by Matt Englund
Ranked 34th nationally in US News and World Report’s annual list of the country’s best hospitals, the department of medicine’s division of Pulmonary Diseases and Critical Care Medicine excels at treating a variety of chronic diseases from chronic obstructive pulmonary disease (COPD) to cystic fibrosis (CF) and manages a large volume of critically ill patients in the medical intensive care unit at UNC Hospitals.
Advances in technology and an expansion in subspecialty expertise has led to rapid growth in treatment options in pulmonary medicine, and as the field has grown, the division has worked hard to lead the way, says Shannon Carson, MD, professor of Medicine, Pulmonary Diseases and Critical Care Medicine division chief, and recent recipient of the UNC School of Medicine’s prestigious H. Fleming Fuller Award.
“We have new services available for interventional pulmonary medicine, pulmonary hypertension and interstitial lung disease. These subspecialties have grown rapidly in the last decade, and now exist alongside services like those offered by our cystic fibrosis program that are more well-established,” says Dr. Carson. “The best way we can serve the needs of our patients is by providing the latest therapies and technologies in a multidisciplinary environment.”
The division has an established record of providing the highest level of care for patients with complex diagnoses. UNC’s cystic fibrosis center, for example, has been one of the country’s preeminent CF programs for decades. Scott Donaldson, MD, associate professor of medicine, says this reputation is the result of the comprehensiveness of the CF care available at UNC.
“In treating CF, the patient support needs are extensive and go well beyond a patient coming into the clinic and seeing their doctor,” he says. “In addition to serious disease, a typical CF patient may have bad sinus and intestinal disease. Many have liver disease. Forty percent or so have insulin-requiring diabetes. So patients need specialists in a variety of other areas who have expertise in CF in addition to pulmonologists and that is something we can offer them at UNC.”
The program was one of the first in the nation to focus on adult CF as treatments for the genetic condition became increasingly effective and life expectancy grew. This has been the result of major advances in basic research of the kind performed at UNC’s Marsico Lung Institute.
“Research has been one of the great strengths of UNC’s CF program,” says Dr. Donaldson. “We have a large basic research effort run by Dr. Richard Boucher at the Marsico Lung Institute, and under Dr. Boucher’s leadership there has always been an eye towards translating that into new therapies.”
The CF center also has a substantial clinical research arm that, through its affiliation with the Therapeutic Development Network, has led to exciting breakthroughs in treating CF.
“In the last four or five years,” says Dr. Donaldson, “drugs have been developed that target the basic defect of CF. We are in a brand new era in that regard: basic research has led to clinical studies through a well-organized and highly functioning network of sites, and this has resulted in getting new medications to patients.”
In the clinic, a support staff makes sure CF patients have access to care and are following through with their treatments.
“The daily treatment routine for a CF patient can be time-consuming and complicated so we work with them on adherence,” says Dr. Donaldson. “With so many moving pieces in the treatment for each patient, our nurse coordinators play an important role in making sure everyone is working together efficiently and things are getting accomplished for the patient.”
Newer programs in the division are also building a reputation for the comprehensiveness of their care. In July, the division’s Pulmonary Hypertension Program was accredited by the Pulmonary Hypertension Association as a Comprehensive Care Center.
H. James Ford, MD, director of the Pulmonary Hypertension Program, led the accreditation effort along with UNC cardiologist Lisa Rose-Jones, MD, making UNC Hospitals the first in the state to receive this distinction. As part of the accreditation process, medical centers must demonstrate the ability to quickly diagnose and comprehensively care for patients with the condition.
“A robust support structure is essential for our patients,” he says. “Treatments for pulmonary hypertension can be very expensive and patients often need financial assistance and support programs to get the care they need. Our nurse coordinator helps with all the paperwork and stays in touch with them between visits”
In addition to assisting patients already under his care, Dr. Ford will sometimes reach out to community providers who, in attending to the day-to-day concerns of a pulmonology or cardiology practice might wish to collaborate in the care of patients with something as specialized as pulmonary hypertension.
“It’s a diagnosis that can get lost among the more common things pulmonologists and cardiologists look for,” says Dr. Ford. “The medical community as a whole is better at looking for pulmonary hypertension than it used to be, and it’s valuable for providers to know a program like ours exists that is equipped to meet the unique challenges faced by these patients, as well as the complexities involved in treating them.”
Dr. Ford has also been active in organizing an annual symposium on pulmonary hypertension with colleagues from Duke University. This year’s North Carolina Research Triangle Pulmonary Hypertension Symposium will be the seventh of these events.
As with many of the subspecialties in the division of Pulmonary Diseases and Critical Care Medicine, the Pulmonary Hypertension Program has an active research component that works to uncover new and more effective therapies for the condition. Dr. Carson says that research is an important priority for the division as a whole.
“Our research programs – from those that address lung disease to those that advance critical care medicine – are an important part of what makes our division great,” he says. “Our growth has been the result of an expansion in available therapies and technologies, which in turn has been made possible through collaborations between our established and experienced clinicians, and their bright young counterparts.”
This growth has also been in evidence in the increasing number of referrals to the division’s critical care medicine program, which deploys well-coordinated, multidisciplinary teams to treat patients with the most complex needs.
“Our critical care clinicians oversee the medical intensive care unit and work collaboratively with skilled nurses, respiratory therapists, pharmacists, and intensive care physicians from other programs like surgery and cardiology,” says Dr. Carson.
As with the other subspecialty programs, critical care medicine emphasizes the kind of comprehensiveness that will ensure patients receive the best care possible.
“Collaboration is essential in critical care medicine,” says Dr. Carson. “We work closely with intensivists across UNC Hospitals to provide comprehensive global critical care services. As demand for our services has grown, we have worked hard to stay ahead of the needs of patients from across North Carolina.”
To learn more about the division of Pulmonary Diseases and Critical Care Medicine visit their website at https://www.med.unc.edu/pulmonary.