Chief’s Corner: Life in Pulmonary During COVID-19

Lisa Young, MD Breathing and sleep are two of the most essential functions for life and health, impacting physical, emotional, behavioral, and developmental functioning in infants and children.

The threats to lung health are numerous and ever-present. For some children, premature birth, congenital anomalies, and genetic disorders pose early challenges. For others, complications of neuromuscular diseases, immunodeficiency, oncologic therapies, or exposure to environmental tobacco smoke impact pulmonary function over time. Collectively, the majority of visits to pediatricians and the Emergency Department, as well as hospital admissions are for respiratory illnesses. Further, as lung development is ongoing in childhood, many lung diseases that start early in life result in long-term health consequences.

Families of children with chronic lung diseases have heightened concern about their child contracting a respiratory infection, let alone one as unpredictable and unknown as COVID-19. Fortunately, to date, respiratory complications of COVID-19 have been far milder and less frequent in children than in adults. However, the COVID-19 pandemic has disrupted the standard approaches for delivery of care and challenged us to innovate to ensure we continue to meet the needs of our patients—particularly those who require complex medical interventions and multidisciplinary teams.

As the COVID-19 pandemic reached our region, we, along with other clinical areas at CHOP, shifted to providing most outpatient services via telemedicine, with the pulmonary function testing lab, sleep lab, and on-site clinics remaining available as needed. And remarkably, we’ve found that we can indeed provide most of our ambulatory consultative services in this format, enabling us to assess breathing patterns and plan for in-person visits and testing when needed.

We’ve also taken steps to proactively reach high-risk patient populations. For example, our team contacted the families of hundreds of children who were hospitalized at CHOP this winter for asthma, ensuring that they had an asthma care plan and medications on hand. In the Technology Dependence Center, which cares for >850 children who are tracheostomy-ventilator dependent or on noninvasive ventilation, Pulmonary team members worked with CHOP Home Care and the leadership of the Respiratory Therapy Department to ensure scheduled replacement of disposable supplies and establish criteria for backup ventilators for patients in the community, given the possible shortages of such equipment that could occur as a result of the COVID-19 pandemic.

And in the Sleep Center, via telemedicine, the team evaluated and prescribed positive airway pressure (PAP) for children with obstructive sleep apnea, reaching more than 3-fold numbers of patients than in a typical month. Importantly, this care involved an interdisciplinary team including a respiratory therapist and psychologist, ensuring proper use of equipment and aiding the family in developing a behavioral plan to help the child acclimate to the equipment and use it successfully.

Thus, while COVID-19 has impacted our workflows, the Division of Pulmonary and Sleep Medicine remains dedicated to providing expert and compassionate clinical care for children and families with lung diseases and sleep disorders. After much preparation and thoughtful planning to ensure maximum safety, we are now resuming more in-person outpatient clinic visits. Telemedicine options will remain in place as well, for those patients that would prefer to be seen that way and do not need to have an in-person exam as determined by your care team. We want you to know that we are confident we can offer all of these services responsibly and safely. Here’s what you can expect when you come back to see us.

Please contact us if you’d like to learn more about our programs, including the Cystic Fibrosis Center, Sleep Center, Technology Dependence Center, Asthma Program, Lung Transplant Program, Thoracic Insufficiency Center, Bronchoscopy/Aerodigestive Program, or clinics for children with chronic lung disease of infancy, neuromuscular disease, interstitial lung disease, primary ciliary dyskinesia, and other rare lung diseases. In simpler terms, for any child with concerns about breathing or sleep, we are here.

Lisa R. Young, MD, is Chief of the Division of Pulmonary and Sleep Medicine at Children’s Hospital of Philadelphia.