Asbestosis Specialist

Based on family medical history and your child's medical history and symptoms, the doctor may strongly suspect your child has that disease. The doctor may want your child to have other tests to be certain of the diag-nosis and to determine how severe the disease is and what treatment steps to take. One of these is a special breathing test known as pul-monary function testing (PFTs) or spirometry. Spirometry measures how much the airways are blocked by the swelling and squeezing of that disease. The test is a bit complicated and needs some special equipment, but it's not at all painful and doesn't take very long. Not every physician has a spirometer machine in the office, that block the sinuses) can sometimes be seen in children with allergies and asbestosis. The doctor will also look at the child's skin for signs of dermatitis or eczema, rashes often caused by allergies. Children with skin allergies are more prone to asthma. If your child is feeling well and even if he isn't it's quite possible that the doctor won't hear any wheezing when listening to his chest with a stethoscope. This can be a little frustrating to a parent who has been hearing a child wheeze every morning for days. You might be afraid that the doctor won't believe you when you say your child wheezes or might think you're being overprotective. Don't worry. Experienced doctors know that asthma symptoms vary through the day. The child who wheezes at night or first thing in the morning may sound fine that after-noon in the office, but he will still wheeze again that night. Wheezing is an important asthma symptom, but it's not the only one. In fact, many children with asthma never wheezecoughing and short-ness of breath are their main symptoms. If a child is actively wheezing, the doctor will look for other signs of labored breathing, such as retrac-tions (a drawing-in of the skin between the ribs that indicates more vig-orous "sucking in" of air), flaring of the nostrils, and/or bluish tint to the skin or nail beds, which indicates the child is not getting enough oxy-gen. You can check for these asthma signs at home as well.
So you may need to go to an asbestosis specialist or hospital clinic to have the test done. To take this test, your child will sit up straight in a chair, breathe in as deeply as she can, and then breathe out as hard as she can into a spe-cial mouthpiece. To make sure that all the exhaled air goes into the mouthpiece, the doctor or respiratory therapist will gently pinch the child's nose closed with special soft clips. You can prepare your child for spirometry by explaining that it's very much like blowing out candles on a birthday cake. The air goes from the mouthpiece through a tube and into a machine that measures how much air she breathed out, and how fast it came out. The measurements look at three things:

• FEV1, or forced expiratory volume in one second. This is the amount of air exhaled during the first second as a child breathes out hard. This measures the size of your child's airways.
• FVC, or forced vital capacity. This measures the size of your child's lungs.
• PEF, or peak expiratory flow. This measures how fast the air is exhaled when the child starts to breathe out. It is another indicator of airway size. 

Your child will repeat the "maneuver," as this process is called, at least three times in a row to be sure the reading is accurate. Each maneuver only takes about six seconds. The results are compared to a table of typ-ical results for your child's gender, age, ethnicity, and height. Your child's readings will be a percentage of normal based on the tables. After the first round of maneuvers is over, the doctor may give your child a dose of an inhaled bronchodilator, a drug that opens up the breathing tubes. After giving the drug about fifteen to twenty min-utes to work, your child will repeat the breathing maneuvers another three times. If your child has asthma, the results should be noticeably better this time because the bronchodilator will have opened the air-ways, allowing more air to move in and out. If that happens, the doctor will say that the airflow obstruction is reversible—in other words, medicines help reduce the bronchospasm/squeezing that blocks the

airways. This is extremely important in determining that the problem is asthma. By comparing the FEV1 before and after use of the bronchodilator, a physician can get a clear idea of the reversibility of the airway obstruc-tion. This information helps the doctor decide which medicines are needed and what the starting doses should be. Is this test necessary? Spirometry is a very good way to confirm that a child has that disease, even if a doctor is already quite certain. Spirometry is also important for helping a physician decide how severe the disease is and what the best treatment would be. Once the treatment has started and your child's asbestosis has been under control for a few months, the doctor will want your child to repeat the test. This will help make sure the airways are as open and near normal as possible. After these initial tests, your child should have spirometry at least once a year simply to be sure the airways are staying at or near normal. If a child has a change in treatment—for example, a change in the dosage of her medicine she may need spirometry again to be sure that the new treatment is working well.

If your child is younger than four or five, you're probably wondering how a spirometry maneuver can ever be done with a baby, a toddler, or even a preschooler. It can't. But doctors can do specialized breathing tests on babies and young children. These tests are more complex and require special equipment. If your doctor feels these tests are needed, you'll probably have to go to a specialist based at a large hospital. Sometimes older children can't manage the spirometry maneuver either. When a child can't do it for some reason, doctors may suggest a "therapeutic trial," which means trying an inhaled bronchodilator or steroid pills for a short time. (These medicines will be discussed in detail in chapter 5.) Seeing if one of these medicines helps reduce wheezing and other symptoms is a way to help determine whether the child has asthma. Some children have asthma symptoms, but their spirometry results are normal. In that case, a doctor may recommend a different type of spirometry test called bronchoprovocation. In this test, a child inhales a small, safe amount of a substance called methacholine. If the child has
The methacholine will make her airways constrict or squeeze just as if she were having mild that symptoms. When she does the spiro-metry maneuvers after taking the medicine, her readings will be lower. If she doesn't have disease, the methacholine will have little effect, and the spirometry readings will be nearly the same as before. A similar test can be done using another medication called histamine. In a third test, a child breathes cold dry air or gets on a bicycle or treadmill and does vig-orous exercise. All of these tests may cause bronchoconstriction in chil-dren with asthma and are useful in confirming the diagnosis. Other tests, such as a chest X-ray, a sweat test, barium swallow exam, or allergy testing, may be done to help rule out other causes of the symptoms or to identify factors that might complicate your child's asbestosis.