Yale Center for Asthma and Airways Disease has 3,000 patient visits a year and is a hub of clinical/translational research
Geoffrey Chupp, MD, is committed to defeating asthma, a disease that afflicts 10 percent of the U.S. population.
[January 2010] About 13 years ago, when Geoffrey Chupp, MD, was training to be a doctor, his 18-month-old son, Billy, was diagnosed with asthma. “I remember so vividly seeing him standing next to the bed, short of breath, wheezing,” Chupp recalls. Parental concern merged with professional curiosity, and Chupp, who had long been interested in immunology, found his calling. “Asthma really piqued my interest, and I had this desire to do something about it,” he says.
The center, which opened in 2002, is housed in the Winchester Chest Clinic at Yale-New Haven Hospital, and is staffed by a dedicated team of ear, nose and throat, gastrointestinal, pulmonary and allergy specialists.
A multidisciplinary team of specialists examines each patient to develop a customized treatment plan.
The only dedicated adult asthma center between Boston and New York, YCAAD receives more than 3,000 patient visits a year and is the hub of Yale’s program for clinical/translational research. YCAAD treats adults, starting with teenagers (typically young athletes who need help maximizing their performance while managing their asthma) up through patients in their 80s.
New Haven is an ideal location for the clinic, Chupp says, because of the large number of people afflicted with asthma. “Close to 10 percent of the population has the disease, and if you add in allergies and other airways diseases, it’s even higher,” he says. “So we’re talking about a major need for specialty evaluation and management of patients.”
When patients come to the clinic, they are evaluated by a physician, who reviews their medical history and records. Pulmonary function is measured and, if necessary, blood work and a CT scan are ordered. Specialists, including an allergist and a gastroenterologist, are available to examine the patient. If physicians suspect that something in the patient’s environment – dust, mold, cleansers or second-hand cigarette smoke – is causing the illness, home and workplace inspections are conducted. Once a treatment has been developed and put into effect, they closely monitor the patient’s progress.
Patients often receive a preliminary diagnosis during their first visit and leave with a medication to relieve their breathing problems.
“A multidisciplinary clinic enhances the quality of care,” Chupp says. “It provides an intellectual environment that puts all the physicians working on the patient in the same place at the same time.”
That intellectual environment also means YCAAD has become a hub of bench and clinical research into airways disease. Since the clinic opened its doors, about 500 patients have signed up to participate in clinical trials, and Chupp recently received a $3.2 million grant to identify the molecules that drive the severity of the disease.
“If we just give our patients the same medication every other pulmonologist has, then we’re just kicking the can down the road,” Chupp says. “It’s critical as an academic medical center to not only provide standard treatments, but also novel ones, ones that are just coming out of the pipeline.”
Patients have opportunities to participate in clinical trials of new treatments when standard medications aren’t working.
Lauren Cohn, MD, YCAAD’s associate director, treats patients as well as conducts research in immunology and asthma. Cohn says a lot of what they do at the clinic is “undiagnosing” asthma. “People think that everything that wheezes is asthma, but often it’s something else, and every patient is subtly different. Our goal is to personalize our patients’ treatment regimens.”
Key to meeting that goal is a steady stream of patients coming to the clinic with respiratory ailments who want to participate in clinical trials. On that score, Chupp is confident YCAAD is fulfilling its mission.
“My approach is Field of Dreams: if we build it they will come,” he says. “And that’s what I’m finding. We’re getting referrals; walk-ins come to us and say, ‘I want to be evaluated.’ It’s really starting to take hold.”
Story by Jennifer Kaylin
Photographs by Robert A. Lisak
For years Sadiann Ozment ran 20 miles a week, worked full time as director of hospital education at the VA Connecticut Healthcare System in West Haven and led an active life. Then, four years ago, when she was 53, she developed respiratory problems. “It got so bad I could barely breathe. It was very depressing,” she recalls.
Ozment was referred to Yale Center for Asthma and Airways Disease by her ear, nose and throat specialist. “It was like they were expecting me,” she recalls. “The entire clinic just kind of rose to the occasion.” The staff immediately tested Ozment’s breathing ability. Then they drew blood, took X-rays and did a CT scan. “Within two hours, I’d received a preliminary diagnosis and they gave me medication to help me breathe better,” she says.
Ozment was diagnosed with hypereosinophilic syndrome, an autoimmune disease characterized by an increase in the eosinophil count in the bloodstream. An elevated blood eosinophil count is associated with damage to some organs, including lungs. “It’s like the worst asthma you can imagine. It takes away all your activities of daily living,” Ozment says.
Hypereosinophilic syndrome is incurable, but with the right medication, a patient’s life can return to near normalcy. The challenge is finding the right medication. Geoffrey Chupp, MD, YCAAD director, put Ozment on prednisone, a powerful steroid that alleviates the symptoms but has so many dangerous side effects that physicians only like to use it as a short-term solution. The trouble was that every time Chupp tried to taper Ozment off the prednisone, her symptoms flared.
“There were many times I sat in Dr. Chupp’s office, and I was really down,” Ozment says. “But he just kept telling me, ‘Don’t worry. We’re going to figure this out.’ And he did.”
Chupp enrolled Ozment in a clinical trial for the biologic drug mepolizumab, an anti-IL 5 antibody. “It was amazing,” Ozment recalls. “Two days after starting the drug, I was walking out of work. I was almost to my car and all of a sudden I took a breath, and for the first time it felt so light. My entire chest opened up like a balloon.” A month later, Ozment took a breathing test and the results were perfect.
That was nine months ago. Today Ozment is running again and she feels stronger every day. Since her recovery, she has been approached by a few people seeking advice on their respiratory problems. “I always refer them to the Yale clinic,” she says. “I tell them, ‘They will help you, and you will have an improved quality of life.’ ”
Yale Center for Asthma and Airways Disease
Winchester Chest Clinic
Yale-New Haven Hospital
789 Howard Ave.,
New Haven, CT 06510
The building is handicapped accessible.