Profile: Patricia J. Dubin, MD

For the new chief of Pediatric Pulmonology, the pursuit of treatments is personal

For Le Bonheur's new Chief of Pediatric Pulmonology and Sleep Medicine Patricia J. Dubin, MD, pursuing new treatments for respiratory issues is more than just a passion.

It's personal.

As a child, Dubin suffered from severe asthma and was often ill. As she grew older and honed in on a career in medicine, she knew wanted to find a way to help children with respiratory problems breathe easier. But for Dubin, it was more than her own experience that shaped her future in pulmonology. During her senior year of undergraduate studies, the daughter of a favorite professor, just 10 years old, died. The young girl had cystic fibrosis.

"It had a pretty profound effect on our entire campus, because we all kind of knew this little girl, and that was one of the first exposures that I really had to cystic fibrosis," says Dubin. "When we look at our field, many people think pulmonary evolved out of a need to take care of patients with asthma and other types of breathing disorders, but in large part it evolved around the disease of cystic fibrosis."

Dubin began her medical school training at the University of Rochester School of Medicine and Dentistry, followed by a pediatric residency at Yale New Haven Children’s Hospital, where she was able to engage in a fair amount of pulmonary training through the general pediatrics residency. She completed her pediatric pulmonology fellowship at the Children’s Hospital of Pittsburgh, and she stayed on for a decade, focused on research and clinical work. She moved to West Virginia University School of Medicine, where she was chief of Pediatric Pulmonology and Sleep Medicine, and served as the director of the Mountain State Cystic Fibrosis Center.

At Le Bonheur, Dubin will focus on developing research, clinical and education programs.

The connection between sleep medicine and breathing disorders drew Dubin's particular interest, something she calls a natural fit for people who think a lot about respiratory problems.

"A good portion of pediatric sleep medicine is secondary to breathing problems," said Dubin. "When we look at the different kinds of pathology, we think of obstructive sleep apnea or difficulty breathing during sleep. While that is a large part of pediatric sleep medicine, it is not the entire story. There are many other types of disorders."

Dubin will also continue her clinical work with young respiratory patients who seek treatment at Le Bonheur from across the region. Each year, asthma is the cause of more than 3,500 asthma-related visits to Le Bonheur.

"There are many things that attracted me to Le Bonheur," says Dubin. "I was attracted by the institutional commitment to community service, clinical program development, research and education."

She also cites the potential of Le Bonheur's programs, opportunities for partnering with other research hospitals, and Le Bonheur's focus on the needs of the community when it comes to respiratory treatment and therapy.

"There is a clear commitment to the Memphis community through development of programs that address unmet needs for the city and region as well through the development of programs that will garner national attention. The partnership with St. Jude also allows us to focus on respiratory care in oncology and hematology patients."

"I think many of us in medicine are inspired by our personal experiences, and that drives us to do what we do."

In the next year, Dubin will lead Pulmonary and Sleep program development.

Asthma: Pulmonology will focus on streamlining care and improving clinical outcomes through collaboration with our colleagues in Allergy and the CHAMP program. We will continue to provide excellent care for individuals with asthma and other complicating respiratory comorbidities.

Cancer-related respiratory disease: Cancer and the treatments it necessitates (e.g. radiation, chemotherapy and bone-marrow conditioning regimens) can cause significant respiratory damage. We will work with our oncology colleagues at St. Jude to develop a better understanding of the impact of cancer therapies on respiratory function as well as approaches to improving outcomes for these children. In patients with brain tumors (CNS tumors), the tumors and the therapies used to treat them can affect the centers in the brain that help control breathing and sleep cycles. We will collaborate with our oncology and neurosurgery colleagues to help develop treatment strategies targeted at these breathing and sleep-related problems.

Hematology-related respiratory disease: The Memphis region also has a large population of individuals with sickle cell disease. Sickle cell disease is a blood disorder that can cause severe respiratory problems as well as strokes. While outcomes have drastically improved with the use of hydroxyurea therapy, the risks of significant cumulative respiratory and stroke damage over a lifetime remain high. We are developing a program to identify and manage respiratory and sleep complications in sickle cell disease with the ultimate goal of improving outcomes.

Primary Ciliary Dyskinesia: PCD is a respiratory disease that is present at birth and causes permanent and irreversible respiratory damage if not identified early. It is treatable, though not curable. Early identification and intervention markedly improves outcomes. Dr. Catherine Sanders is an expert in PCD and was recently hired to develop and grow our PCD program here at Le Bonheur/UTHSC. Our program will be one of only a handful of nationally recognized pediatric PCD centers in the country.

Medically Complex and Technology-Dependent: children who require chronic ventilation or airway clearance require individualized treatment plans that fall within a rubric of care. Pulmonology is the primary group responsible for managing their care and partners closely with our intensivists and neonatologists to develop hospitalbased, as well as home-based care plans. Chronic lung disease (CLD) of prematurity, commonly referred to as “BPD”: Infants who are born premature have varying degrees of lung dysfunction that improves over time and with supportive treatment. Consistent and evidence-based care can prevent this vulnerable population from having further complications secondary to acquired infections and environmental exposures. Our group will continue to develop standardized care for the many infants and children with CLD of prematurity through our BPD clinic.