DIVISION of PEDIATRIC PULMONOLOGY · 2018. 1. 17. · Mission Pediatric Pulmonology • Provide family-centered, child-focused, comprehensive, state of the art clinical care for children

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)


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


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)


• 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)


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)


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)


Who are we?


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


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


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)



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



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



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”



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


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



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)


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)


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


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


Documents

DIVISION of PEDIATRIC PULMONOLOGY · 2018. 1. 17. · Mission Pediatric Pulmonology • Provide family-centered, child-focused, comprehensive, state of the art clinical care for children