Pulmonary and Critical Care Research and Education Updates – March 2023

Message from Imre Noth, MD, Pulmonary and Critical Care Division Chief

What a difference a year makes! Our fantastic faculty have come into 2023 stronger and smiling after putting COVID-19 (mostly) in the rear window. As spring is upon us and the sun is shining, our outlook continues to get brighter and brighter. We are growing both our inpatient and outpatient services to give our patients the best possible access. And while the severity of illness and numbers in MICU have thankfully tempered, renewed efforts have increased our outpatient volumes over the last few years. We have developed a significant telehealth presence with virtual-based ambulatory clinics.

Specifically, Katarine von Lang Egressy, MD, MPH, recently created a hybrid lung nodule clinic with both physical and virtual appointments available. Tessy Paul, MD, has been spearheading our telehealth ambulatory efforts for the division and inspired Eric Davis, MD, to use telehealth to meet the demand for Sleep Medicine visits. Similarly, we have continued to see growth in Interventional Pulmonary referrals and procedures. In this issue of Medicine Matters, several programs are highlighted, but they are a small representation of terrific work across the board.

Several faculty are taking on new leadership roles within the department or institution, to name a few. Kyle Enfield, MD, is assuming the Vice Chair for Quality and Safety for the department. Taison Bell, MD, is the department’s Vice Chair for Faculty Affairs. Alexandra Kadl, MD, will be transitioning into the role of Medical Director for the MICU in July.

Our research endeavors continue to grow, with more grant applications and publications in the last 12 months than ever! Getting our fellows involved in the ever-growing number of research opportunities has been a true pleasure. We also added one new faculty member in 2022, Hitesh “Heath” Patel, MD, who comes to us from the University of North Carolina. He has been a welcome addition and has already left an imprint on the educational goals of the MICU.

I’m excited to see what the next twelve months have in store.

~ Imre Noth, MD, Division Chief

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Clinical Updates

Pulmonary Hypertension Update

The Division of Pulmonary and Critical Care Medicine continues to provide regional support as a major referral center for pathologies affecting pulmonary vasculature. PCCM collaborates with the Department of Radiology to operate the Hereditary Hemorrhagic Telangiectasia (HHT) clinic to service patients with inheritable forms of vascular overgrowth. In addition, the pulmonary embolism response team (PERT) averages ten consults per month to providers throughout the system who develop treatment plans for patients afflicted by intermediate and high-risk pulmonary emboli. The Division also continues collaborating with the Division of Cardiovascular Medicine to offer world-class services to patients with pulmonary hypertension in the UVA Multidisciplinary Pulmonary Hypertension Clinic. Lastly, PCCM recently partnered with the Divisions of Cardiac Surgery and Thoracic Surgery to form a multidisciplinary team to treat chronic thromboembolic pulmonary hypertension (CTEPH), a rare form of pulmonary hypertension. In the fall of 2022, the team successfully offered a pulmonary thromboendarterectomy to a patient, making UVA the only institution in Virginia to offer this surgery.

Interventional Pulmonary Update

PCCM is excited to announce the addition of a pulmonary nodule clinic to the Interventional Pulmonary Program. The program aims to address any concerning pulmonary nodules that may be detected through incidental imaging or lung cancer screening computer tomography. This clinic aims explicitly to integrate research into an evidence-based approach to the new domain of biomarker use for lung cancer screening and pulmonary nodule evaluation.

The pulmonary nodule clinic is created in partnership with the Emily Couric Clinical Cancer Center and the Department of Radiology. This collaborative effort aims to highlight the University’s existing lung cancer early detection program and further outreach efforts for all qualifying patients in Virginia. Furthermore, this clinic takes a hybrid approach by offering telemedicine and in-person visits, allowing us to tackle transportation and geographic location barriers. To refer a patient or request additional information, please contact Dr. Katarine von Lang Egressy at ybm8rk@uvahealth.org

Lung Transplant Update

The Lung Transplant Program at UVA continues to offer interdisciplinary, state-of-the-art, compassionate care to patients with end-stage lung disease in Virginia and the tri-state area. The program, led by Phil Carrott, MD (surgical director) and Hannah Mannem, MD (medical director), performs approximately 30 lung transplants annually. The lung transplant team comprises highly specialized lung transplant pulmonologists, surgeons, advanced practice providers, nurse coordinators, nutritionists, pharmacists, neuropsychologists, physical therapists, and social workers. The team works exceptionally hard to ensure innovative and quality care for each patient. Based on patient satisfaction surveys, the three lung transplant pulmonologists and the outpatient transplant clinic have received the Outstanding Patient Experience Award multiple years in a row. The program’s lung transplant support group has existed for over 30 years. It continues to be successful in a virtual forum as a resource for lung transplant candidates, recipients, and caregivers.

