division of pediatric pulmonology · 2018. 1. 17. · mission pediatric pulmonology • provide...
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DIVISION of PEDIATRIC
PULMONOLOGY
Faculty Meeting, Department of Pediatrics
January 15, 2013
Mission
Pediatric Pulmonology
• Provide family-centered, child-focused, comprehensive, state of the art clinical care for children with respiratory disorders in North Carolina
• Provide a specialized medical home for children with chronic respiratory illnesses that interfaces with hospital-based and community-based care
• Conduct clinical research that directly translates new discoveries and therapies into improved care of children with respiratory disorders
• Educate and train future clinician scientists to sustain and expand our specialized programs
Who are we?
Elisabeth Dellon, MD MPH
• Director of Pediatric Supportive Care Team
• Research: End of Life Decision Making
• Pediatric Lung Transplant Program
• Directs Pediatric Pulmonology Elective
Charles Esther, MD PhD
• Director of Pediatric Pulmonology Fellowship
• Research:
• Biomarkers in CF (K23)
• Early Lung Disease in CF (R01)
Pediatric Pulmonology
Who are we?
Marianna Henry, MD MPH
• Clinical Care of Complex Respiratory Patients
• Teaching Pediatric Bronchoscopy
• Class Advisor to Pediatric Residents
• SOM Admissions Committee
Margaret Leigh, MD
• Director, UNC Cystic Fibrosis Center
• Research: Primary Ciliary Dyskinesia
• Multi-national, EU funded
• NIH funded Rare Diseases
• Mentoring Faculty (Award)-7 committees
Pediatric Pulmonology
Who are we?
Ceila Loughlin, MD
• Director, NC Children’s Asthma Program
• Partnership with Allergy/Immunology
• Asthma care pathways
• Rex/Raleigh Pulmonology Clinic
• Teaching Scholars Program
Marianne Muhlebach, MD
• Clinical Research in Cystic Fibrosis
• Early CF Lung Disease (R01)
• MRSA in CF (CFF multicenter trial)
• Biomarkers in CF
(metabolomics/proteinomics)
Pediatric Pulmonology
• Medical Director for Outreach Clinics • Wilmington, Raleigh
Who are we?
Terry Noah, MD
• Vice Chair for Faculty Development
• Research:
• Viral infection and airway immune response
• Environmental modifiers of lung immune
response
• Medical Director, Pediatric Lung Transplant
Jessica Pittman, MD MPH
• Director, Infant and Preschool Pulmonary Function Lab
• Research:
• Children’s lung function
• Development of new measures for infants,
children • LCI marker of early lung disease (R01 co-I)
Pediatric Pulmonology
Who are we?
Cindy Reilly, PNP
• Care of children with tracheostomies
• NC Children’s Airway Center
• Consultant to NC Medicaid re: PDN
George Retsch-Bogart, MD
• Division Chief
• Development of Therapeutics for Cystic Fibrosis
• UNC TDC, CFF TDN
• NC Children’s Airway Center
• NC TraCS Institute (CTRC, Child Health Core)
Pediatric Pulmonology
Clinical Programs
Specialty Clinics
UNC Pediatric Cystic Fibrosis Center
NC Children’s Airway Center
Technology Dependent Children
NC Children’s Bronchoscopy Service
UNC Pediatric Lung Transplant Program (related--Children’s Supportive Care Program)
NC Children’s Infant and Preschool Pulmonary Function Lab, Pediatric PFT Lab
NC Children’s Asthma Program
PCD Diagnostic Clinic
Pediatric Pulmonology Clinics
(FY12: 4785 visits, 390 admissions, 310 consults, ~2600 pt. days)
NC Children’s (Tues, Weds, Thurs, Fri)
Rex Pulmonology Clinic (Tues, Thurs)
Wilmington Pulmonology Clinic (monthly, Weds)
Pediatric Pulmonology
Who are we?
