Logo, Chicago Pulmonary Specialists - Pulmonary Specialist 

 (847) 998-3434
2401 Ravine Way, Suite 302, Glenview, IL 60025

Conditions Treated


CARE Specialists offers comprehensive diagnostic and treatment options for people with asthma.

Asthma is a chronic inflammatory condition of the lungs.  The lungs of an individual with asthma are predisposed to over reacting to various triggers, such as allergens, cold air, exercise, viruses or irritants.  It has no known distinct etiology, and there are many different signs and symptoms, making asthma often times difficult to diagnose and manage.

Asthma is the most common chronic disease of childhood, and affects more than 7 million children in the United States.  In children, establishing a diagnosis of asthma involves comprehensive history taking, physical examination, and often times diagnostic studies.  Other potential causes of symptoms must be carefully considered, particularly in young children, when lung function testing is technically difficult.

In a child or a teenager, many times asthma can be managed by a pediatrician or an allergist.  However, if the symptoms are difficult to control, or if the diagnosis is uncertain, then additional evaluation by a pulmonologist is warranted.   A pulmonologist will be able to help verify an asthma diagnosis, establish if other diagnoses are present, determine asthma severity and triggers, and will help control asthma symptoms and prevent flare-ups.

Testing is often required for this evaluation.  This might include baseline pulmonary function studies, bronchodilator assessment, an asthma exercise or chemical challenge test, a chest x-ray, or blood work to check for allergies or problems with the immune system.

The appropriate evaluation for children or teenagers with suspected asthma is individualized with careful consideration to determine the appropriate treatment.

Exercise Induced Asthma

Exercise is one of the common triggers causing bronchoconstriction in the lungs.  Bronchoconstriction during exercise is called Exercise Induced Asthma or EIA.  In most cases of EIA, bronchoconstriction occurs 4-8 minutes into exercise and peaks about 10 minutes after stopping.  Often this condition results in decreased performance.  The airways usually return to a normal state within 30-60 minutes after the activity has ceased.

Why perform an Exercise Provocation Test?

  • To detect the presence or absence of Exercise Induced Asthma.
  • To assist in the explanation of exercise-related symptoms:  Cough, Wheeze, Stridor, Shortness of Breath, Chest Pain, Dizziness or Light Headedness, Heart Burn, and Exercise Intolerance
  • To help detect diseases that mimic Exercise Induced Asthma: Inducible Laryngeal Obstruction, Laryngospasm, Laryngomalacia, Tracheomalacia, Cardiac Chest Pain, Gastroesophageal Reflux
  • To assess the effectiveness of medications:  Preventative short acting medication and long acting asthma medications
  • To assess the effectiveness of non-pharmacological interventions

What are the parts of an exercise provocation test?

Before the Test   Dr. Boas or a member of his clinical staff will review the present health status and the medication your child is taking at the time of the test.  A baseline breathing test will be performed and compared to the last test your child performed.  A clinical staff member will also examine your child before determining that it is safe for the child to perform the test.

During the Test   The test will be performed on a treadmill in most cases.  Monitors will be placed on your child’s forehead to assess heart rate and oxygen levels.  The treadmill will be started and quickly advanced to about 70-80% of the expected maximal intensity.  Throughout the test, staff members will monitor your child as well as assess your child’s symptoms.  As symptoms are reached with an adequate intensity, determined by heart rate, the treadmill will be stopped.  The test will last anywhere between 3 and 8 minutes.

Following the Treadmill   Upon completion of the test, your child will immediately perform a breathing test while a clinician listens to the lungs and upper airways.  Monitors continue to show heart rate and oxygen levels and will be in place until your child’s values return to baseline.  Breathing tests will be performed again at 5, 10, and 15 minutes post exercise.  A breathing medication, albuterol, may be given to your child.  Once your child returns to his or her baseline, he or she will be ready to go home.  The test is then reviewed by Dr. Boas and his clinical for interpretation.

How to prepare for the test?

Your child should wear comfortable clothing, such as a T-shirt, shorts, and gym shoes (girls should wear a v-neck shirt, tank top, or sports bra).  Do not eat anything heavy 2 hours prior to the test.  If you require albuterol on the day of the test, please contact the office to see if the test will be able to be performed. Avoid strenuous exercise on the day of the test as this might interfere with the exercise challenge.

What if your child gets sick before the test?

If your child is wheezing, coughing, or having trouble breathing on the day of the test, give our office a call as the test may have to be rescheduled.

Chest Wall Deformities

The Pectus Excavatum Center at Children’s Asthma Respiratory and Exercise Specialists offers a unique and comprehensive approach for the child or teenager with Pectus Excavatum (“sunken in chest”), Pectus Carinatum (“Pigeon chest”), or other Chest Wall anomalies.  Our program consists of several components.

