Clearing the Airways for Research Into Respiratory Health

Image of Dr. Ian Jacobs

From the nostrils down to the larynx, the airways of a child’s respiratory system form a fragile but fundamental area for breathing, swallowing, and speaking. Airway disorders can range from those acquired at birth, such as subglottic stenosis, to those that result from an accident, such as when a child swallows a button battery or other foreign object. At Children’s Hospital of Philadelphia, the Center for Pediatric Airway Disorders has become the largest multidisciplinary center in the world for treating all such airway conditions, whether common or complex. As a newly designated Frontier Program, the Center will receive internal funding to expand both its clinical reach and its translational research effort.

Established in 1998, the Center provides both comprehensive coordinated care and surgical interventions, strengthened by its multidisciplinary team of four full-time airway surgeons, five advanced practice nurses, a triage nurse, two administrative coordinators, a social worker, and numerous consultants in speech, pulmonary medicine, gastroenterology, neonatology, cardiac surgery, and critical care medicine.

The Center also has been a leader in innovative management of pediatric voice disorders. Led by Karen Zur, MD, associate director of the Center for Pediatric Airway Disorders, the Pediatric Voice Program is dedicated to studying pediatric voice disorders and championing various aspects of care for children with voicing issues.

Several internationally recognized breakthroughs have emerged and gained traction through the Voice Program and Dr. Zur’s work. These include the use of recurrent laryngeal nerve reinnervation for rehabilitating dysphonia and aspiration in children with iatrogenic unilateral vocal fold paralysis, and the management of complex cases of recurrent respiratory papillomatosis (RRP) with the use of intravenous bevacizumab (Avastin®, Genentech). Thanks to a collaboration with Elizabeth Fox, MD, head of Developmental Therapeutics at the CHOP Cancer Center, Dr. Zur has established a protocol for managing these complex and recalcitrant cases that has led to a change in the management paradigm for children with RRP internationally.

With a portfolio of successful research discoveries and a strong team, Ian Jacobs, MD, medical director of the Center for Pediatric Airway Disorders, believes the Center is a perfect fit for the Frontier Program and poised to address the growing increase in the number of airway procedures that are conducted at CHOP.

“The Frontier Programs combine extraordinary clinical care, innovative translational research, and a significant return on investment,” Dr. Jacobs said. “The Center for Pediatric Airway Disorders is on the cutting edge of pediatric airway reconstruction and laryngology.”

Clinical expansion will involve bringing an outreach nurse practitioner onto the team, as well as a new bioengineering materials scientist. The latter will help lead and develop one arm of the translational research effort: a new cartilage and bioengineering materials laboratory. In addition, Dr. Jacobs said the research effort will include the development of novel treatment strategies, with one example geared toward treating button battery injuries. Currently, Dr. Jacobs and his team are working on identifying the most ideal beverage or solution for mitigating these injuries, which occur when young children accidentally swallow lithium button batteries.

Frontier Program funding also will help to develop and commercialize a small but powerful tool in the airway disorders field: a 3-D printed tracheal model to be used in simulation training for teaching tracheostomy care to healthcare professionals and parents. Dr. Jacobs said that no such commercial model exists yet, and this simulation device could help everyone from physicians to a patient’s parents better visualize how the trachea, also known as the “windpipe” in the body, works. This windpipe connects the upper respiratory tract to the lungs.

“We want the users to experience the real muscle memory feel of changing a trach tube in a trach site, with different scenarios or situations that could occur,” Dr. Jacobs said. “This device can save many lives because of the potential to increase the skill level and preparation for emergency situations. This teaching model will be marketed to emergency rooms, intensive care units, nursing home facilities for children, and for parents to learn.”

What excites Dr. Jacobs about the new Frontier Program designation is how it will help the Center continue to touch many different lives, from Philadelphia to across the world, by growing clinically and developing new innovations.

“To be of service to patients and to improve outcomes based on these conditions, that really excites me the most,” Dr. Jacobs said.

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