Pediatric Pulmonology
Clinical Staff:
Nurse Clinicians (CF): Sheree Berckmans, RN CF Team: Kimberly Stephenson, RD
Denise Hudson, RN Kelly Bamberger, RD
Nancy Lee, RN Kelli Johnson, RRT
Benjamin Butler, RN Asli Serlo, MSW
Asthma nurse: Lisa Alarcon, RN Amy Sangvai, MSW
Airway Center Team: Kathy Abode, RN, MPH Linda McCluskey, PT
Mark Hall, RRT
Cathie Tutka, MSW
Mandy Gee, BS
Research Staff: Administration: Charlotte Weaver
Airway Modeling, PCD: Betsy Pitkin, RN Darlene Gilliland
CF Therapeutics: Carol Barlow, RN CF Registry: Danie Cockrum
Kelly Stephenson, BA Grants Mgmt: Kira Frediani
Pediatric PFT: Robin Johnson, RRT
Jim Ronk, RRT
Research Assoc. : Sally Ivins, BS
Paula Murphy, BS
Education
Pediatric Pulmonology Fellowship Program, NIH-T32 (began mid-1980’s)
• Pulmonology Fellows Jen Goralski, MD Leroy Mathews Physician Scientist Award, CF Foundation
Med/Peds trained, Adult and Pediatric Pulmonology Fellowship →joining the Dept. of Medicine Faculty
Translational research in mucociliary clearance therapeutics
Justin Paulson, MD 3rd Year Fellow, Research with T. Noah on immune response to influenza vaccine by BMI in children
Keith Robinson, MD 2nd Year Fellow, Use of EMR for clinical care management
Jennifer Guimbellot, MD, PhD 1st Year Fellow, work with Martina Gentzsch on a project involving CFTR gene expression
Pediatric Pulmonology
Total Grant Dollars
Research Primary Ciliary Dyskinesia (PCD) Research
Functional Modeling of Upper Airway Obstruction
CF Translational Research)
Early Lung Disease in CF
Infant and Childhood Lung Function
Viral Infection and Immune Response in Lung
End of Life Decision Making, Care and Outcomes
FY 2012: $2,572,461 FY 2013: $2,880,424
Pediatric Pulmonology
Publications: 37 Papers 31 Abstracts (at national meetings)
Grants: 22 Submitted 11 Funded
Primary Areas of Research
Primary Ciliary Dyskinesia (M Leigh)
Multi-center, 5 yr. prospective study to characterize onset and progression of lung disease in children (lead PI)
Evaluation of nasal nitric oxide measurement as screening test for PCD (with M. Hazucha)
Identification of PCD genes (with M. Zariwala and M. Knowles)
Heterotaxy and PCD (with A. Shapiro, MD and B. Robinson, MD at UNC)
Creating Quality of Life instrument for PCD (collaboration with S. Dell at Toronto and A. Quittner at Miami)
BESTCILIA: Better Experimental Screening and Treatment for PCD (European Commission funding, multicenter study, US PI,consultant)
Pediatric Pulmonology
Primary Areas of Research
Functional Airway Modeling of Upper Airway Obstruction
Multi-PI grant, NIH R01
Davis (Pulm), Zdanski (OHNS), Superfine (Physics)
Cohorts of children with PRS, SGS and normal airways
4 other sites, older patients with UAO (UC, Penn, USC, Einstein)
NC Children’s Airway Center Program
Pediatric Pulmonology
Primary Areas of Research
CF Therapeutics Development Network
Conduct of investigator-initiated and industry-sponsored clinical trials, outcome measure development and multicenter observational studies
Novel outcome measures
Muhlebach: Biomarker Consortium
• Proteomics, metabolomics
Esther: Exhaled breath condensate, metabolites
Leadership for network of 77 sites, 7 national resource centers, working collaboratively
eQUIP-CR: web-based improvement
program for clinical research
Pediatric Pulmonology
Primary Areas of Research
Early Lung Disease in Cystic Fibrosis
Response to NIH RFA
R01: Muhlebach, Esther, Stick (Australia). “Mucus and Hypoxia in Heterogeneous and Progressive Lung Disease”
R01: Fatjen (Toronto): J Pittman as Co-investigator. “The Lung Clearance Index as a Marker of Early Lung Disease in Cystic Fibrosis”
Pediatric Pulmonology
Primary Areas of Research
Infant and Preschool Lung Function Testing (J. Pittman)
Key outcome measure for early disease
Sedated infant lung function testing
Spirometry, lung volumes (controlled breathing)
Preschool spirometry
Lung Clearance Index by multiple breath washout
Populations
CF, PCD, chronic or recurrent wheezing
Pediatric Pulmonology
Primary Areas of Research Air Pollution, Viral Infection and Immune Response in Lung (T Noah)
Body mass index and influenza vaccine responses in children (J Paulson, E Perrin, M Steiner)
Impact of air pollutants on viral respiratory infection in humans
Studies with human volunteers and natural or controlled pollutant exposures
Characterize the effects of oxidant pollutants on inflammatory, antiviral, and mucin responses to influenza virus. T
Goal: to define therapeutic targets
for improved innate immune defenses
Pediatric Pulmonology
Primary Areas of Research
End of Life Decision Making, Care and Outcomes (E Dellon)
Qualitative research methods for
Decision making at end-of-life
Perspectives from patients, family caregivers, physicians
Quality of life scales
Application to palliative care programs
CF Foundation
Transition of care research (G. Sawicki/Boston Children’s)
Pediatric Pulmonology
External Collaborators Research Collaborations
Boucher, Donaldson, Knowles- Pulmonary and Critical Care Medicine, Dept. of Medicine
Microbiology, Department of Laboratory Medicine
Kosorok, Department of Biostatistics, School of Public Health
Zdanski, Department of Otolaryngology Head and Neck Surgery
Superfine, Department of Physics
Fordham, Department of Radiology
Cairns and Jones, Burn Center, Department of Surgery
Clinical Program Collaborations
Adult Cystic Fibrosis Center
Department of Anesthesiology, PICU and OR
Vaughn, Sleep Center, Department of Neurology
Pediatric Gastroenterology
CEMALB, Division of Allergy and Immunology
Lung Transplant Program (CT Surgery)
Pediatric Pulmonology
External Collaborators National:
S. Davis, Indiana University
B. Ramsey, M. Rosenfeld-University of Washington
PCD Rare Diseases Consortium, US multi-center program
CF TDN participating sites
International:
Ratjen, Toronto/Sick Kids
Stick, Australia
Elborn, Belfast
BESTCILIA, European Union
European CF Society, Clinical Trials Network
Pediatric Pulmonology
Where are we going?
Clinical
Education
Research
Expand clinical program to meet growing need for referrals from the community and consider outreach clinics in other areas
Maintain excellence in fellowship training, provide pulmonology elective to students and residents
Continue collaborative research at UNC, nationally and internationally, while protecting successful investigators to complete research, publish, and sustain funding for their successful programs
Pediatric Pulmonology