P&S Journal: Fall 1997, Vol.17, No.3
Clinical Advances: By Devera Pine
A Lung and CF Center for Children
Every year roughly 2,000 children come to Columbia-Presbyterian for treatment of chronic asthma, pulmonary hypertension, cystic fibrosis, lung and airway abnormalities, and other pulmonary disorders. Now, a new center aims to help reduce that number through better preventive measures and care.
The Sarah E. Nash Children's Lung and Cystic Fibrosis Center will have new treatment areas, doctors offices, and clinical pulmonary function labs on a renovated floor of Babies & Children's Hospital. Initially funded with a $1 million gift from L. Dennis Kozlowski, the chairman and CEO of Tyco International, the center is named for Ms. Nash, a longtime supporter of the hospital.
The center will accommodate the ever-growing pediatric pulmonary division. "Interest in the medicine and biology of the lung has exploded in the last few decades," says Dr. Robert B. Mellins, professor of pediatrics and director of the pediatric pulmonary division. "The lungs do more than just breathe. They contain more than 40 different cell types, which have a lot to do with controlling and protecting other systems of the body."
With the recent emphasis on outpatient care and the subsequent evolution of home care, many patients who traditionally were hospitalized--including patients with cystic fibrosis or asthma--now receive specialized treatment at home. As a result, the patients being hospitalized often have much more severe diseases and require complex care, often delivered in an intensive care unit. Even when these patients' primary illness is not related to the lungs, they may develop various pulmonary problems that pulmonologists must diagnose and manage. P&S investigators are studying the pulmonary aspects of diseases such as sickle cell, HIV/AIDS, pulmonary hypertension, chest wall abnormalities, congenital diaphragmatic hernia, and heart transplants in collaboration with faculty from other divisions.
Recent advances in organ transplantation also have an impact on pulmonary illnesses. Organ transplants can now aid people with otherwise fatal illnesses, such as terminal CF, severe pulmonary hypertension, or severe congenital lung disorders. Transplantation makes up a significant part of the clinical activities of the pulmonary division.
Physicians in the pediatric pulmonary division also rely on bronchoscopy to help detect abnormalities in the lungs and airways of infants and children. Flexible fiberoptic bronchoscopy is a relatively non-invasive diagnostic or therapeutic procedure that has provided a quick, safe, and reliable alternative to more invasive and costly procedures.
Another area of increasing importance is the treatment of asthma. Many people see asthma as an episodic disease, to be attended to only when it results in an asthma attack or crisis. But increasingly, studies show that asthma is a chronic inflammatory lung disease and that managing asthma via a daily self-treatment program can prevent it from developing into a life-threatening crisis. "In a disease like asthma, people who manage their disease well can win Olympic medals. People who manage their disease poorly can end up in a medical catastrophe," says Dr. Mellins.
To help promote proper management of asthma in children, P&S researchers developed the Open Airways health education programs for children with asthma. The American Lung Association now distributes the program to schools nationwide.
The new center also will be home to research and treatment facilities for cystic fibrosis, continuing the historical role P&S has played at the forefront of CF research. For instance, clinical trials begin this fall on the use of meropenem, an antibiotic that treats the pulmonary exacerbations of CF. Researchers also are set to test the efficacy of Pulmozyme, an FDA-approved drug for older patients and young adults, in young children.
Laboratory science in the center is especially concerned with the development of airway branching and of blood vessels in the lungs. This research may someday lead to a greater understanding of congenital malformations of the lung, alterations in lung growth that result from diseases early in life, and the complications of ventilation and oxygen therapy.