The Section of Pulmonary and Critical Care Medicine provides exemplary care for a wide range of clinical problems in both the outpatient and inpatient settings. Our subspecialist physicians have expertise in treating disorders of the lung ranging from relatively common problems such as emphysema to rare disorders that require highly integrated and technology laden care. In addition, an accomplished group of critical care specialists provides dedicated inpatient care to severely ill patients in our state-of-the art medical ICU, and also provides expert supervision in the performance of a broad range of commonly performed procedures. For these reasons and others, our pulmonary program is the only one in Illinois ranked amongst the best by U.S. News & World Report.

This has been an extraordinary year of growth and innovation for our group, including the initiation of a lung transplant program, the implementation of virtual bronchoscopy with computer-assisted biopsy, and the expansion of our work with interstitial lung disease to include participation in a NIH-sponsored network of specialized centers spanning North America.

Outpatient care in the Pulmonary Clinic offers patients the opportunity to choose a physician from amongst a broadly trained and highly accomplished group of specialists. Because each physician not only treats common problems such as asthma and emphysema, but also specializes in the care of several other clinical problems of personal academic interest, patients have the opportunity to partner with physicians that match their needs. Physicians work alongside nurses, respiratory therapists, and social workers experienced in the care of patients with pulmonary problems. We also work in close collaboration with other subspecialists, such as medical oncologists and thoracic surgeons. Our section has assumed a leading role nationally and in our community in the evaluation, treatment, and research of asthma through The University of Chicago Asthma Center. This center not only supports basic science research into the causes of asthma, but also provides free asthma classes that are open to the public that teach patients living with asthma how to maximize their health. Our Respiratory Clinical Research Group screens more than 1,000 people annually for participation in studies of the treatment of asthma, interstitial lung disease, and COPD.

Our cardiopulmonary function lab provides a full range of diagnostic testing. Bronchopulmonary challenge is available to assist in the diagnosis and assessment of asthma, and we routinely evaluate patients jointly with colleagues from ENT for vocal cord dysfunction and other upper-airway syndromes confounding the diagnosis of obstructive lung disease. Pressure-volume relationships using esophageal balloon manometry are employed to quantify components of chest wall and lung restriction. Unilateral and bilateral diaphragm dysfunction is diagnosed by joint assessment with our neurophysiology laboratory and thoracic radiologic imaging, and we have initiated assessment of surgical treatment by plication in selected cases. Comprehensive invasive and non-invasive cardiopulmonary function testing is conducted to distinguish heart and lung contributions to dyspnea, to stage ventricular and lung dysfunction, and to follow patients treated in our chronic heart and lung disease programs.

Our Section has also assumed leadership of the Sleep Laboratory at the University of Chicago, formerly administered through the Department of Neurology. We have begun active recruitment of sleep physicians, with the appointment of Dr. Esra Tasali this Summer and active search for other sleep clinicians ongoing. Dr. Tasali and others will staff a dedicated sleep clinic, build their sleep practices by consultation throughout the Department of Medicine, and begin planning for expansion of the sleep lab when this becomes timely.

The inpatient Pulmonary consultation service provides expert care in the evaluation and treatment of a range of clinical problems encountered in hospitalized patients, including pneumonia, lung cancer, pulmonary embolism, unexplained pulmonary infiltrates, and breathlessness. We also provide assistance in the perioperative management of high-risk patients with lung disease who are pregnant or are undergoing surgery.

Critical care physicians provide dedicated care to all patients admitted to the state-of-the-art Medical Intensive Care Unit at The University of Chicago, a 16-bed ICU that opened in 2001. Our physicians are experts in the evaluation and management of critically ill patients, particularly those with respiratory failure requiring mechanical ventilation, shock, and multi-organ failure. Our center is one of a select few supported by the National Institutes of Health (NIH) in conducting ongoing studies in the treatment of the acute respiratory distress syndrome (ARDS). In addition, our critical care physicians edit an authoritative textbook in the field while performing a variety of clinical investigations into critical illness that include studies of best sedation strategies, sleep in the critically ill, and noninvasive evaluations of volume status. Our physicians also provide consultation in the care of other critically ill patients, such as those undergoing surgery. Multidisciplinary care is provided through close collaboration with the entire spectrum of subspecialty services offered by The University of Chicago, including specialists in surgery, infectious diseases, nephrology, cardiology, and many others.

