UAB MEDICINE PULMONARY SERVICES SPRING 2020
FEATURE STORIES
To read these and past stories online, please visit uabmedicine.org/referpulm.
MACHINES HELP SCIENTISTS SPOT NEW PATTERNS IN COPD
Over 16 million Americans have been diagnosed with COPD,
according to the CDC. Millions more suffer undiagnosed from
the disease, which is characterized by blocked airflow and
breathing-related problems.
Surya Bhatt, MD, PhD, is training a machine model to review
CT scans and recognize an often-overlooked and untreated
subset of patients. His work, funded by an R21 Exploratory/
Developmental Research grant from the NIH’s National Institute
of Biomedical Imaging and Bioengineering, could improve
treatment for millions of patients.
For most COPD patients, the main site of blockage is in the
small airways of the lungs. However, for approximately 5% of
patients, breathing problems may be caused by collapse of
the large airways when they exhale. The distinction is crucial
because bronchodilators – the first-line treatment for COPD –
are effective in expanding the small airways, but they do not
help when the problem is collapsed large airways.
“Unfortunately, the symptoms [shared by the two] are almost
exactly the same,” Dr. Bhatt says. “It’s very difficult to identify
these patients in clinical practice. We estimate that there are 3.5
to 4 million people in the United States with this condition. It is
significantly underappreciated.”
Currently, when physicians suspect large airway collapse, they
can investigate with bronchoscopy or with two CT scans. The
first method is invasive, and the second involves substantial
radiation exposure. Dr. Bhatt hopes his machine learning model
can provide a third way.
“We’re going to feed the raw images [of large airway collapse]
into the computer and use deep learning to identify features
that humans haven’t been able to pick up: subtle changes in
branching patterns or geometry of the airways or differences in
the wall,” he says.
Deep learning uses multiple layers of learning algorithms, with
each node of a layer trained to recognize one specific feature of
its dataset input and each layer wired into the next along a host
of connections. It involves numerous prediction attempts, and
the results are used to reshape the model’s architecture.
“If this is successful, it could lead to a paradigm shift,” Dr. Bhatt
says.
UAB PULMONARY FACULTY DEVELOP COVID-19 CARE GUIDELINES, EARN RESEARCH GRANTS
Faculty members from The University of Alabama at
Birmingham (UAB) Division of Pulmonary, Allergy & Critical
Care Medicine have been working on the front lines of the
COVID-19 pandemic, caring for patients, developing clinical
care protocols, and earning grants to study the virus.
Steve Stigler, MD, medical director of UAB’s Medical Intensive
Care Unit and assistant chief medical officer of the medical
service line, has been providing operational leadership at
the UAB Hospital Command Center during the pandemic and
overseeing the activities of the division’s intensivists. Dr. Stigler
– along with colleagues Sheetal Gandotra, MD; Derek Russell,
MD; and Daniel Kelmenson, MD –implemented care processes
for COVID-19-positive patients, created staffing models, and
worked on preparing for contingencies related to ICU capacity,
ventilator availability, and other challenges. Some of those
efforts included developing guidelines for COVID-19 clinical
care, proning patients, running codes, proper use of PPE, and
organizing appropriate staffing. They also were involved in the
simulation and education processes that led to implementation
of these guidelines and protocols.
COVID-19 Grants
Two other division faculty members – Steven Rowe, MD, and
Jessy Deshane, PhD – are among 14 UAB physicians and
researchers who received grants to investigate various aspects
of the virus. The 14 grants awarded were the product of a
partnership between the UAB School of Medicine and UAB’s
Hugh Kaul Precision Medicine Institute. The School of Medicine
contributed $350,000 from philanthropic gifts toward the
effort, and the Hugh Kaul Precision Medicine Institute provided
$300,000. The request for applications drew more than 50
proposals, and the awards averaged $46,000 each.
Seven of the 14 awards were given to faculty members from
the UAB School of Medicine. Those faculty members and their
studies are:
• Steven Rowe, MD (Professor, Pulmonary, Allergy & Critical
Care Medicine), “A Ferret Model of COVID-19 Pathogenesis
and Treatment”
• Jessy Deshane, PhD (Associate Professor, Pulmonary, Allergy
& Critical Care Medicine), “Human Lung Tissue Model of
SARS-CoV-2 Infection to Monitor Treatment Response”
• Winn Chatham, MD (Professor, Clinical Immunology and
Rheumatology), “Early Identification and Treatment of
Cytokine Storm Syndrome in COVID-19”
• Randall Davis, MD (Professor, Hematology and Oncology),
“Defining Serologic and Neutralizing Humoral Immunity to
COVID-19”
• Paul Goepfert, MD (Professor, Infectious Diseases),
“Establishment of a Biospecimen Repository to Enable SARS-
CoV-2/COVID19 Research at UAB”
• Yulia Khodneva, MD, PhD (ABIM Research Pathway fellow,
General Internal Medicine), “Baseline Use of Renin-
Angiotensin-Aldosterone system (RAAS) Inhibitors and the
Risk of Severe Novel Coronavirus Infection (COVID19)”
• Troy Randall, PhD (Professor, Clinical Immunology and
Rheumatology), “Development of SARS-2 Recombinant
Proteins for Diagnostics, Vaccine Testing and Research”