  1. Initial Consultation – At this initial visit, a comprehensive history will be taken to identify the factors associated with your child’s Pectus Excavatum.  A physical examination will be performed to assess the severity of the Pectus Excavatum and to determine associated findings such as syndromes or other conditions.  Additionally, potential for pulmonary rehabilitation will be determined.
  2. Comprehensive Lung Function Testing – These tests will also be part of the initial visit.  These tests will help determine the physiologic impact of the chest wall deformity on resting breathing and to assess for co-existing conditions.
  3. Completion of the diagnostic work-up will be performed over the ensuing weeks and may include:
  •  Pulmonary Stress Testing – The specialized test will evaluate the complex interaction between the lungs, heart, and exercising muscle to determine the presence or absence of limitations associated with the chest wall anomaly.  This test is critical in establishing physiologic abnormalities that the chest wall anomaly might be causing.  Note: this test is different than an exercise challenge or cardiac stress test which has different protocols used to answer different questions.
  • Cardiac – An echocardiogram (ECHO) and electrocardiogram (ECG) are often performed to see if the chest wall anomaly is impacting the normal functioning of the heart and to determine if any cardiac associated findings of various syndromes are present.
  • Physical Therapy Consultation – A consultation with a physical therapist who has expertise in chest wall dynamics and physiology may be needed to deterine if physical therapy is warranted as an adjunct to the treatment plan in order to improve the chest wall anomaly, slow the rate of progression, or prepare one for surgery.
  •  Chest Radiograph and/or Chest CT – For selective patients with a chest wall anomaly, an imaging study such as a CT scan or radiograph may be performed in order to better define the anatomy of the chest wall.
  1. Follow-up visit to review work-up and to determine appropriateness of surgical or non-surgical interventions.
  2. For surgical candidates, consultation with a surgeon with expertise on Pectus Excavatum, Pectus Carinatum, or Chest Wall Anomalies.  If patient is amenable to physical therapy, sessions will be initiated in preparation for surgery to optimize medical condition prior to surgery.
  3. For non-surgical candidates, determination of need for physical therapy.  Monitor progress of PT by follow up visits every 3-6 months with retesting in 6-12 months.  For non-PT candidates, close monitoring of progression of consideration every 6 months with repeat comprehensive lung function assessment with exercise testing once a year.

Every person with a Pectus Excavatum, Pectus Carinatum, or Chest Wall Anomaly manifests the condition in a unique fashion.  No one approach works or is right for all patients.  The Pectus Excavatum Center at Children’s Asthma Respiratory & Exercise Specialists is committed to tailoring the best therapy for the patient by careful and meticulous diagnostic assessment, utilization of consultant healthcare providers as required, and by close monitoring.

Recurrent Pneumonia

Recurrent pneumonia in a child or teenager usually requires an evaluation to determine if there is any underlying factor(s) that may be responsible.  CARE Specialists treat many pediatric patients with recurrent pneumonia and arrives at the appropriate diagnosis through use of appropriate diagnostic and therapeutic modalities.

Many children who get frequent infections such as upper respiratory tract infections, repeated bouts of pneumonia or bronchitis, warrant an evaluation by a pulmonologist.  Often times, some of the infections are viral in nature but others may be caused by bacteria.  A pulmonologist will be able to help determine whether these increased bacterial infections represent a more serious condition such as an immune deficiency, cystic fibrosis, ciliary dyskinesia, or congenital structural abnormalities in the lungs or airways.

Testing is often required to determine the cause of these recurrent infections and may include blood tests, radiographs and/or CT scans, sweat test, and bronchoscopy.

Cystic Fibrosis

Since 2002, The Cystic Fibrosis Center of Chicago has been revolutionizing care for children and adults with cystic fibrosis.  Although multiple CF care centers in the Chicagoland area exist, The Cystic Fibrosis Center of Chicago is the only independently run care center offering individualized and outcome-driven medical care.  Our philosophy:

  • Independence
  • Individuality
  • Partnership
  • Accessibility   
  • Pioneering  

Inducible Laryngeal Obstruction/Vocal Cord Dysfunction

Inducible Laryngeal Obstruction or ILO has become a fashionable diagnosis over recent years.  While the term vocal cord dysfunction (VCD) has been widely used, the term ILO is more appropriate in describing the various types of abnormalities that may account for symptoms.  While VCD was initially meant to include the paradoxical movement of the vocal cords, especially on inhalation with resultant adduction or coming together of the cords, the term VCD has transitioned to include almost any condition involving the extrathoracic airway.  At CARES Specialists, a comprehensive approach has been developed by Dr. Boas based on over 20 years of clinical expertise.  This approach includes 4 distinct clinical assessments – history, physical examination, baseline diagnostic studies, and dynamic assessment via laryngoscopy and provocation challenges.

In our pediatric and adolescent exercise practice, Inducible Laryngeal Obstruction at the glottic level is the most common type of laryngeal obstruction seen in our adolescent athletes.  The athlete generally has no symptoms at rest and only experiences inspiratory shortness of breath with high intensity exercise.  While the glottic structures ultimately demonstrate partial or complete closure, it is the high inspiratory flows generated at intense exercise that creates this collapse.  These intense flows at high ventilation rates are the culprit for the symptoms.  Symptoms usually resolve within a few minutes of resting.  A history of mild asthma is often seen.  This diagnosis is made with appropriate history, physical examination and baseline lung function studies with confirmatory exercise provocation and laryngoscopy to rule out other secondary causes.  Therapy is geared towards lowering the flow rate.

Other causes of Inducible Laryngeal Obstruction may occur at any age including adolescence but appears to be more common in the younger school aged group.  While symptoms may also occur in the same intensity-related fashion, the underlying cause is a condition that triggers the upper airway compromise.  Commonly found secondary triggers include gastroesophageal reflux, sinus drainage, allergic and non-allergic post-nasal drainage, laryngeal polyps, laryngeal nodules and anxiety.  Additionally, supraglottic causes of ILO such as laryngomalacia and an enlarged protracted epiglottis may occur.  The diagnostic approach is similar as noted above with the critical element being a look at the laryngeal structures to determine if any of these causes are present.  Therapy begins by treating the underlying cause.

Primary or Secondary Pervasive Laryngeal Obstruction is less common in the pediatric age group in our practice and consists of symptoms that can occur at rest in a random fashion.  Exercise provocation may not be necessary in the evaluation, but a direct inspection of the laryngeal structures is required.

The appropriate workup for children or teenagers with suspected ILO is individualized with careful evaluation required to determine the ultimate type of appropriate therapy.

In addition to the resources present at CARE Specialists, association with sports psychology counselors, behaviorial psychologists, and other resources offers a comprehensive team approach for the child with this condition.