Expanded Yale Center Enhances Access to Asthma, COPD, and Bronchiectasis Diagnosis, Care, and Research

The diagnostic and therapeutic options for patients with common chronic airway diseases such as asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis have dramatically improved over the last decade. In recognition of the need to improve access to novel diagnostic modalities, therapies, and research, the Yale Center for Asthma and Advanced Airway Disease (YCAAD) in Yale School of Medicine’s Section of Pulmonary, Critical Care and Sleep Medicine (Yale PCCSM) is expanding to become a home for patients with chronic airway disease in the Northeast.

Led by Geoffrey Chupp, MD, Yale PCCSM professor of medicine, YCAAD has long provided world-class care for patients with asthma. YCAAD is located in the Winchester Center for Lung Disease, a partnership between Yale PCCSM and Yale New Haven Health.

With the recent addition of the Chronic Obstructive Pulmonary Disease Program and the Bronchiectasis and NTM Infections Program, the center offers increased access to nationally renowned clinicians, innovative technologies, evidence-based therapies, and cutting-edge research.

The expanded center will help Yale develop a more unified and efficient approach to treating patients, Chupp said. It will also help the programs better compete for grants, spark ideas for training and research, and increase opportunities for patients to participate in clinical trials, he added.

Treatments for airway diseases have advanced dramatically in recent years from bronchodilators and steroid inhalers to targeted biologics and endobronchial valves, he said. Now Yale practitioners can, for example, analyze patients’ blood with hard-to-control disease for biomarkers that identify treatments targeting specific disease pathways that may dramatically improve symptoms, he said. As research has offered a better understanding of these disease pathways, treatments proven effective for asthma are now proving effective for diseases including COPD and possibly bronchiectasis, he added. And patients may have overlapping conditions, such as asthma with COPD, so a unified management approach makes sense, he noted.

Combining the programs into one center “is a more deliberate way to acknowledge and leverage this change to benefit patients, physicians, and the system,” he said. “We are starting to borrow each other’s learnings in the different diseases to develop a more centralized approach.”

“The new YCAAD epitomizes the strength of our programs and the collaboration between Yale School of Medicine and YNHH,” said Naftali Kaminski, MD, Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine (Pulmonary) and Yale PCCSM section chief. “Putting all airway disease within one center will allow us to streamline access, improve diagnosis and care, and provide our patients with opportunities to participate in cutting-edge research.”

Led by Carolyn Rochester, MD, Yale PCCSM professor of medicine, the COPD program was established in 2016. The program treats patients holistically to stabilize their disease, helping them live longer with a better quality of life, and incorporates the recent advances made in the diagnosis, detailed characterization, and management of people with COPD. For example, while tobacco smoking is a well-known risk factor for developing COPD, many factors, from environment and genetics to early life events, can contribute, Rochester said. Through performing a comprehensive assessment and characterization of each patient’s COPD features and comorbidities, the program intervenes where possible to minimize patients’ symptoms and disability, prevent disease progression, and minimize the risks of exacerbations.

The program employs a multidisciplinary team, including a nurse practitioner expert in managing airway disease, a nursing specialty team, a physiotherapist, clinic pharmacists, a social worker, and respiratory therapists. “The team addresses the spectrum of patients’ needs and gives them the opportunity to partner with us in a positive way to optimize their health,” Rochester said.

The program studies not only patients’ clinical features but also their radiographic and other biologic features to optimize their therapy precisely, said Sebastian Kurz, MD, PhD, Yale PCCSM associate professor of medicine and clinical director of the program.

The COPD program has historically collaborated closely with the asthma and bronchiectasis programs, but having a more formalized and unified structure for care of all obstructive lung diseases “smooths the path for even closer collaborations in patient care, education for trainees, and clinical and translational research,” Rochester said.

Kurz noted that the collaboration helps with challenging cases through its network of specialists who reach out to each other for consultation. “It’s intellectually a very stimulating group of people,” he said.

Led by Ashley Losier, MD, Yale PCCSM assistant professor of medicine, the Bronchiectasis and NTM Infections Program specializes in managing bronchiectasis patients and treating patients with chronic respiratory tract infections, including one of the most common caused by nontuberculous mycobacteria (NTM). Patients with bronchiectasis may also have asthma or COPD. The program gives patients a diagnostic workup to determine the cause of their disease, which could be a history of respiratory infections or a genetic or inflammatory condition. Treatment includes chest physical therapy for airway clearance, anti-inflammatories, and antibiotics, depending on the patient’s underlying conditions, Losier said.

Because YCAAD encompasses all airway disease, the Bronchiectasis and NTM Infections Program can share management strategies, education, and research opportunities with airways disease specialists to help patients get access to bronchiectasis care, Losier said. The collaboration means “additional input from team collaboration with more opportunities for patient care and therapeutics, research, and patient and medical trainee education,” she said. Being part of the expanded center “offers a more well-rounded review from all our clinicians and of our available treatments for our patients. It’s where some of the more nuanced care might exist,” she said.

The expansion also offers research opportunities that could benefit students and trainees and provide the opportunity for better grant applications and participation in clinical trials, Chupp said.

Clinical trials are successful when patients who are good candidates have access to trials of cutting-edge therapies. Expanding the center allows information about all the airway disease trials to be efficiently distributed to all providers, who can then identify appropriate patients that might want to participate, he said.

Chupp said the three programs of YCAAD—asthma, bronchiectasis, and COPD—now have monthly meetings to discuss integration, operational efficiencies, clinical trials, challenging cases, and research. Students and trainees will be involved in projects that result from those discussions.

“When you have a lot of people studying different things coming together, there are opportunities for brainstorming and new ideas,” he said. “You can potentially put together a very interesting project to study the novel use of a therapy or a novel mechanism of disease that will improve the lives of patients.”

The Section of Pulmonary, Critical Care and Sleep Medicine is one of the eleven sections within Yale School of Medicine’s Department of Internal Medicine. To learn more, visit Yale PCCSM's website, or follow them on Facebook and Twitter.