Since the start of the COVID-19 pandemic, indications for a lung transplant have expanded to include COVID-19-associated acute respiratory distress syndrome along with COVID-19 fibrotic lung disease. In 2021, according to the United Network of Organ Sharing (UNOS), COVID-19 was the third most common indication for a lung transplant. UVA was one of the first transplant centers in the region to transplant a patient for COVID-19 respiratory failure. With the multidisciplinary work of the lung transplant team, the cardiothoracic ICU, physical therapists, and ECMO specialists, a system was developed for urgent inpatient referrals and expedited transplant work-ups, which includes prehabilitation using extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant. Outreach to the community’s primary care physicians has been broadened, increasing opportunities to assist in diagnosing and managing patients with potential post-COVID-19 related lung fibrosis.

The program has grown over the past few years due to expanding its selection criteria for transplant and donor pool acceptance. The lung selection criteria have been expanded broadly to include advanced age, coronary artery disease revascularization, specific malignancies, coal workers’ pneumoconiosis, and lung fibrosis (black lung disease). The donor pool also now accepts organs from donors with hepatitis C and death after cardiac donation (DCD) organs.

The lung transplant team continues to expand patient care on a multi-system level with the assistance of colleagues from PCCM and beyond. The team has established ongoing working relationships, workflows, and research projects with the Division of Gastroenterology and Hepatology to diagnose and treat common gastroenterological complications after lung transplants that can dramatically affect outcomes. In collaboration with interventional pulmonary, thoracic surgery, and pulmonary colleagues, the team recently created a multidisciplinary active working group for patients with COPD to assess barriers and options for treatment in this patient population, including lung volume reduction surgery, endobronchial lung volume reduction, and lung transplant.

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Research Updates

The Division of Pulmonary and Critical Care Medicine proudly maintains a diverse clinical, translational, and basic science research portfolio.

Pulmonary fibrosis or interstitial lung disease (ILD) remains a major interest for several division members, including John S. Kim, MD, MS, who is NIH K23 funded to study the role of polyunsaturated fatty acids in pulmonary fibrosis, and Catherine Bonham, MD, whose K23 funded the study of T cells in idiopathic pulmonary fibrosis.

In 2022 Jeffrey Sturek, MD, PhD, was awarded a foundation grant to evaluate the IgM-CXCL13 axis in pulmonary fibrosis.

Tessy Paul, MD, Clinical Director of the Interstitial Lung Disease Program, Numaan Malik, MBBS, Pulmonary Clinic Director, and Hannah Mannem, MD, Lung Transplant Director, are principal investigators for multiple clinical trials currently underway in our ILD population.

Division Chief Imre Noth, MD, Shwu-Fan Ma, PhD, and Yong Huang, MD, MS are internationally recognized leaders in translational genetics and genomics of idiopathic pulmonary fibrosis. The Division is proud of its lead role in the NIH-funded 42-site PRECISIONS clinical trial, the first and largest pharmacogenomics trial to test personalized therapy for patients with idiopathic pulmonary fibrosis.

Drew Harris, MD, has also had a significant role in occupational/environmental health as Medical Director of the Black Lung Clinic at Southwest Virginia’s Stone Mountain Health Services, the only federally funded black lung clinic in Virginia. His research on the mental health crisis in coal miners is the first of its kind, and he is recognized as a leader in health disparity research.

In COPD research, the Division is continuously R01 NIH funded under the leadership of Y. Michael Shim, MD, who uses hyperpolarized Xenon-129 MRI to measure pulmonary physiologic responses to therapeutics and examines the effect of male and female sex hormones on lung disease. Dr. Shim straddles the scientific and clinical areas by leading the advanced obstructive lung disease clinic and the pulmonary function lab.

Lung transplant faculty Max Weder, MD, Hannah Mannem, MD, and Charles Alex, MD, curate an international database to track the experiences and outcomes of COVID-19 lung transplant patients.

Jamie Macleod, MD, studies the role of calcineurin inhibition in lung transplants.

The cystic fibrosis and non-CF bronchiectasis program, led by Dana Albon, MD, MS, and Lindsay Somerville, MD, has been a leader in publishing clinical research on using telemedicine-based care.

The research capacity of the critical care faculty was showcased during the COVID-19 pandemic. Alexandra Kadl, MD, MS, and Kyle Enfield, MD, MS, published on the clinical experiences of the COVID-19 survivor clinic and Drs. Somerville, Kadl, and Bonham published an immune signature associated with COVID-19 prognosis, funded by the Global Infectious Diseases Initiative. Drs. Kadl, Bonham, Shim, Sturek, and their collaborators received Dean Kibbe’s 2022 Faculty Research Award for Team Science for their interdivisional initiatives on COVID-19.

