UPMC Physician Resources

Respiratory Reader: Recent Issues

February 2017

In 2001, the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease (ILD) at UPMC was endowed by the Simmons family with a charge to find the cause and cure for idopathic pulmonary fibrosis (IPF), and to care for patients and their caregivers. Over the past 15 years, the Center has seen more than 4,000 ILD patients from all over the United States. Due to the generous spirit of our patients who have enrolled in research studies, and our visionary leadership including Medical Director Kevin Gibson, MD, and clinical nurse specialist, Kathleen Lindell, PhD, RN, we have achieved international recognition for seminal discoveries in IPF. 

The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease (ILD) at UPMC

"I Just Dont't Have the Energy:" Aging Mitochondria and Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by progressive scarring of the lung (1,2). IPF prevalence dramatically increases with age, and aging is a known risk factor for IPF (3). Ana Mora, MD

Case Presentation: Lymphocytic Interstitial Pneumonia

This article examines a 64-year old male diagnosed with lymphocytic interstitial pneumonia. Eric Nolley, MD; Jared Chiarchiaro, MD, MS 

Meet the Rojas Lab

Mauricio Rojas, MD, is Associate Professor of Medicine and Scientific Director of the Simmons Center. Since 2004, the research in Dr. Rojas' lab has focused on the use of bone marrow-derived mesenchymal stem cells, or MSCs, as an alternative therapy for lung repair after acute and chronic injury.

Case Presentation: Hard Metal Pneumoconiosis

This article examines a 60-year old man diagnosed with hard metal pneumonconiosis. Hannah Otepka, MD

It Takes a Village: Multidisciplinary Discussion for Interstitial Lung Disease

The diagnosis and management of ILD is one of the most challenging areas of pulmonary medicine. For many patients with ILD, it is difficult to assign a true diagnosis. Daniel Kass, MD; Jared Chiarchiaro, MD, MS

Meet the Team

Meet the team at the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease (ILD) at UPMC.

Download the complete February 2017 issue of Respiratory Reader.

Summer 2016

For more than 20 years, UPMC's Sleep Medicine Center has been dedicated to helping to diagnose and treat a wide variety of sleep disturbances and disorders. This issue of Respiratory Reader will highlight a number of clinical and research initiatives, in which our team is currently participating. 

New Frontiers in the Treatment of Sleep Apnea: Unilateral Hypoglossal Nerve Stimulation

Unilateral stimulation of the hypoglossal nerve is a new treatment for people with moderate to severe obstructive sleep apnea (OSA) who are unable to use CPAP. CPAP, oral appliances, and some surgeries work "from outside in" to prevent the tissues from releaxing and blocking the upper airway. This nerve stimulation therapy works "from the inside out" to move the muscles and keep the airway open. Patrick Strollo, MD 

Current Clinical Trials

This article discusses the current clinical trials going on at UPMC's Sleep Medicine Center.

Weight Loss Management in the Management of Sleep Apnea

Obesity has long been recognized as an important risk factor for obstructive sleep apnea (OSA). Analyses from the Wisconsin Sleep Cohort study suggest that nearly 60 percent of all cases of moderate to severe OSA in the US could be prevented by eliminating overweight/obesity. Sanjay R. Patel, MD, MS

Case Presentation: Cognitive-Behavioral Therapy for Insomnia

This article examines the optimal setting for cognitive-behavior therapy for insomnia. Deborah A. Gillman, PhD 

Case Presentation: Positive Airway Pressure for Sleep Apnea in Advanced Heart Failure

This article examines the diagnosis and management of an 88-year old male with advanced heart failure. Ailia Ali, MD; Rachel Givelber, MD 

Non-invasive Ventilation for Neuromuscular Disease

The Sleep Disorders Center supports patients with neuromuscular weakness through the UPMC Comprehensive Lung Center at Falk Clinic. Patients are typically referred following a diagnosis of neuromuscular weakness with associated concerns for respiratory insufficiency and a need for noninvasive inspiratory positive pressure ventilation (NIPPV). David Kristo, MD 

Awakening A.W.A.K.E.!

