Children’s Hospital of Philadelphia (CHOP) is home to one of the largest and most comprehensive Pediatric Pulmonary and Sleep Medicine programs in the world. With a team of more than 45 physicians and research faculty, alongside dedicated fellows, nurse practitioners and sleep psychologists, the division manages over 22,000 outpatient visits and 14,000 inpatient encounters each year — caring for children with conditions ranging from common respiratory issues to rare and complex lung diseases.
Experts from CHOP’s Division of Pulmonary and Sleep Medicine recently shared insights on the program’s comprehensive approach to pediatric respiratory care, including specialized treatment for bronchopulmonary dysplasia (BPD), innovations in managing technology-dependent patients, the role of advanced bronchoscopy in solving diagnostic challenges, and opportunities for fellowship training that will help shape the next generation of pediatric pulmonologists and sleep physicians.
Participants:
Lisa R. Young, MD, Chief of the Division of Pulmonary and Sleep Medicine
Sharon Mcgrath-Morrow. MD, MBA, Associate Chief of the Division of Pulmonary and Sleep Medicine and Director of the Post-preemie Lung Disease Clinic
Pelton A. Phinizy, MD, Co-Director of the Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center, Associate Fellowship Program Director
Julie L. Fierro, MD, attending physician
Danna Tauber, MD, MPH, Senior Medical Director, Inpatient Pulmonary and Sleep Services
What are some of the most recent advancements and expansions in the Pulmonary and Sleep Medicine Program that are improving patient access and care delivery?
Dr. Young: The scope of pediatric pulmonary medicine has dramatically expanded in recent years, as we strive to address the broad spectrum of acute and chronic respiratory conditions that impact infants and children. We’ve seen a lot of exciting growth recently that reflects CHOP’s ongoing commitment to increasing access and advancing care. Our care models frequently include close collaboration with other specialists, including multidisciplinary approaches to rheumatologic lung diseases, neuromuscular diseases and aerodigestive disorders, to name just a few.
In addition to the transformative impact of new therapies for many individuals with cystic fibrosis, I’m also really excited about the advances in how we treat asthma, autoimmune-mediated disorders and neuromuscular diseases. Further, we work very closely with colleagues in hematology and oncology, as we see a high burden of pulmonary complications in children treated for childhood cancers or who undergo hematopoietic cell transplantation. I look forward to the emerging and greatly needed advances in treating sickle cell disease, primary ciliary dyskinesia and childhood interstitial lung diseases, including pulmonary fibrosis.
Equipment and medications developed for adults must also be evaluated for safety and made available to children. Since early life lung health impacts adult lung function and health across the lifespan, it’s important to focus on promoting lung health and preventing disease in early life. We have much more to do, and we look forward to partnering through professional organizations like the American Thoracic Society (ATS), as well as collaborating across clinical and research networks to accelerate progress.
I’d like to invite you to continue reading to learn more from the dedicated physicians who lead important work in several of our clinical programs at CHOP, including the Bronchopulmonary Dysplasia (BPD) program, the Technology Dependence Center (TDC) and the Pulmonary Advanced Bronchoscopy Center.
What sets CHOP’s Division of Pulmonary and Sleep Medicine apart from other pediatric institutions in the way it delivers care to children with bronchopulmonary dysplasia?
Dr. Fierro: Our patients with BPD are followed long-term by a dedicated team specializing in BPD management. We often begin caring for them in the NICU through our consultative service and continue that care after discharge in our outpatient Post-preemie Lung Disease Clinic. There, we offer multidisciplinary support from physicians, dietitians and therapists, along with lung function testing to monitor long-term respiratory health. Access to advanced imaging, bronchoscopy and sleep studies — plus close collaboration with cardiology, ENT, neonatology and gastroenterology — helps us deliver comprehensive, high-quality care for children with severe BPD.
How do you balance long-term outcomes with the immediate clinical needs of infants with BPD?
Dr. Fierro: In children with BPD, clinical needs change over time, so we focus on addressing immediate concerns while also considering the long-term impact of each intervention. Our comprehensive BPD clinic addresses short-term health concerns as they arise, offering children with BPD the greatest opportunity for normal lung function and optimal health outcomes throughout childhood. Collaborating closely with caregivers is key to providing effective care and supporting the best possible outcomes for these infants
What recent advancements or research in BPD care are you most excited about?
Dr. Mcgrath-Morrow: Health outcomes in extremely preterm children have improved in recent years thanks to advances in care, leading to better quality of life for both children and their caregivers. The BPD Collaborative unites national and international centers, helping to standardize care for children with BPD. Clinical research through the Collaborative has guided the development of guidelines aimed at improving outcomes for all children born preterm. We are also beginning to build partnerships with adult healthcare providers, ensuring continuity of care as children with BPD transition into adulthood.
