Expanding Care for Patients with Chronic Respiratory Failure is a Team Effort at University Hospitals Cleveland Medical Center

Innovations in Pulmonology, Critical Care & Sleep Medicine | Fall 2024

Many diseases, such as chronic respiratory failure (CRF), involve more than one system in the body. Historically, they have been treated by clinicians with specialty training in a single area, where ideally, patients with these types of multisystem diseases would be treated by a multidisciplinary team of specialists. University Hospitals (UH) Cleveland Medical Center is working toward this model of care.

Zachary Strumpf, MD

Chronic Respiratory Failure

In patients with CRF, the lung tissue itself, and/or the muscles that aid in respiration, have failed to the extent that the lungs do not effectively exchange oxygen and carbon dioxide, leading to abnormal blood gas levels despite the body’s attempts to compensate. This abnormal physiology tends to become more extreme and severe during sleep, and some patients may require supplemental oxygen or ventilatory support at night. Over time, patients may require oxygen or ventilatory support during the day.

The incidence of chronic respiratory failure is significant, although the exact size of this population is unknown. According to the Centers for Disease Control, chronic lower respiratory disease is the sixth-leading cause of death, responsible for about 44 deaths per thousand people annually. Within the UH system, hundreds to thousands of patients may be affected by CRF, says Zachary Strumpf, MD, a pulmonary, critical care and sleep medicine physician at UH Cleveland Medical Center.

CRF can be caused by primary lung pathology such as asthma, chronic obstructive pulmonary disease or pulmonary fibrosis. Patients with chronic lung disease are generally treated by pulmonologists.

Neurologists typically care for CRF patients with progressive neuromuscular disorders (ALS, muscular dystrophy or other congenital myopathies), and sleep medicine providers care for those with severe sleep apnea or other causes of sleep-related hypoxemia/hypoventilation. Potential underlying causes of CRF highlight the need for a multidisciplinary approach, Dr. Strumpf says.

Unfortunately, many who might benefit from ventilation support are unidentified and therefore not properly evaluated and managed. However, once identified, Dr. Strumpf says, UH has the resources to successfully care for these patients.

“There’s not a perfect dividing line between pulmonology, sleep medicine and neurology,” he says, “and some clinicians practice multiple specialties. However, CRF offers exciting opportunities for patient care and research using multidisciplinary collaboration. One of my focus areas at UH is to better identify who needs what treatment, and who will most likely benefit from therapy.”

Dr. Strumpf is collaborating with faculty in the Division of Pulmonary, Critical Care and Sleep Medicine, as well as Case Western Reserve University School of Engineering, to develop and validate novel diagnostic tools. The goal is to identify those patients hospitalized for any reason — who are at high risk for severe sleep-disordered breathing and respiratory failure — to enroll them in care pathways and ensure they see the right specialist and receive the appropriate ventilatory support.

“We are currently collaborating with our colleagues in the department of neurology to learn from their care of patients with respiratory failure due to neuromuscular disease,” he says. “That is not a population often seen in pulmonology. We’re joining them in their clinics so we can learn together, with the goal of eventually providing multidisciplinary clinics for complex patients who have both neurological and pulmonary needs. This is also an area ripe for scientific discovery at an academic setting like UH and an opportunity for us to participate in clinical trials and other innovative research endeavors.”

It Takes a Team

In partnership with the CWRU School of Medicine, there’s been a strong historical link between pulmonary and sleep medicine.

“We offer fellowship training in both subspecialties, and these individuals are contributing to clinical trials and publishing scientific articles,” he says. “Having these clinicians and researchers under the same roof on the same floor in the hospital fosters a collaborative environment that bridges the two specialties.”

To round out the team, the division of pulmonary and sleep medicine partners with experienced, highly qualified respiratory therapists with significant clinical and research experience in a wide array of devices and modes of invasive and noninvasive ventilation. These professionals work closely with providers to ensure success for patients.

Although close collaboration between pulmonary and sleep providers has historical precedence at UH Cleveland Medical Center, it is one of only a few centers in the country with this strong partnership.

Dr. Strumpf encourages physicians who are managing patients with CRF or other disease processes such as chronic lung disease, severe sleep apnea and neuromuscular disease and who are at risk for CRF, to schedule an evaluation by a University Hospitals specialist.

To refer a patient, or for more information, contact Dr. Strumpf at 216-844-3201.

Contributing Expert:
Zachary Strumpf, MD
Division of Pulmonary, Critical Care and Sleep Medicine
University Hospitals Cleveland Medical Center
Clinical Assistant Professor
Case Western Reserve University School of Medicine