Dr. Enfield and senior fellow Claire DeBolt Davis, MD, are extending their clinical informatics expertise to research the effect of a new clinical dashboard to reduce complications of critical care, such as catheter-associated bloodstream infections.

Andrew Barros, MD, MS, continues to utilize high-dimensional electronic health record data and medical data science techniques to investigate hospitalization outcomes.

The Division is proud of multiple faculty members who mentor young investigators. Recently Jeffrey Sturek, MD, PhD, was appointed Associate Program Director for Research for the Internal Medicine Program and Director of the Physician-Scientist Training Program, which will utilize the ABIM Research Track training pathway to develop physician-scientists in the department of medicine.

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Educational Updates

It has been another successful year for the fellowship program! We welcomed five new fellows in July: Drs. Nelson Mandrell, Ryan Sessums, Joe Russo, Mustafa Ali, and Sam Lazoff.

Meanwhile, our four most recent graduates have dispersed to four points of the country (Coeur d’Alene, ID; Miami, FL; Rochester, NY; Newport News, VA), representing the University of Virginia in their new positions.

Under the guidance of our co-chief fellows, Drs. Sam Oliver and Eva Otoupalova, our senior class are leading the program in new directions including: improving our curriculum, volunteering in community clinics, participating in national conferences, and developing bundle boards for intensive care units.

For next year’s co-chief fellows we will have Drs. Naima Farah and M. Ibrar Islam. We expect the program to continue to thrive under the new co-chiefs and look forward to welcoming an outstanding group of fellows this summer.

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Division Events

Spring BBQ
Division Chief Imre Noth and his wife, Sheila, hosted a barbecue at their home last May for the families of faculty, fellows, and staff. About 80 guests braved the blustery spring day to enjoy food from Smoked Kitchen and Tap and Sheila’s famous homemade pastries.

ILD Patient Education Day
Interstitial lung disease (ILD) is a heterogenous group of diseases that range from rheumatoid lung disease to sarcoidosis to the devastating idiopathic pulmonary fibrosis (IPF) which has a median survival of 2-5 years. The UVA ILD program offers comprehensive, longitudinal, and multidisciplinary care for this complex population.

One of the key aspects of the care of patients with ILD is patient education. In addition to a biweekly patient support group under the leadership of Drs. Tessy Paul and Catherine Bonham, the team, held its fourth annual ILD Patient Education Day on September 17, 2022. The theme was “Living Well with Pulmonary Fibrosis” and featured keynote speaker Dr. Joyce Lee, a nationally renowned ILD expert from University of Colorado and the Senior Medical Advisor for the Pulmonary Fibrosis Foundation (PFF).

Additional topics discussed included pulmonary rehabilitation, nutritional considerations, oxygen therapy, palliative care, and clinical trials in ILD. This hybrid event was accessible both virtually and in-person with support from the PFF and was received with overwhelmingly positive response from patients and their caregivers.

Community Service
This winter, PCCM partnered with the Health Wagon to collect and distribute cold-weather outerwear to residents of Appalachia. Winter is a challenging time for Southwest Virginia as its rural population experiences economic struggles disproportionate to the rest of the state. According to VA Social Services reporting (2019) and household census data (2020), Buchanan, Lee, and Wise county households utilized the Energy Assistance Program at a concerning rate of 22%, 23%, and 15%, respectively.

The Division gathered eleven scarves, thirty-nine hats, ten coats, forty-eight pairs of gloves, and eight other winter items. The Health Wagon, an organization providing compassionate, quality health care to the medically underserved community of Appalachia, is distributing these needed goods from their clinic locations. Dr. Drew Harris, frequently in southwest Virginia for his black lung clinics, graciously transported the donations.

Holiday Party
In December 2022, PCCM had its first holiday party in three years! To celebrate this return to tradition, the Division did it in style with a dinner at the Omni Hotel, issuing a special invitation to faculty, fellows, and staff, but also to NPs, and access staff.

Upcoming ATS Alumni & Friends Reception
The American Thoracic Society has selected Washington, D.C., as the location for its 2023 ATS International Conference this May. And having the conference so close is the perfect opportunity to host a networking social! Faculty and fellows look forward to reconnecting with program alums, friends, and former colleagues in the capital.

Filed Under: Basic Research, Clinical Research, Education, In the Know, News and Notes, Notable Achievements, Publications, Research

Tags: Education, faculty, fellows, March 2023, March 2023 Newsletter, medicine matters, profile, Pulmonary, Research, staff