What was the focus of the BPD symposium at ATS, and what were some of the key questions it aimed to address regarding respiratory outcomes in children with BPD?
Dr. Mcgrath-Morrow: CHOP physicians led a symposium on BPD that included pediatric and adult pulmonologists. The goal of this symposium was to address current and emerging concerns regarding the respiratory health of children with BPD across the lifespan by exploring the evolving landscape of respiratory outcomes in survivors of preterm birth, with a focus on the following topics:
- How can we optimize alveolar growth after delivery in the preterm child with BPD?
- After the NICU, how can we predict which children with BPD will have normal or abnormal lung function and growth as they age?
- How do environmental exposures, such as indoor and outdoor air pollution, impact respiratory outcomes in formerly preterm children, and what can we do to mitigate these exposures?
- How do interactions between genes and the environment influence lung health outcomes in formerly preterm children?
- How can we optimize lung function outcomes in formerly preterm adults?
How does the Technology Dependence Center help medically complex children and their families transition from hospital to home care?
Dr. Tauber: The TDC brings together a multidisciplinary team — nursing, respiratory therapy, social work, nutrition, advanced practice providers (APPs) and physicians — to support pulmonary patients who need ongoing technological care. We work closely with hospital teams, home nursing agencies, equipment providers and case managers to ensure a smooth transition from hospital to home. During a patient’s stay, we follow them closely and meet weekly with care teams to assess discharge readiness.
Several weeks before discharge, we hold a comprehensive planning meeting with the family and all key partners — home nursing, DME providers, TDC staff and hospital caregivers — to walk through what home care will look like. Within 24 to 48 hours after discharge, we conduct a video visit with the family, one of the patient’s hospital APPs, and TDC nursing staff to check on the initial transition, review equipment setup and make any needed adjustments. This hands-on approach helps set families up for success. Families and home nurses are encouraged to join weekly check-in calls with the TDC team, and an in-person follow-up visit is scheduled within the child’s first month at home.
What innovations in home ventilation or chronic respiratory support are being implemented through the TDC?
Dr. Tauber: Two years ago, we teamed up with the CHOP Simulation Center to offer a course called Respiratory Care of the Medically Fragile Child. This hybrid course blends online learning with hands-on sessions, featuring respiratory therapists demonstrating equipment and educators leading simulations of common home care scenarios. It’s been well-received by home nursing agencies, offering a great chance to learn new technology and review emergency response skills.
Our TDC team also hosts virtual “Coffee Hours” for families of children on home ventilation. These sessions give families a space to share experiences and ask questions to social workers, nutritionists, nurses and respiratory therapists. We’ve learned that families often seek support beyond medical care, focusing on life with a child who depends on medical equipment. Forward thinking of this program includes expanding the use of continuous noninvasive ventilation, not only for patients with neuromuscular weakness but also for those with a variety of parenchymal lung disorders, such as pulmonary hypoplasia or BPD. This broader application of technology reflects our commitment to improving quality of life and long-term outcomes for medically complex children.
Additionally, our TDC Young Adult Transition Program helps patients and families move from pediatric to adult care. In partnership with the Fishman Program for Home Assisted Ventilation at the Hospital of the University of Pennsylvania (Penn), families meet the adult care team at our office and get ongoing support throughout the transition. We make sure medical histories are clearly communicated and provide extra help from TDC nurses and social workers to navigate insurance waivers and secure medical equipment.
How is CHOP’s advanced bronchoscopy program different from those in other pediatric centers?
Dr. Phinizy: The Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center is the country’s first pediatric advanced diagnostic bronchoscopy program, and we now have more than a decade of experience performing advanced diagnostic and interventional procedures in children. Our team collaborates closely with adult medicine experts at Penn Medicine to adapt cutting-edge, evidence-based techniques for pediatric use. In fact, we’ve helped pioneer the transition of many of these procedures from adult to pediatric care, demonstrating that they are both safe and effective for children.
Our team works together with specialists in radiology, pathology, rheumatology, oncology, infectious diseases, surgery and interventional radiology to ensure timely diagnoses and effective treatment plans. Together, we determine the best diagnostic approach — whether bronchoscopic, interventional radiologic percutaneous or surgical — always aiming for the least invasive and safest option.
