The multidisciplinary Washington University Division of Pediatric Allergy and Pulmonary Medicine at St. Louis Children’s Hospital is a premier academic program, and its commitment to excellence in patient care, teaching, and research was recognized by our inclusion as one of America’s best pulmonary services, according to Parent magazine’s survey and the US & World Report Best Hospitals ranking.
The Division supports an active clinical practice, and our faculty and nurse practitioners saw over 10,000 outpatient visits at all sites last year, with ~one quarter of these visits being new patient referrals and outpatient consultations. Inpatient clinical volumes and consultations at St. Louis Children’s Hospital are typically over 7,000 patient-days per year.
Our faculty are nationally prominent, both through publishing manuscripts in high impact journals including the New England Journal of Medicine, Lancet Respiratory Medicine, Journal of the American Medical Association, American Journal of Respiratory and Critical Care Medicine, and the Journal of Allergy and Clinical Immunology, and through leadership in national societies, academies and foundations. The division has a core of innovative basic, translational, and clinical investigators working on both investigator-initiated studies and through multicenter collaborative research networks to further our understanding and treatment of childhood lung diseases and asthma. This work is supported by the National Institutes of Health and other foundations, including the Cystic Fibrosis Foundation and the Primary Ciliary Dyskinesia Foundation, as well as through the Pediatric Pulmonary Diseases & Asthma Center of Excellence of the St. Louis Children’s Hospital Children’s Discovery Institute.
Pediatric Asthma and Allergy Center
Asthma care and research are prominent activities of the division. More than 3,000 children and adolescents with asthma are seen annually by our physicians, nurse practitioners, and staff. Children hospitalized with asthma are admitted to St. Louis Children’s Hospital receive care by division physicians or advanced practice nurses who collaborate in our evidence-based Asthma Intervention Model (AIM).
Management of children with all forms of allergic disease is also an important part of the division’s clinical activities. Faculty physicians provide expert consultation for children and adolescents with food and drug allergy, rhinitis, sinusitis, eczema, urticaria/angioedema and other atopic disorders. The division offers diagnostic testing for penicillin allergy and oral challenges for the assessment of food allergy, as well as approved desensitization treatments for peanut allergy and other allergens. A state-of-the-art Pulmonary Function Laboratory supports patient care by providing comprehensive lung function testing. Patients can be referred for clinical evaluation by calling our office at 314-454-2694.
Faculty in the Pediatric Asthma and Allergy Center at St. Louis Children’s Hospital have led and collaborate in multiple National Institutes of Health-supported pediatric asthma initiatives, including AsthmaNet, the Childhood Asthma Management Program (CAMP), the Severe Asthma Research Program and the Inner City Asthma Consortium. These research networks are critical in helping us understand the origins of asthma as well as the best approaches to asthma management. Division faculty have also pioneered the use of asthma coaching to overcome barriers that interfere with asthma care delivery for children with severe asthma in urban communities, and have developed a multidisciplinary program focused on reducing asthma-associated morbidities and mortality in these children.
Cystic Fibrosis Center
Caring for patients with cystic fibrosis for over five decades, the comprehensive, fully accredited Cystic Fibrosis Center at Washington University Medical Center is a premier clinical and research program in cystic fibrosis. Located at the St. Louis Children’s Hospital, the Pediatric Cystic Fibrosis Clinical Center regularly sees more than 200 children and adolescents. In addition, we are involved in the care of cystic fibrosis patients from across the U.S. who have been referred for or received lung or liver transplantation. Referrals should be made through the division office at 314-454-2694.
The Center is a member of the Cystic Fibrosis Foundation Therapeutics Development Network, and division investigators and clinicians continually collaborate in this cutting-edge clinical research that has brought exciting new therapies to people living with CF. In addition, the center is one of six primary sites of the National Institutes of Health-supported Genetic Disorders of Mucociliary Clearance Consortium, a clinical research network to study rare diseases of the airways. National Institutes of Health- and CF Foundation-funded investigators have collaborated on cystic fibrosis-related projects examining the early origins of lung disease, host-pathogen interactions, Cystic Fibrosis Related Diabetes, ototoxicity, and hepatic involvement. The center has close collaborative relationships with Washington University investigators in clinical and basic science departments, which has allowed us to consider questions fundamental to our understanding of the disease.
