The designation from the condition’s oldest patient organization is awarded to programs with the infrastructure and experience needed to provide high-quality care to people with pulmonary hypertension, a type of high blood pressure that occurs in arteries of the lungs.

Pulmonary hypertension can make it difficult for blood to circulate through the lungs, forcing the heart to work harder. In severe cases, the condition can lead to heart failure. People with pulmonary hypertension often need care from several specialists.

The Cedars-Sinai Pulmonary Hypertension Clinic includes six physicians and one nurse practitioner. The pulmonary hypertension program combines cardiology and pulmonology, which allows patients to access multidisciplinary care from experts in the disease. Providers care for more than 250 patients each year and address multiple aspects of the disease, including diagnosis, medication management, symptom control and disease progression.

“At Cedars-Sinai, pulmonary hypertension specialists collaborate with colleagues in rheumatology, congenital heart disease, critical care medicine, lung transplantation and other specialties to create treatment plans tailored to patients,” said Yuri Matusov, MD, assistant professor of Medicine at Cedars-Sinai. “We are proud to care for an extraordinarily diverse patient population, some of whom come from very far away for their care.”

The association noted several outstanding aspects of the Cedars-Sinai Pulmonary Hypertension Clinic including:

• A team that collaborates and provides timely evaluation and management of people who are hospitalized and continues to provide consistent care when they leave the hospital.
• Monthly conferences with specialists in the Southern California region that allow for the review of complex pulmonary hypertension cases, knowledge-sharing and regional care coordination.
• For people with advanced disease, access to top-notch heart, lung and thoracic transplant programs.
• A research program led by doctors investigating potential treatments.

“We are honored for our clinic to have received this designation, the highest recognition available to pulmonary hypertension programs in the United States,” said Dael Geft, MD, assistant professor of Cardiology in the Smidt Heart Institute at Cedars-Sinai. “Ultimately, the greatest reward is helping our patients live longer, healthier and more fulfilling lives.”

Read more on the Cedars-Sinai Newsroom: Unique Cell-Based Approach for Pulmonary Arterial Hypertension Shown to Be Safe

“Early on, I worked with a lot of patients with underlying illnesses such as asthma and chronic obstructive pulmonary disease [COPD] who experienced significant worsening of their symptoms due to wildfire smoke,” said pulmonologist Samuel Cohen, MD.

“Thankfully, most of those patients have improved now that the major trigger has subsided, and they’re back to a more baseline maintenance.”

Stephanie Koven, MD, a Cedars-Sinai primary care physician in Santa Monica, also treated many patients affected by the Palisades fire.

“Not only were we seeing flare-ups of asthma and emphysema for those in affected areas, but a significant increase in anxiety and depression,” Koven said. “I had patients in their 70s and 80s who were retired, and the home they were planning to live in for the rest of their lives was just gone.”

In addition to those retirees, Koven has cared for several members of the L.A. Fire Department who were on the front lines battling the blazes across Southern California.

“With firefighters, we’re most concerned about ongoing exposures over years,” Koven said. “Because of this, we’re more proactive with testing for things like heavy metals and PFAs, often called ‘forever chemicals.’ Firefighters also typically will receive earlier cancer screenings.”

While the general air quality has improved, Cohen said it’s possible that construction in the affected areas could rustle up particulate matter that may have previously settled in the soil.

“It’s especially important for workers in these areas to be sure they have appropriate respirators for protection,” Cohen said.

Koven agreed, adding that while residents who have moved back amid these construction zones may not need to wear masks in their own homes, they can still take other precautions.

“Using a HEPA filter in the home to help pull particulate matter from the air can be helpful,” Koven said. “If you’ve been to a burn site and are returning home, a general recommendation is to take off your shoes so you’re not tracking anything inside. You also could consider changing your outer layer of clothes when entering your home.”

Cohen also noted that some new smart thermostats can track air quality inside your home and will even set reminders for when to change your filters.

And if patients want to increase their overall respiratory health to combat any potential negative impact of returning to an affected area, Cohen says frequent cardiovascular exercise is key.

Both experts say it’s difficult to know yet what, if any, lingering health issues the public may experience because of the initial wildfire smoke exposure or rebuilding in and returning to burn areas.

“If you’re someone who will be moving back to these areas, it’s just important to make sure you’re in tune with how you’re feeling,” Cohen said. “If you begin to experience new-onset symptoms such as shortness of breath or a lingering cough, it’s time to speak to a medical professional.”

Read more on the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

“I noticed it most when I lay down to sleep,” said Scott, whose family has lived in Altadena for three generations. “I could hear wheezing, I could hear a lot of wheezing, which I had never experienced before.”

Scott is not the only one. Since the wildfires ravaged the area, residents have been seeking help for symptoms that indicate difficulty breathing, such as coughing, wheezing, chest tightness and fatigue.

“We know that heavy exposure to wildfire smoke can have a delayed and long-term impact on lung function,” said Talar Kavafyan, MD, medical director of the ambulatory care center at Huntington Health, an affiliate of Cedars-Sinai. “Following the devastating fires our community experienced in January, providing enhanced pulmonary care is an important step in recovery—and an important example of how Huntington is dedicated to improving community wellbeing.”

So dedicated that, in response to the potential health impact in the wake of the fires, Huntington Health recently expanded pulmonary medicine for the community at the Huntington Ambulatory Care Center (HACC).  