To improve diagnostic accuracy, we use the latest tools and techniques. For peripheral pulmonary lesions and nodules (caused by infections, tumors or autoimmune diseases like granulomatosis with polyangiitis or sarcoidosis), we use CT navigation, radial endobronchial ultrasound (EBUS) and cone beam CT to precisely target the area of concern. For mediastinal lymphadenopathy and masses (often due to lymphoma, infection or sarcoidosis), we rely on convex or linear EBUS for accurate and safe sampling. We also use cryoprobes to obtain larger tissue samples through cryobiopsy, which allows for more precise diagnoses and often spares children from more invasive procedures.
How does advanced bronchoscopy impact a patient’s care trajectory and outcomes?
Dr. Phinizy: Advanced diagnostic bronchoscopy allows doctors to make accurate diagnoses using minimally invasive techniques, often avoiding the need for more invasive procedures like thoracotomy. These approaches carry lower risks of significant bleeding, post-op chest tube placement, and pain, which typically means shorter hospital stays and more time at home for the child and their family.
What opportunities are available at CHOP for fellows or residents interested in pulmonary medicine and technology-dependent care?
Dr. Phinizy: The ACGME-accredited pediatric pulmonology fellowship at CHOP offers a comprehensive, hands-on training experience for graduates of accredited pediatrics residency programs. Welcoming up to four fellows each year, the program combines close mentorship from over 40 faculty with robust clinical and scholarly development, preparing trainees for leadership in the field.
What distinguishes CHOP’s pediatric pulmonology fellowship from others of its kind?
Dr. Phinizy: CHOP’s pediatric pulmonology fellowship offers unmatched clinical breadth, with rotations through key subspecialty programs like the Technology Dependence Center, the Advanced Diagnostic and Interventional Bronchoscopy Program, the Neuromuscular Program, the Cystic Fibrosis Center, and programs in Interstitial Lung Disease, Primary Ciliary Dyskinesia and other rare lung diseases. This wide-ranging experience ensures exposure to nearly every aspect of pediatric pulmonary medicine. Fellows also have the flexibility to pursue clinical, laboratory or translational research with mentorship available both within and beyond the division.
The program is designed to evolve with the needs of our fellows. Recent improvements, driven by fellow feedback, include restructured clinical schedules that front-load research time, customizable training paths in the second and third years, and redesigned staffing models with separation of day and night responsibilities to improve focus and work-life balance.
With a cohort of 11–12 fellows, the program fosters a supportive, collaborative environment that enhances both learning and quality of life.
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Children’s Hospital of Philadelphia (CHOP) is home to one of the largest and most comprehensive Pediatric Pulmonary and Sleep Medicine programs in the world. With a team of more than 45 physicians and research faculty, alongside dedicated fellows, nurse practitioners and sleep psychologists, the division manages over 22,000 outpatient visits and 14,000 inpatient encounters each year — caring for children with conditions ranging from common respiratory issues to rare and complex lung diseases.
Experts from CHOP’s Division of Pulmonary and Sleep Medicine recently shared insights on the program’s comprehensive approach to pediatric respiratory care, including specialized treatment for bronchopulmonary dysplasia (BPD), innovations in managing technology-dependent patients, the role of advanced bronchoscopy in solving diagnostic challenges, and opportunities for fellowship training that will help shape the next generation of pediatric pulmonologists and sleep physicians.
Participants:
Lisa R. Young, MD, Chief of the Division of Pulmonary and Sleep Medicine
Sharon Mcgrath-Morrow. MD, MBA, Associate Chief of the Division of Pulmonary and Sleep Medicine and Director of the Post-preemie Lung Disease Clinic
Pelton A. Phinizy, MD, Co-Director of the Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center, Associate Fellowship Program Director
Julie L. Fierro, MD, attending physician
Danna Tauber, MD, MPH, Senior Medical Director, Inpatient Pulmonary and Sleep Services
What are some of the most recent advancements and expansions in the Pulmonary and Sleep Medicine Program that are improving patient access and care delivery?
Dr. Young: The scope of pediatric pulmonary medicine has dramatically expanded in recent years, as we strive to address the broad spectrum of acute and chronic respiratory conditions that impact infants and children. We’ve seen a lot of exciting growth recently that reflects CHOP’s ongoing commitment to increasing access and advancing care. Our care models frequently include close collaboration with other specialists, including multidisciplinary approaches to rheumatologic lung diseases, neuromuscular diseases and aerodigestive disorders, to name just a few.
In addition to the transformative impact of new therapies for many individuals with cystic fibrosis, I’m also really excited about the advances in how we treat asthma, autoimmune-mediated disorders and neuromuscular diseases. Further, we work very closely with colleagues in hematology and oncology, as we see a high burden of pulmonary complications in children treated for childhood cancers or who undergo hematopoietic cell transplantation. I look forward to the emerging and greatly needed advances in treating sickle cell disease, primary ciliary dyskinesia and childhood interstitial lung diseases, including pulmonary fibrosis.
