of both conditions.

Smoking is the main cause of COPD, but in rare cases, nonsmokers can develop emphysema. Other risk factors for COPD include exposure to certain gases or fumes in the workplace, exposure to heavy amounts of secondhand smoke and pollution, or frequent use of cooking fire without proper ventilation.

Symptoms include a cough, with or without mucus, fatigue, many respiratory infections, shortness of breath that gets worse with mild activity, wheezing and trouble catching one’s breath. There is no cure for COPD, but there are many things you can do to relieve symptoms and keep the disease from getting worse.

Medicines used to treat COPD include inhalers (bronchodilators) to help open the airways, inhaled or oral steroids to reduce lung inflammation, and anti-inflammatory drugs to reduce swelling in the airways. But there are a lot of common misuses with these medications.

Dr. William Abraham is a board-certified internal medicine physician with TMC One who has more than 30 years of experience. He sorted out some of the misinformation about popular medications in hopes of getting you to breathe easier.

Rescue inhalers: When are you puffing “too much”?

Short-acting bronchodilators or “rescue inhalers” are commonly used when a patient becomes short of breath. These are usually albuterol, under the brand names of ProAir HFA, Proventil HFA and Ventolin HFA. The liquid form may also be put in a nebulizer. They are designed to bring quick relief and work by relieving spasms in the airways or bronchial tubes. For inhalers, doctors usually prescribe two puffs every four to six hours as needed for shortness of breath or wheezing. While these medications provide instant relief, it’s important to keep in mind that they can also affect the heart and cause an irregular or a racing heartbeat. Using a rescue inhaler as it’s prescribed tends to only help the lungs although it’s not uncommon for some patients to notice their heart beat just a bit faster.

With COPD patients, the problem develops when they are short of breath and their condition is quickly becoming so severe that they start using their rescue inhaler significantly more than is prescribed – sometimes every 5 to 10 minutes! These medications can become quite dangerous and induce potentially fatal, irregular heart rhythms.

Bottom line: Never use a rescue inhaler more than every four hours.

▪ Maintenance inhalers: Do they really need to be used every day?

Many patients with COPD also have long-acting bronchodilator and corticosteroid combination inhalers prescribed for them. The common brand names for these are Advair, Symbicort and Dulera. Unlike rescue inhalers, which provide instant relief, these medications become effective only when used over a long period of time. For example, the corticosteroid component must be taken for seven days in order to become completely effective! When used correctly, these inhalers can prevent severe wheezing and shortness-of-breath attacks or episodes when there is a lot more mucus produced than usual.

As a result, patients can absolutely feel the effects of these long-acting bronchodilator and corticosteroid combination inhalers. Since they find themselves needing their rescue inhaler less often, doctors say these maintenance inhalers have a good compliance rate.

Problems develop, however, when patients use their long-acting, combination inhalers once a day instead of the recommended twice a day in an attempt to save money. Keep in mind, the bronchodilator component is only effective for 12 hours. If you’re using one of these maintenance inhalers only once a day, that means that for half your day, your lung function will be significantly decreased while the medication is no longer active. Or, patients may only start using their long-acting, combination inhaler when they begin to feel sick and their breathing starts to suffer. By then, it’s too late in the game to be able to experience any real benefit.

Bottom line: All of these maintenance inhalers should be used every 12 hours every day in order to receive the maximum benefits of these medications.

▪ I was recently diagnosed with COPD. Realistically, what’s my quality of life going to be and is there anything I can do to slow down the progression of the disease?

Oftentimes, newly diagnosed COPD patients believe that they will gradually lose more and more lung function over the years. These patients also often think that how quickly they’ll decline is predetermined by aging and severity of the disease. A common misconception is that, eventually, their lung function will become so poor that simple breathing will become impossible. Realistically, however, there are many factors that determine how quickly someone’s lung function will deteriorate.

There are things COPD patients can do to preserve their lung function for as long as possible. Perhaps the most important: quit smoking. Studies show that patients with COPD who continue to actively smoke will have their lung function decline about twice as fast as patients who quit smoking. Regardless if you are diagnosed with mild, moderate or severe COPD, it is never too late to quit smoking. Even if your lung function is tempered by the disease, making it the best it can be will translate to a stronger ability to be active, and therefore, have a better quality of life.

Bottom line: Even if you have been diagnosed with COPD, it is never too late to quit smoking.

Dr. Abraham is available for same-day appointments including annual physicals
if you are finding it difficult to get in to your regular provider.
His office is located at 1396 N. Wilmot Road in Tucson, 85712.
Call (520) 324-2160 to make an appointment.

Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461