Applied Pulmonary Physiology Research
The André Cournand Pulmonary Physiology Research Laboratory is the center for applied physiology research in NYU Langone’s Division of Pulmonary, Critical Care, and Sleep Medicine.
Kenneth I. Berger, MD, Beno W. Oppenheimer, MD, and Roberta M. Goldring, MD, are the laboratory’s principal investigators. Research interests include small airway disease, obesity and cardiorespiratory consequences, and early detection of lung rejection post-transplant. The laboratory has trained many of the leaders of the newly developed field of cardiopulmonary medicine. Learn more about our laboratory’s history within the division.
Small Airway Disease Syndromes
A major focus of the laboratory research program is evaluation of small airway function in symptomatic patients. Although airway disease originates in the small airways, the physiologic changes resulting from small airway pathology may not be detected by standard lung function measurements. Studies of lung compliance in patients with asthma and occupational asthma demonstrate dysfunction of small airways even when standard lung function measurements are normal. This observation led to the hypothesis that subjects with respiratory symptoms have functional abnormalities in their small airways even if spirometric results are normal.
To investigate this hypothesis, multidisciplinary studies are under way to evaluate small airway function in patients at risk for obstructive lung disease, including smokers, patients with asthma (including those with occupational or environmental asthma), and individuals who were exposed to World Trade Center dust. Researchers study the links between persistent symptoms, small airway dysfunction, and in vivo inflammation and evaluate patients’ response to therapeutic interventions.
Cardiorespiratory Consequences of Obesity
Scientists are studying the impact of the central circulatory congestion of obesity on hemodynamic parameters and respiratory function at rest and during an exercise challenge.
Research methods involve assessment of the distal lung unit (airways and alveoli), pulmonary capillary blood volume, and cardiac function (noninvasive cardiac output and arterial–venous oxygen content difference). Recent studies are focused on distinguishing the contribution of a variety of factors in producing respiratory symptoms and functional abnormalities in obese subjects including mass loading due to excess body weight, central circulatory congestion, intrinsic airway disease and metabolic syndrome.
Early Detection of Lung Rejection Post-Transplant
This program uses an interdisciplinary approach to early detection of small airway abnormalities after lung transplant. Small airway function is assessed in the physiology laboratory using innovative techniques, including forced oscillation, inert gas washout, alveolar membrane diffusion, and cardiopulmonary exercise testing.
Collaboration with the radiology utilizing functional MRI is used to confirm distal lung heterogeneity as an early marker of both presence and location of small airway disease. Given that our patient population undergoes routine pre- and post-transplant surveillance, serum and bronchoalveolar lavage biomarkers are also being assessed. The overarching goal is to observe changes in airway function and their clinical correlates longitudinally, along with identifying potential therapeutic targets and reducing post-transplant morbidity and mortality.
Bohart I … Berger KI. Metabolic syndrome is associated with distal airway dysfunction and respiratory symptoms in obese subjects. Am J Respir Crit Care Med. 2020;201:A6378.
Berger KI. Small airway disease syndromes: Piercing the quiet zone. Ann Am Thorac Soc. 2018. DOI.
Berger KI … Segal LN. Distal airway dysfunction identifies pulmonary inflammation in asymptomatic smokers. ERJ Open Res. 2016. DOI.
Oppenheimer BW … Goldring RM. Pulmonary vascular congestion: A mechanism for distal lung unit dysfunction in obesity. PLoS One. 2016. DOI.
Berger KI, Goldring RM, and Oppenheimer BW. POINT: Should oscillometry be used to screen for airway disease? Yes. Chest. 2015. DOI.