Equipment and medications developed for adults must also be evaluated for safety and made available to children. Since early life lung health impacts adult lung function and health across the lifespan, it’s important to focus on promoting lung health and preventing disease in early life. We have much more to do, and we look forward to partnering through professional organizations like the American Thoracic Society (ATS), as well as collaborating across clinical and research networks to accelerate progress.
I’d like to invite you to continue reading to learn more from the dedicated physicians who lead important work in several of our clinical programs at CHOP, including the Bronchopulmonary Dysplasia (BPD) program, the Technology Dependence Center (TDC) and the Pulmonary Advanced Bronchoscopy Center.
What sets CHOP’s Division of Pulmonary and Sleep Medicine apart from other pediatric institutions in the way it delivers care to children with bronchopulmonary dysplasia?
Dr. Fierro: Our patients with BPD are followed long-term by a dedicated team specializing in BPD management. We often begin caring for them in the NICU through our consultative service and continue that care after discharge in our outpatient Post-preemie Lung Disease Clinic. There, we offer multidisciplinary support from physicians, dietitians and therapists, along with lung function testing to monitor long-term respiratory health. Access to advanced imaging, bronchoscopy and sleep studies — plus close collaboration with cardiology, ENT, neonatology and gastroenterology — helps us deliver comprehensive, high-quality care for children with severe BPD.
How do you balance long-term outcomes with the immediate clinical needs of infants with BPD?
Dr. Fierro: In children with BPD, clinical needs change over time, so we focus on addressing immediate concerns while also considering the long-term impact of each intervention. Our comprehensive BPD clinic addresses short-term health concerns as they arise, offering children with BPD the greatest opportunity for normal lung function and optimal health outcomes throughout childhood. Collaborating closely with caregivers is key to providing effective care and supporting the best possible outcomes for these infants
What recent advancements or research in BPD care are you most excited about?
Dr. Mcgrath-Morrow: Health outcomes in extremely preterm children have improved in recent years thanks to advances in care, leading to better quality of life for both children and their caregivers. The BPD Collaborative unites national and international centers, helping to standardize care for children with BPD. Clinical research through the Collaborative has guided the development of guidelines aimed at improving outcomes for all children born preterm. We are also beginning to build partnerships with adult healthcare providers, ensuring continuity of care as children with BPD transition into adulthood.
What was the focus of the BPD symposium at ATS, and what were some of the key questions it aimed to address regarding respiratory outcomes in children with BPD?
Dr. Mcgrath-Morrow: CHOP physicians led a symposium on BPD that included pediatric and adult pulmonologists. The goal of this symposium was to address current and emerging concerns regarding the respiratory health of children with BPD across the lifespan by exploring the evolving landscape of respiratory outcomes in survivors of preterm birth, with a focus on the following topics:
- How can we optimize alveolar growth after delivery in the preterm child with BPD?
- After the NICU, how can we predict which children with BPD will have normal or abnormal lung function and growth as they age?
- How do environmental exposures, such as indoor and outdoor air pollution, impact respiratory outcomes in formerly preterm children, and what can we do to mitigate these exposures?
- How do interactions between genes and the environment influence lung health outcomes in formerly preterm children?
- How can we optimize lung function outcomes in formerly preterm adults?
How does the Technology Dependence Center help medically complex children and their families transition from hospital to home care?
Dr. Tauber: The TDC brings together a multidisciplinary team — nursing, respiratory therapy, social work, nutrition, advanced practice providers (APPs) and physicians — to support pulmonary patients who need ongoing technological care. We work closely with hospital teams, home nursing agencies, equipment providers and case managers to ensure a smooth transition from hospital to home. During a patient’s stay, we follow them closely and meet weekly with care teams to assess discharge readiness.
Several weeks before discharge, we hold a comprehensive planning meeting with the family and all key partners — home nursing, DME providers, TDC staff and hospital caregivers — to walk through what home care will look like. Within 24 to 48 hours after discharge, we conduct a video visit with the family, one of the patient’s hospital APPs, and TDC nursing staff to check on the initial transition, review equipment setup and make any needed adjustments. This hands-on approach helps set families up for success. Families and home nurses are encouraged to join weekly check-in calls with the TDC team, and an in-person follow-up visit is scheduled within the child’s first month at home.
What innovations in home ventilation or chronic respiratory support are being implemented through the TDC?
