The Division of Pediatric Pulmonology, Allergy and Sleep Medicine in the Department of Pediatrics at Indiana University School of Medicine conducts basic, translational and clinical research. Specific areas of study include cystic fibrosis, asthma, bronchopulmonary dysplasia, primary ciliary dyskinesia, specialized physiologic testing, allergic diseases and sleep disorders. The division has a history of participating in investigator-initiated studies as well as drug trials and is a part of the Cystic Fibrosis Foundation Therapeutic Development Network, the Food Allergy Research and Education Network, and the Pediatric Behavioral Sleep Research Network. The division has been awarded funding from the NIH, the Cystic Fibrosis Foundation, the American Lung Association, the American Academy of Allergy, Asthma and Immunology, and the Food Allergy Research and Education Network.
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In January 2019, James F. Chmiel, MD, joined the faculty at Riley Hospital for Children and Indiana University School of Medicine as the Division Chief for Pediatric Pulmonology, Allergy, and Sleep Medicine. Dr. Chmiel brings to an exceptional translational research expertise with an outstanding educational talent to develop new generation of pediatric pulmonologists.
Dr. Chmiel was Associate Director, LeRoy W. Matthews Cystic Fibrosis Center, Division of Pediatric Pulmonology, Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and Director of the Pediatric Pulmonology Fellowship at Case Western Reserve University (CWRU) for 14 years. Early in his career, Dr. Chmiel primarily focused in basic science and translational research to study the airway inflammatory response in a mouse model. He then transitioned to a clinical research career to better understand the inflammatory response of the lung, particularly as it relates to asthma and CF and the impact of anti-inflammatory therapeutics upon this response. Dr. Chmiel is particularly interested in studying the counter-regulatory mechanisms responsible for modulating the airway inflammatory response.
Dr. Chmiel participates in both independent and multi-center clinical trials and has been the lead PI on several multi-center studies sponsored by the Cystic Fibrosis Foundation’s Therapeutic Development Network (TDN). With more than fourteen years of experience mentoring various levels of academic trainees, Dr. Chmiel has mentored dozens of assistant or associate level professors, several of which have received NIH loan-repayment, early investigator Cystic Fibrosis Foundation or K awards.
The Pulmonary Inflammation/Asthma and Allergic Diseases Research Group within the Wells Center for Pediatric Research studies the initiation, pathogenesis and progression of these diseases to identify better ways to treat or prevent allergic symptoms. Research spans many areas–from examining the regulation of genes important for the development of T cells involved in allergic inflammation and the biology of cytokines and other factors that promote allergic disease to examining lung development and function and how changes contribute to lung reactivity to allergens.
The Pediatric Translational Research Center is the flagship pediatric research facility located in Riley Hospital for Children. This is the primary site for most of the pediatric patient-oriented research conducted at IU School of Medicine, the Department of Pediatrics, and Indiana Clinical and Translational Sciences Institute. The Translational Research and Integrated Biology Lab facility is housed within this facility and is the site of the Division of Pediatric Pulmonology, Allergy and Sleep Medicine’s storage freezers, lab equipment and workspace for laboratory technicians.
Specialty Areas of Pulmonary Research
Aerodigestive Center Research
The Aerodigestive team in the Division of Pediatric Pulmonology, Allergy and Sleep Medicine aims to provide multidisciplinary care to pediatric patients with complex airway and gastrointestinal problems to improve clinical outcomes by coordinating evaluations and operative procedures while providing an educational environment for trainees entering the field of aerodigestive care. In addition, this team is tailoring its management approach to encourage the implementation of research protocols.
