CENTER FOR ADVANCED LUNG DISEASE

LAC+USC MEDICAL CENTER
The Division of Pulmonary and Critical Care Medicine runs the Medical Intensive Care Units at the LAC+USC Medical Center. The Division, in addition, provides consultative services to inpatient and intensive care units of other divisions and departments, including internal medicine, surgery, neurology, neurosurgery, burns, emergency medicine and cardiology. The Division conducts a weekly Chest Clinic, at which residents and fellows follow new and follow-up patients, and a weekly Sarcoidosis Clinic. Each year, the Division has approximately 5,100 outpatient visits, sees approximately 650 consultations, and performs about 400 bronchoscopic examinations and numerous other procedures, including bronchoalveolar lavage, transbronchial and percutaneous needle biopsy and Wang needle biopsy. The Pulmonary Physiology Laboratory is under the direction of the Division of Pulmonary and Critical Care Medicine. PCCM performs on average 3,000 arterial blood gas studies, 1,000 lung function tests and 200 sleep studies every month.

USC UNIVERSITY HOSPITAL
The Division of Pulmonary and Critical Care Medicine administers the Intensive Care Units of the USC University Hospital (USCUH). We are involved in direct care of inpatients with a wide spectrum of lung and critical illnesses. The Pulmonary and Critical Care Medicine fellow performs all diagnostic and therapeutic procedures. Diagnostic and therapeutic bronchoscopies are performed by the fellow with an attending staff physician supervising the procedure. The Lung Transplantation Center, Adult Cystic Fibrosis Center and Cough Disorders Clinic have been established. Drs. Barbers, Baydur, Borok, Chang, Escalante, Ganesh, Juarez, Liebler, Lubman, Qiao, Rao, Shigemitsu, Soto and Sharma carry out major clinical roles at USCUH and at the Ambulatory Health Center.

USC/NORRIS CANCER HOSPITAL
New programs have been developed in fluorescence bronchoscopy, brachytherapy, lung immunology/transplantation, rehabilitation, cough/asthma and chronic pulmonary diseases. USC/Norris Cancer Hospital provides an unparalleled opportunity in delivering care to a large number of patients with complications related to malignancy, immunosuppression and bone marrow transplantation. Critically ill patients are cared for in the six-bed Intensive Care Unit. The Pulmonary and Critical Care Medicine fellow carries out all consultations and performs all diagnostic, invasive and noninvasive, and therapeutic procedures under the supervision of the attending staff. A new Center for Lung Cancer Management has been established. Drs. Barbers, Chang, Juarez, Rao, Sharma, Soto and Shigemitsu carry out major clinical responsibilities for USC/Norris Cancer Hospital inpatients and outpatients.

SPECIAL CLINICAL SERVICES
The Division of Pulmonary and Critical Care Medicine has established several clinical programs which are primarily located at USC University Hospital and our Ambulatory Healthcare Center, but are also located at USC/Norris Cancer Hospital and LAC+USC Medical Center. Each program offers specialized treatment of various pulmonary disorders as well as an educational setting for fellowship training.

• Asthma and Allergy Center
  The USC Asthma and Allergy Center is a comprehensive clinical program for the diagnosis and management of patients with asthmatic and/or atopic disorders (such as allergic rhinitis and sinusitis), which affect more than 20 million people in this country. The Asthma and Allergy Center is staffed by full-time teaching faculty who are certified in pulmonary, allergic and immunologic diseases. Besides physician specialists, resources include clinical nurse specialists, physical therapists, respiratory therapists, nutritionists, social workers and pharmacologists. A state-of-the-art pulmonary function laboratory has capabilities for airflow measurements, including methacholine challenge studies to detect hyperirritable airway disorders. State-of-the-art skin testing for common pollen allergens, animal dander, dust mites, common molds and common foods is available. Testing by the RAST method for hypersensitivity pulmonary disease, including allergic bronchopulmonary aspergillus, is also offered. In addition, skin testing for hymenoptera hypersensitivity (bee venom) and penicillin allergy is also available. If warranted, immunotherapy (desensitization) can be initiated for selected patients. The Medical Director of the Asthma and Allergy Center is Richard G. Barbers, M.D.
• Cough Disorders Center
  The USC Cough Disorders Center is a comprehensive clinical program providing state-of-the-art modalities for the diagnosis and management of patients with unexplained and/or persistent cough, which is a common respiratory symptom affecting tens of millions of people in this country. Cough can be a symptom of asthma, bronchitis, chronic aspiration, lung cancer and other conditions. The USC Cough Disorders Center (CDC) is staffed by certified physician specialists in pulmonary and allergic disorders who are part of the full-time teaching faculty at USC. The latest diagnostic technological tools are available at the CDC, including bronchoprovocation testing, gastrointestinal pH monitoring, and upper and lower airway and esophageal endoscopic procedures, as well as comprehensive state-of-the-art radiologic procedures. The CDC focuses on the unique needs of each patient in order to assure that daily life and function are minimally limited by symptoms or by the underlying disorder that is responsible for the symptoms. The Medical Director of the Cough Disorders Center is Richard G. Barbers, M.D.