Sleep apnea presents a unique challenge to the physicians who manage it. Adherence to PAP, the gold standard treatment for sleep apnea, is poor. Matthew Anastasi, BS, RST; Faith S. Luyster 

Department News

This article discusses the latest department news from the Division of PACCM at UPMC. 

Download the complete Summer 2016 issue of Respiratory Reader.

 Spring 2016

This issue of Respiratory Reader focuses on hereditary hemorrhagic telangiectasis (HHT). HHT is an inheritable, autosomal dominant disorder of the TGF-ß signally pathway that results in disordered angiogenesis. This issue will discuss the research and clinical care provided by the HHT Center of Excellence at UPMC. 

Hereditary Hemorrhagic Telangiectasia (HHT)

HHT is recognized as an autosomal dominant disorder of angiogenesisthat results in vascular malformations of the skin, mucus membranes, andviscera. The first step inpreventing these complications is timely recognition of the condition followedby screening for, and treatment of, high-risk vascular malformations of thelung and brain. Christopher Faber, MD

Using Zebrafish to Understand the Mechanism of HHT Pathogenesis

Heterozygous mutations in activin receptor-likekinase 1, endoglin, and SMAD4 result in hereditary hemorrhagic telangiectasia (HHT) (1-3). However, how these proteins function within endothelial cells toestablish and maintain normal arterial-venous separation remains unknown. Learn how one research laboratory uses a zebrafish model of HHT to uncover the molecularand cellular errors that lead to AVMs. Beth Roman, PhD

Case Presentation

This article examines the diagnosis and management of a six-year old female with HHT.  Suneeta Madari-Khetarpal, MD; Jessica Sebastian, MS, LCGC; Andrew McCormick, MD 


Referrals: Visiting Planning and Care Coordination for the HHT Patient

Visit planning and care coordination are essential to properly and efficiently managing a patient with HHT. Learn how collaborative working relationships enable proper management. Jessica Romanias, BSN, RN; Melody Porter, Kathy Lindell, PhD, RN


Download the complete Spring 2016 issue of Respiratory Reader

Spring/Summer 2015

The 11th issue of Respiratory Reader focuses on pulmonary embolism (PE). PE and deep vein thrombosis affect over 200,000 Americans each year, with a high rate of mortality as well as risk of long-term morbidity among survivors. This issue will feature research and clinical trials from our acute pulmonary embolism and chronic thromboembolic pulmonary hypertension teams.

State-of-the-Art Treatment of Acute Pulmonary Embolism 

Acute pulmonary embolism is the most serious presentation of venous thromboembolism. Acute PE spans a wide spectrum of clinical outcomes and in order to offer the best treatments to patients, UPMC has assembled an Acute PE team to facilitate rapic consultion with clinicians experienced in the care of complex cases. Belinda Rivera-Lebron, MD; Phillip Lamberty, MD; Catalin Toma, MD


Case Presentation: Catheter-Directed Thrombolytic Therapy for Pulmonary Embolism

Anticoagulation is the mainstay of therapy for most Pulmonary venous thromboembolism (PE) patients, with thrombolytic therapy historically reserved for patients with life-threatening hypotension or cardiac arrest. Recent studies have suggested a role for systemic or catheter-directed thrombolytic therapy in selected patients. Roger Alvarez, DO, MPH


Progression of Pulmonary Embolism: Chronic Thromboembolic Pulmonary Hypertension

In most cases, pulmonary thromboembolism resolves completely after treatment with anticoagulation, and patients are able to return to their previous quality of life. However, approximately 0.1-0.5 percent or more of patients who survive PE go on to develop chronic thromboembolic pulmonary hypertension (CTEPH). Patricia George, MD


Download the full Spring/Summer 2015 issue of Respiratory Reader.