The Procedure Service is staffed by critical care physicians in our section and provides expert supervision of hospital physicians in the performance of the following procedures: central line placement, peripherally inserted central catheter (PICC line) placement, thoracentesis, lumbar puncture, paracentesis, and bronchoscopy. Both inpatients and outpatients are treated on a daily basis during the weekday.

The Pulmonary and Critical Care faculty provide around-the-clock bronchoscopy services for the diagnosis of a wide variety of respiratory illnesses. Experienced bronchoscopists, board certified in pulmonary medicine and trained in all aspects of diagnostic bronchoscopy, staff the service. Under the direction of Dr. Imre Noth, they provide visualization of bronchial anatomy, bronchoalveolar lavage, endobronchial biopsy, transbronchial lung biopsy and transbronchial needle aspiration (TBNA). The TBNA procedure allows biopsy of lung lesions as well as mediastinal and hilar lymph node sampling. This relatively non-invasive, outpatient procedure provides an alternative way to sample lymph nodes for staging thoracic malignancies. Transbronchial needle aspiration is an advanced procedure not performed routinely at most medical centers; however, we find that it offers many patients the opportunity for diagnosis and staging of thoracic diseases, including malignancies, without the need for a surgical diagnosis.

Bronchoscopic biopsy can be limited by the size of the lesions noted on imaging or a failure to be able to guide the bronchoscope by direct vision to the area of interest. These limitations are being addressed by spectacular advances in computer technology, which allow the images obtained by CT scanning to be coordinated to the position of the bronchoscope as signaled by magnetic detection. The use of ‘virtual bronchoscopy’ guideing the biopsy procedure by the pre-existing CT scan is no longer a theoretical possibility but is now being conducted by our group. These approaches promise to revolutionize the diagnosis of diverse lung diseases, and we are delighted to offer such cutting-edge technology to our patients.

In an effort to take better care of patients with diverse restrictive lung diseases, we recently initiated a new Interstitial Lung Disease clinic . The goal of this clinic is to provide state-of-the-art evaluation and care of patients and to serve as a nidus for important clinical trials studying mechanisms of disease and new treatments. Physicians will be assigned to this clinic with total focus on the major diseases of the lung intersititium. Dr. Strek has a specific research interest in collagen vascular associated lung disease, Dr. Hogarth has an active interest in patients with sarcoidosis and is an investigator supported by the Sarcoidosis Foundation. Dr. Noth conducts clinical pulmonary fibrosis research protocols, and his work in this area has resulted in the University of Chicago being selected as a study site as part of an NIH-consortium dedicated to improving treatment of lung fiborisis. Together with Dr. White, these clinician scientists will create an environment that will provide patients with options for the most current therapies.

It is truly exciting that we have succeeded in recruiting world-class faculty to head a Lung Transplant Program serving our patients with advanced lung disease. The addition of these faculty and the large group of associated care providers will enable the University of Chicago, already one of the premier centers for treatment of advanced lung diseases, to offer lung transplantation as a therapeutic option for selected patients with end-stage disease. In addition to organ transplantation, lung volume reduction surgery will be provided to the appropriate subset of patients with emphysema benefiting from this novel approach to severe airflow obstruction. Coupled to this large clinical effort will be the expansion of our clinical and translational research efforts in transplant medicine, with particular focus upon the pathogenesis and treatment of bronchiolitis obliterans, the main manifestation of organ rejection and a process limiting survival for many patients.