Allergic diseases are an important area of research in the Division of Pediatric Pulmonology, Allergy and Sleep Medicine at the IU School of Medicine. The faculty in this division are involved in basic and translational projects. Kirsten Kloepfer, MD, MS has received funding from the NIH and the American Academy of Allergy, Asthma, and Immunology for her studies related to the airway microbiome. Mark Kaplan, PhD at the Wells Center for Translational Research has been recognized internationally for his work on understanding the development and function of IL-9-secreting T cells in the development of allergic inflammation. Girish Vitalpur, MD currently heads the FARE Center of Clinical Excellence at Riley. The food allergy program at Riley has compiled one of the country’s largest registries on children with peanut allergy and is expanding it to include other food allergies. The faculty are also involved in trials related to peanut desensitization therapies. Finally, Jay J. Jin, MD, PhD is an allergist and immunologist, with research focus on food allergies, drug allergies, allergic rhinitis and immunodeficiency disorders.
Pediatric asthma is highly heterogeneous in its severity, frequency of exacerbation, and degree of intervention required. IU School of Medicine pulmonologists and allergists perform more than 9,000 outpatient asthma visits each year. With rates of childhood asthma continuing to increase, methods of prevention are a focus of research within the division. Research includes investigations into the natural progression of the airway and gastrointestinal microbiome and its association with early wheeze. Investigators are also studying novel mechanisms that can reduce airway smooth muscle contractility. Clinically, asthma research is focused on quality improvement projects aimed at decreasing hospital readmissions for asthma, implementation of standardized weaning protocols for inpatient asthma care, and examination of clinical outcomes for the Riley High Risk Asthma clinic.
Pediatric Pulmonology faculty at IU School of Medicine work closely with neonatology to evaluate the natural history of preterm lung disease secondary to preterm birth in order to better understand early markers that define phenotype. Investigators participate in both single-center and multi-center work, providing opportunity for fellows. Faculty perform novel physiologic measurements in young children with different types of lung disease. Because early lung disease often carries into adulthood, the ability to better understand the pathophysiology and potential therapeutic markers is important.
Additional research is investigating how genetic variants contribute to the Bronchopulmonary Dysplasia phenotype, particularly on those with severe Bronchopulmonary Dysplasia, requiring home ventilation. Identifying genetic markers of severe Bronchopulmonary Dysplasia will provide an unparalleled opportunity to advance understanding of the role of genetic factors in lung disease associated with premature birth to allow more precise definition of the non-genetic factors involved and to apply this insight rapidly to the prevention and early, targeted treatment of severe Bronchopulmonary Dysplasia.
Center for Infant and Preschool Pulmonary Function Testing
The Center for Infant and Preschool Pulmonary Function Testing, housed within the Division of Pediatric Pulmonology, Allergy and Sleep Medicine at IU School of Medicine, has been performing infant pulmonary lung function tests for more than 20 years. The lab is nationally recognized as a Core Laboratory for Cystic Fibrosis Foundation Therapeutics, and the expertise of the lab staff supports various clinical and research procedures. Areas of expertise include calibration techniques, performance of actual lung function tests and centralized interpretation and analysis of study data from infant and preschool lung function tests. Through a variety of diagnostic and investigational tests, baseline measurements as well as responses to therapeutic interventions are evaluated.
Children Interstitial Lung Diseases
The Division of Pediatric Pulmonology, Allergy and Sleep Medicine at IU School of Medicine is involved with the chILD study and is engaged in developing a registry to participate in defining new treatments and better phenotyping for children battling these life-threatening diseases.
Recognized as one of the leading centers in the nation for providing state-of-the-art care, research, and leadership, the Indiana University Cystic Fibrosis Center is Indiana’s only Cystic Fibrosis Foundation-accredited pediatric care program and supports a number of affiliate sites throughout the state. The center’s team brings together physicians, researchers, advanced practice nurses, dieticians, social workers, respiratory therapists, pharmacists, child-life and mental health specialists to provide support on all fronts for children and families affected by Cystic Fibrosis. The division supports several leading investigators in Cystic Fibrosis research. The CF Center is also a member of the Cystic Fibrosis Foundation’s Therapeutics Development Network and has been a leader in enrolling participants with CF into clinical trials for several years. A major area of focus is the earliest stages of disease progression in infancy and early childhood. By improving understanding of early events and predictors of disease, developing better tools to detect mild disease, and supporting industry-sponsored trials of novel interventions in younger populations, this team of investigators can refine strategies to treat and potentially prevent disease progression.