Winter 2015

UPMC's Asthma Institute was founded in 2009 as a joint venture between the Department of Medicine; the Divison of Pulmonary, Allergy, and Critical Care Medicine; Children's Hospital of Pittsburgh of UPMC; and the Pediatric Environmental Medicine Center. In this issue of Respiratory Reader Sally Wenzel, MD, director of the Asthma Institute, and her team highlight new approaches to clinical therapies and research results to assist in patient treatment.

Immunodeficiency Evaluation in Adults

Although primary immunodeficiency (PI) diseases have typically been associated with the world of pediatrics, there is a growing appreciation that adults can also be affected by the PI disease. The advent of immunosuppressive treatments in autoimmune conditions and organ transplantation has opened the doors for acquired immunodeficiency conditions that can potentially mimic the clinical presentation of PI conditions. Andrej Petrov, MD


Lab Spotlight: Severe Asthma Study Supports a Role for the Mast Cell and Prostaglandin D2 Pathway in Specific Asthma Phenotypes

The Asthma Institute is one of seven organizations funded by the National Institutes of Health National Heart, Lung, and Blood Institute to study severe asthma. As part of this study researchers have shown that the presence and activation of mast cells (MC) in chronic severe asthma differs from milder asthma. Merritt Fajt, MD 

Putting "The Science" Into Asthma Treatment: New Immunologic Approaches to Asthma

In the last 30 years, treatment of asthma has centered on the use of corticosteroids. These treatments have led to substantial improvements in asthma symptoms and attacks, and an overall decline in deaths from asthma. However, it is also recognized that a substantial group of asthmatics remain who do not respond fully to this treatment and whose asthma remains difficult to treat. Sally Wenzel, MD

Can Changes in the Diet Make a Difference in Asthma?

It is widely accepted that obesity adversely affects the respiratory health of people with asthma and that losing weight improves symptoms and lung function for the majority of obese or overweight asthmatics. Yet, it is unclear whether controlling dietary intake beyond the goal of achieving a healthy body mass index (BMI) can clinically influence asthma control or exacerbation rates. Fernando Holguin, MD, MPH

Case Presentation: Chronic Urticaria

This article examines a case of a 26-year-old female with a past medical history of anxiety disorder presented for evaluation of a three-month history of daily generalized pruritic hives intermittently associated with lip and periorbital swelling. Chronic urticaria is present when hives occur regularly for greater than six weeks. Chitra Natalie, MD 


Download the full Winter 2015 issue of Respiratory Reader

Fall 2014

By 2040 it's projected there will be 79.7 million people over 65 years old. Aging is associated with increased susceptibility to a variety of chronic diseases. Lung pathologies are no exception, and the prevalence of lung diseases such as idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PH), and acute lung injury (ALI) has been found to increase considerably with age. 

Case Presentation: Advanced Age and Lung Transplantation: It's About More Than a Number

Advanced age and lung transplant candidacy has been a controversial topic, with some studies suggesting poor outcomes in elderly recipients. This case study looks at an elderly patient who successfully underwent lung transplantation and the parameters that should be considered in elderly patients with end-stage lung disease. Matthew Morrell, MD 


HIV-Associated Pulmonary Disease: Is There a Link to Lung Aging? 

The HIV Lung Research Center at the University of Pittsburgh is investigating the potential contributions of accelerated aging to HIV-associated chronic obstructive pulmonary disease (COPD). 
Meghan Fitzpatrick, MD; Alison Morris, MD, MS



Aging: A Risk Factor for Chronic Lung Disease

The morphologic and physiologic changes in the lungs of elderly individuals occur even in the absence of disease. This article explores the aging process of the lung and how it can affect responses to lung injury.
Marta Bueno, PhD; Mauricio Rojas, MD; Ana Mora, MD



Case Presentation: Community-Acquired Pneumonia: A Common, but Lethal Disease in the Elderly

Community-acquired pneumonia (CAP) is a fairly common disease with pneumonia ranked eighth in the causes of deaths in the United States. This article advocates for clinicians understanding immunosenescence and incorporating it into their care of the elderly. 
SeungHye Han, MD

Download the full Fall 2014 issue of Respiratory Reader. 