The Pediatric Lung Transplantation Center
The Washington University School of Medicine and St. Louis Children’s Hospital pediatric lung transplant program was the first pediatric lung transplant program in U.S., and over 300 lung and heart-lung transplants have been performed here. The program remains preeminent, with referrals from across North America and worldwide. The transplant pulmonologists work closely with cardiothoracic surgeons, pediatric intensivists and clinical staff to provide exemplary pre- and post-operative care of children with advanced lung diseases. The pediatric lung transplantation program collaborates in an international network of academic children’s hospitals focused on understanding the mechanisms of lung graft dysfunction, a project in the Clinical Trials in Organ Transplantation in Children (CTOT-C) consortium.
Pediatric Sleep Clinic and Laboratory
The Pediatric Sleep Diagnostic Center and Laboratory at St. Louis Children’s Hospital serves children who have or are suspected of having sleep-related breathing disorders, including sleep apnea, narcolepsy, restless leg syndrome, periodic limb movements, insomnia, nighttime seizures, and many other problems brought on or made worse by sleep. Accredited by the American Academy of Sleep Medicine, over 900 tests are performed and interpreted annually.
The staff of the Sleep Center includes American Board of Sleep Medicine-certified pediatricians from the Division of Pediatric Allergy and Pulmonary Medicine and the Division of Pediatric Neurology, clinical sleep educators and sleep laboratory technicians, with regular consultations by pediatric otolaryngologists, psychologists and psychiatrists. Experienced pediatric sleep technicians and respiratory therapists with sleep training attend and score studies. Treatment is provided for all children with sleep disorders diagnosed through our center. Extensive expertise in managing non-invasive ventilation in children is available, and early referrals for otolaryngology evaluation can be provided. Referrals can be made to the Pediatric Sleep Disorders Clinic by calling 314-454-2694 or 314-454-4007. Alternatively, practitioners can refer patients directly to the sleep laboratory for overnight studies, 314-454-4503.
Washington University pediatric sleep physicians lead funded research projects characterizing sleep and breathing in children, including the National Institutes of Health-supported grant, titled Physiologic biomarkers predicting ventilatory instability and hypoxemia in premature infants that is examining central control of breathing in premature infants.
Pediatric pulmonary clinics
In addition to the conditions described above, the division treats a variety of less common pediatric lung disorders, including bronchopulmonary dysplasia, bronchiolitis obliterans, interstitial lung diseases, primary ciliary dyskinesia, tracheobronchomalacia, vocal cord dysfunction, aspiration disorders, hypersensitivity pneumonitis and a variety of pulmonary complications associated with neuromuscular disorders. Patients can be referred for clinical evaluation by calling our office at 314-454-2694.
Aerodigestive disorders: Together with colleagues from pediatric otolaryngology and pediatric gastroenterology, we have established multidisciplinary subspecialty care for children with anatomic or functional disorders of the aerodigestive tract. These disorders may include tracheoesophageal fistulas, laryngeal clefts, vocal cord paralysis, and other anomalies of the airway and upper gastrointestinal tract, as well as functional aspiration disorders and their related anatomic causes.
Technology-dependence: Division physicians and nurses also provide subspecialty care in our multidisciplinary pediatric technology-dependent clinic, which coordinates hospital-based and home care of ventilator-dependent children and provides consultative services at Ranken-Jordan Pediatric Bridge Hospital for Children. Members of the division contributed to the official American Thoracic Society Clinical Practice Guideline that outline standards for pediatric chronic home invasive ventilation, published in the American Journal of Respiratory and Critical Care Medicine.
Pediatric Pulmonary Function Laboratory
The Pediatric Pulmonary Function Laboratory at St. Louis Children’s Hospital specializes in pediatric testing from infancy through adolescence and early adulthood. The laboratory offers a full range of lung function tests for clinical and research patients. In addition to standard tests of lung mechanics and function (including spirometry, plethysmography, maximal respiratory pressures and diffusion capacity measures), the laboratory conducts specialized tests including stress cardiopulmonary testing, multiple breath washout studies, and bronchoprovocation tests. The lab also performs state-of-the-art infant pulmonary function testing, including plethysmographic measurements of lung volume and raised-volume forced flows.
Pediatric pulmonologists perform more than 200 flexible bronchoscopy procedures annually. Most procedures are performed in the St. Louis Children’s Hospital Ambulatory Procedure Suite on an outpatient basis, while more emergent procedures can be performed during inpatient admissions. Depending on the indication, bronchial washings, bronchoalveolar lavage, endobronchial biopsies and transbronchial biopsy can be collected during the procedures, and procedures may be performed in conjunction with pediatric otolaryngologists and pediatric gastroenterologists. Because of our extensive experience with lung transplantation, our center is identified as a leader, and has contributed to the American Thoracic Society guidelines for performing flexible airway endoscopy in children, published in the American Journal of Respiratory and Critical Care Medicine. Referrals should be made through the division office at 314-454-2694.