• Sleep Center
  The USC Sleep Disorders Program offers comprehensive outpatient and inpatient sleep disorders evaluation. Individuals with sleep irregularities manifested by symptoms or signs such as excessive daytime sleepiness, excessive snoring, witnessed apneas, morning headaches, insomnia and abnormal nocturnal movements or behaviors would benefit from a comprehensive sleep evaluation. The sleep disorders evaluation begins with a thorough history and physical examination, and if indicated, preparations are made for a formal sleep study. The program offers Attended Standard Sleep Studies, CPAP Titration Sleep Studies, and Multiple Sleep Latency Studies, all performed with state-of-the-art equipment. The Medical Director of the Sleep Center is Ricardo Juarez, M.D.
• Pulmonary Exercise Center
  The USC Pulmonary Exercise Program provides outpatient and inpatient exercise evaluations. The exercise studies are performed with state-of-the-art exercise equipment and experienced exercise technologists. Individuals with suspected functional impairment during any type or grade of exercise would benefit from an exercise evaluation to identify the physiologic causes for the impairment. The information obtained from the study can be used to tailor specific exercise regiments and therapeutic strategies. The program offers Standard Pulmonary Stress Tests, Oxygen Denaturation Exercise Studies, Exercise-Induced Bronchospasm Studies and Metabolic Studies. The Medical Director is Ricardo Juarez, M.D.
• High Altitude Evaluation Test Center
  The USC University Hospital High Altitude Simulation Test (HAST) is a specialized type of oxygenation study. This study is performed on individuals who have marginal oxygenation and are considering excursions into high altitudes, including flying in an airplane. The study objective is to determine the quantity of supplemental oxygen that is required for a safe trip at various altitudes. The study is performed at rest and with gradients of activity. The Medical Director is Ricardo Juarez, M.D.
• Pulmonary Rehabilitation Program
  Nearly all patients with chronic pulmonary disease benefit from participation in a pulmonary rehabilitation program. The USC Pulmonary Rehabilitation Program offers a wide range of services, from single sessions focused upon a specific need (such as training the asthmatic patient in the use of metered dose inhalers), to a comprehensive two afternoon per week program for a total of six weeks. The comprehensive program includes exercise training, patient education in a broad range of subjects (from the pathophysiology of disease to therapy), psychosocial support services, physical therapy, vocational therapy, symptom control techniques and the use of low flow oxygen. In addition, there are specialized programs targeted at patients with particular problems, such as emphysema and pulmonary fibrosis. The Program Medical Director is Ahmet Baydur, M.D.
• Smoking Cessation Consultation Service
  The Division of Pulmonary and Critical Care Medicine at USC is interested in promoting lung health. As tobacco-related lung diseases comprise a significant portion of the pulmonary disorders we see, smoking cessation is paramount in improving overall lung health. Smoking cessation can be achieved through health education, sometimes with medical intervention. Assessment for smoking cessation includes a thorough history and physical examination, personal counseling, appropriate medical intervention (e.g., transdermal nicotine patches) and follow-up. Other interventions (e.g., acupuncture) can be arranged when indicated. Patients appropriate for referral include all adult users of tobacco products, with emphasis on patients with cardiopulmonary and vascular disorders, and especially those smokers anticipating elective surgeries. The physician in charge of assisting patients in smoking cessation is Richard Lubman, M.D.