Spring 2014

At UPMC, we have developed a comprehensive pulmonary hypertension (PH) clinical program that combines experts who work together to diagnose and treat patients with PH. In addition to standard FDA–approved therapies, we provide access to clinical trials and are supported by one of the largest lung transplant programs in the nation. 

Comprehensive Pulmonary Hypertension Clinic at UPMC

This clinic uses a multidisciplinary approach in the evaluation and management of patients with pulmonary vascular disease. The clinic combines the expertise of cardiologists, pulmonologists, and specialists in sleep and pulmonary transplant medicine in the evaluation and treatment of pulmonary hypertension.
Michael Risbano, MD


Case Presentation:
Pulmonary Veno-Occlusive Disease: The Other Pulmonary Arterial Hypertension

A 64-year old African-American female with progressive dyspnea had a right heart–catheterization (RHC) in June 2013 consistent with pulmonary arterial hypertension. She also endorsed a history of Raynaud’s phenomenon.
David C. Ishizawar, MD; Jeffrey S. Nine, MD 


Nitrate Therapy for Metabolic Syndrome, Pulmonary Arterial Hypertension, and Pulmonary Venous Hypertension 

Pulmonary hypertension is divided into five categories according to the classification system endorsed by the World Health Organization. Pulmonary arterial hypertension belongs to Group I, which is a progressive, proliferative vasculopathy in pulmonary arterioles that results in right heart dysfunction.
Yen-Chun Lai, PhD; Marta Bueno, PhD; Mark T. Gladwin, MD 


When to Refer for Lung Transplantation in Pulmonary Hypertension

Early discussion of lung transplantation is important in the management of patients with this disease.
Patty George, MD 



Download the complete Spring 2014 issue of Respiratory Reader or view the suggested reading references.

Fall 2013

Through the combined clinical and research efforts of the Division of Pulmonary, Allergy, and Critical Care Medicine; UPCI; UPMC CancerCenter Lung Cancer Specialty Care; the Division of Hematology/Oncology; and the Department of Cardiothoracic Surgery, UPMC is moving closer to advancing the diagnosis, treatment, and management of patients with lung cancer.

Experts from these disciplines aim to reach the ambitious goals of improving long-term outcomes for lung cancer patients and their families, as well as developing innovative methods to support prevention and early detection.

Lung Cancer Screening

Lung cancer is the most common cause of cancer-related death in both men and women. This article discusses the possibility of reducing lung cancer mortality through improved screening methods.
Christopher N. Faber, MD; Toni Opalko, RN

Personalized Medicine: Use of Genetics to Individualize Lung Cancer Therapy

With new breakthroughs and the increased use of genetic testing, personalized medicine is practiced every day at UPMC. Two cases illustrate this approach.
Liza C. Villaruz, MD; Mark A. Socinski, MD


The Emerging Role of Stereotactic Body Radiotherapy in Early-Stage Lung Cancer

This case report discusses a 55-year-old male who was found to have a 1.5 cm suspicious right upper lobe nodule on CT of the chest. 
Neil A. Christie, MD; Brian J. Karlovits, DO; Matthew J. Schuchert, MD;
J. Austin Vargo, MD


Evolving Role of Advanced Bronchoscopy in Thoracic Oncology

Accurate staging and management of lung cancer requires access to the mediastinum for lymph node sampling. Advanced bronchoscopic techniques are making this a possibility.
James Luketich, MD; David O. Wilson, MD, MPH; Johnathan D'Cuhna, MD, PhD;
Arjun Pennathur, MD


Download the complete Fall 2013 issue of Respiratory Reader.