Faculty in the Division of Pediatric Pulmonology, Allergy and Sleep Medicine perform clinical research internationally, including asthma studies in Honduras and Cystic Fibrosis registry studies in Latin America. Investigators are currently working on a cross-sectional case control study comparing baseline lung function among children with sickle cell anemia currently on hydroxyurea for at least a year and enrolled in the Novel Use of Hydroxyurea in an African Region With Malaria (NOHARM) study compared to sickle cell anemia controls not on hydroxyurea followed in the Mulago Hospital Sickle Cell Clinic (Uganda). The team is also working closely with investigators in Perth and Melbourne, Australia, to elucidate the impact of viruses and the microbiome on early lung disease.
Lung Growth and Development
Lung growth and development is an important area of current research with laboratories focusing on the pulmonary pathophysiology of lung disease that occurs following premature birth. Additionally, in collaboration with another division of Indiana University School of Medicine, this research program is studying the effects of maternal preeclampsia on the development of pulmonary and vascular dysfunction in infants.
With the availability of disease-modifying therapies for various neuromuscular disorders, the natural history of these conditions is changing. Division faculty are studying the predictive factors of pulmonary involvement as well as the changing pulmonary morbidity and outcomes in this new era of treating neuromuscular disorders. Research is focused primarily on Duchenne Muscular Dystrophy and Spinal Muscular Atrophy, two of the most common pediatric neuromuscular disorders. However, as the multidisciplinary neuromuscular disorders clinical program expands, investigators intend to broaden their epidemiological studies to other neuromuscular diagnoses.
Primary Ciliary Dyskinesia
Indiana University School of Medicine has the only Primary Ciliary Dyskinesia center in the state. As a PCD Foundation accredited center, our faculty lead some of the clinical trials in PCD in addition to supporting other research in Primary Ciliary Dyskinesia, including heterotaxy. Increasing understanding in the areas of genetics and early diagnosis of Primary Ciliary Dyskinesia may lead to the implementation of tailored individualized treatment plans for children and adults with this rare disease.
The Division of Pediatric Pulmonology, Allergy and Sleep Medicine is determined to help young patients suffering from pulmonary hypertension and participates in industry trials involving this disease. The division is in the process of applying for Pulmonary Hypertension Association (PHA) accreditation as a Pediatric Center of Comprehensive Care.
The pediatric sleep program at Riley Hospital for Children is one of the largest in the world with more than 3500 pediatric polysomnograms and more than 2000 patient visits completed each year. Riley also has one of the largest neonatal polysomnography programs in the world with almost 400 neonatal and infant polysomnograms completed each year. Faculty investigators in this area have published manuscripts on the determinants and outcomes of neonatal obstructive sleep apnea and are completing a study on polysomnograms in normal newborns to facilitate clinical decision making, providing a frame of reference for interpretation of these complex studies. Over the next few years, this team will investigate the determinants and outcomes of the full spectrum of pediatric sleep disordered breathing. Almost 40 percent of patients presenting to a pediatric sleep clinic have insomnia, and investigators are studying the determinants of pediatric insomnia and the outcomes of various therapeutic interventions in this common clinical problem. Additional sleep research examines the development and implementation of evidence-based care for children’s sleep disorders with a focus on the primary care setting. Active studies include 1) the use of a computer decision support system to identify obstructive sleep apnea in primary care; 2) management of infant night wakings in primary care; and 3) behavioral sleep treatment as a therapeutic for children with disruptive behavior disorders.
IU School of Medicine Pediatric Pulmonology, Allergy and Sleep Medicine faculty lead and participate in a number of research trials ranging from asthma to Primary Ciliary Dyskinesia and Cystic Fibrosis, allowing pediatric pulmonary fellows to focus in their specific area of interests. The division is involved in both investigator-initiated and pharmaceutical sponsor trials with more than 70 ongoing protocols. The division also has a dedicated research team that includes a research director, twelve research coordinators/nurses, two respiratory therapists and a regulatory specialist. This team has wide-ranging experience in recruiting patients for research studies.