Dr. Tauber: Two years ago, we teamed up with the CHOP Simulation Center to offer a course called Respiratory Care of the Medically Fragile Child. This hybrid course blends online learning with hands-on sessions, featuring respiratory therapists demonstrating equipment and educators leading simulations of common home care scenarios. It’s been well-received by home nursing agencies, offering a great chance to learn new technology and review emergency response skills.
Our TDC team also hosts virtual “Coffee Hours” for families of children on home ventilation. These sessions give families a space to share experiences and ask questions to social workers, nutritionists, nurses and respiratory therapists. We’ve learned that families often seek support beyond medical care, focusing on life with a child who depends on medical equipment. Forward thinking of this program includes expanding the use of continuous noninvasive ventilation, not only for patients with neuromuscular weakness but also for those with a variety of parenchymal lung disorders, such as pulmonary hypoplasia or BPD. This broader application of technology reflects our commitment to improving quality of life and long-term outcomes for medically complex children.
Additionally, our TDC Young Adult Transition Program helps patients and families move from pediatric to adult care. In partnership with the Fishman Program for Home Assisted Ventilation at the Hospital of the University of Pennsylvania (Penn), families meet the adult care team at our office and get ongoing support throughout the transition. We make sure medical histories are clearly communicated and provide extra help from TDC nurses and social workers to navigate insurance waivers and secure medical equipment.
How is CHOP’s advanced bronchoscopy program different from those in other pediatric centers?
Dr. Phinizy: The Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center is the country’s first pediatric advanced diagnostic bronchoscopy program, and we now have more than a decade of experience performing advanced diagnostic and interventional procedures in children. Our team collaborates closely with adult medicine experts at Penn Medicine to adapt cutting-edge, evidence-based techniques for pediatric use. In fact, we’ve helped pioneer the transition of many of these procedures from adult to pediatric care, demonstrating that they are both safe and effective for children.
Our team works together with specialists in radiology, pathology, rheumatology, oncology, infectious diseases, surgery and interventional radiology to ensure timely diagnoses and effective treatment plans. Together, we determine the best diagnostic approach — whether bronchoscopic, interventional radiologic percutaneous or surgical — always aiming for the least invasive and safest option.
To improve diagnostic accuracy, we use the latest tools and techniques. For peripheral pulmonary lesions and nodules (caused by infections, tumors or autoimmune diseases like granulomatosis with polyangiitis or sarcoidosis), we use CT navigation, radial endobronchial ultrasound (EBUS) and cone beam CT to precisely target the area of concern. For mediastinal lymphadenopathy and masses (often due to lymphoma, infection or sarcoidosis), we rely on convex or linear EBUS for accurate and safe sampling. We also use cryoprobes to obtain larger tissue samples through cryobiopsy, which allows for more precise diagnoses and often spares children from more invasive procedures.
How does advanced bronchoscopy impact a patient’s care trajectory and outcomes?
Dr. Phinizy: Advanced diagnostic bronchoscopy allows doctors to make accurate diagnoses using minimally invasive techniques, often avoiding the need for more invasive procedures like thoracotomy. These approaches carry lower risks of significant bleeding, post-op chest tube placement, and pain, which typically means shorter hospital stays and more time at home for the child and their family.
What opportunities are available at CHOP for fellows or residents interested in pulmonary medicine and technology-dependent care?
Dr. Phinizy: The ACGME-accredited pediatric pulmonology fellowship at CHOP offers a comprehensive, hands-on training experience for graduates of accredited pediatrics residency programs. Welcoming up to four fellows each year, the program combines close mentorship from over 40 faculty with robust clinical and scholarly development, preparing trainees for leadership in the field.
What distinguishes CHOP’s pediatric pulmonology fellowship from others of its kind?
Dr. Phinizy: CHOP’s pediatric pulmonology fellowship offers unmatched clinical breadth, with rotations through key subspecialty programs like the Technology Dependence Center, the Advanced Diagnostic and Interventional Bronchoscopy Program, the Neuromuscular Program, the Cystic Fibrosis Center, and programs in Interstitial Lung Disease, Primary Ciliary Dyskinesia and other rare lung diseases. This wide-ranging experience ensures exposure to nearly every aspect of pediatric pulmonary medicine. Fellows also have the flexibility to pursue clinical, laboratory or translational research with mentorship available both within and beyond the division.
The program is designed to evolve with the needs of our fellows. Recent improvements, driven by fellow feedback, include restructured clinical schedules that front-load research time, customizable training paths in the second and third years, and redesigned staffing models with separation of day and night responsibilities to improve focus and work-life balance.
With a cohort of 11–12 fellows, the program fosters a supportive, collaborative environment that enhances both learning and quality of life.
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Division of Pulmonary and Sleep Medicine