The expansion came just in time for Scott, who continued to have difficulty breathing months after the flames were extinguished. “I began to talk to my primary physician about it,” Scott said, “and I kept telling her I don't feel like I'm getting a good capacity of air.”

That is a symptom that Raj Dasgupta, MD, has heard from dozens of patients who lived through the wildfires.

“It's understandable to be concerned when someone is having difficulty breathing [dyspnea], which is the sensation of not being able to get enough air, tightness in the chest, or working harder to breathe,” said Dasgupta, associate professor of Clinical Medicine and associate program director of Huntington Health’s Internal Medicine Residency Program. “By offering a wider range of tests in an outpatient setting, we can potentially detect pulmonary issues earlier and initiate treatment more quickly, which can lead to better outcomes and help bring some peace of mind to our patients who might be experiencing pulmonary issues right here in our community.”

Conditions frequently treated by the center’s physicians include asthma; chronic bronchitis and bronchiectasis; persistent cough; chronic obstructive pulmonary disease (COPD); lung scarring, or fibrosis; and sarcoidosis, an autoimmune disease that causes growths on the lungs.

“When you arrive at HACC, the first step of treatment is to collect information about your lungs and their function,” Dasgupta said. “We do this by conducting a breathing test in our office called spirometry, which is a valuable tool for diagnosing, monitoring and evaluating lung function. It provides essential information for managing lung conditions and improving respiratory health. After additional tests and evaluations, we then discuss the next steps to best support your lung health. Remember,  difficulty breathing and coughing can have various causes, and it's essential to seek medical evaluation for a proper diagnosis and treatment.” 

The pulmonary clinic is open every second and fourth Tuesday of the month from 1–5 p.m. For an appointment, call (626) 397-5711.

Read more from the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s.

“Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU,” Cardello said. “We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa.”

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

“I would honestly say Safaa had the smallest windpipe I’ve ever seen,” said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s and one of Safaa’s consistent care providers.

To bypass her narrow airway, Safaa’s doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedars-Sinai Guerin Children’s NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa’s Airway

“When I first met Safaa, her airway opening was only a couple of millimeters wide,” said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children’s. “And even though she was growing, her windpipe needed help to expand.”

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa’s family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

“Every few months, we would look at Safaa’s airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway,” Liu said.

In March 2024, shortly after Safaa’s 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa’s Cedars-Sinai care team became quite close.

“Safaa got to know us really well and I think that helped when she would come in for her balloon dilation,” Dralyuk said. “I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She’s a tough cookie. She and her parents have done an amazing job.”

Dralyuk said she especially loves to hear Safaa say her name. “Early on, we didn’t know what Safaa’s voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, ‘Hi Dr. Dralyuk,’ it is really special.”

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

“The advice Drs. Liu, Dralyuk and all of Safaa’s other doctors gave us always felt like it was something they would recommend for their own child,” Ahmadi Cardello said. “We didn’t feel alone.”

What’s Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

“I can’t wait to teach her how to swim,” Cardello said, “It’ll be fun to finally take her to the park and let her play in the sand. We haven’t been able to do that until now.”

Ahmadi Cardello is relieved. “Now that Safaa’s tracheostomy has been removed, I feel like we can all breathe a little easier,” she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

And for approximately 4.2 million children coping with asthma or other respiratory conditions, seasonal weather changes can pose severe, persistent, and potentially life-threatening risks. According to the National Institutes of Health, asthma is the most prevalent chronic childhood disease.

Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children's, emphasizes the importance of controlling asthma in children through all seasons, as poorly managed cases can lead to serious complications.

“Every asthmatic will have their own sets of triggers,” said Dralyuk. “For some kids, it could be changes in the weather, allergies or dust, while others may be more sensitive to viral episodes like respiratory syncytial virus (RSV) or influenza that can lead to an exacerbation of their asthma.”

Ahead of the American Academy of Pediatrics 2023 national conference Oct. 20-24 in Washington, D.C., Dralyuk spoke with the Cedars-Sinai Newsroom about pediatric asthma and offers guidance on treatment options.

What is asthma?

Asthma is a chronic condition affecting individuals of all ages, characterized by a recurring pattern of respiratory symptoms. These symptoms can vary in frequency, severity, and duration, and they differ from one patient to another. At its core, asthma involves heightened airway sensitivity to specific triggers, leading to a pronounced response known as bronchospasm. This heightened response can manifest as symptoms like coughing, wheezing, and shortness of breath, albeit in unique combinations for everyone.

What are the signs of asthma in children?

You may observe a child who coughs in specific situations, experiences wheezing, or develops shortness of breath. These situations can include weather changes; cold temperatures; vigorous physical activity; exposure to dust, strong odors, certain animals; excitement; or emotional responses. Suddenly, you may notice the onset of respiratory issues in such scenarios.

What treatment options are best for children with asthma?

Treatment options for asthma vary based on the condition's severity and insurance coverage. There are several approaches available, with two primary categories: rescue medications and controller medications. These represent the initial steps in managing asthma.

In cases of acute symptoms, where there's bronchoconstriction or airway tightening, we turn to a class of drugs known as bronchodilators. One well-known medication in this category is albuterol. It acts swiftly, providing rapid relief during asthma attacks or acute symptoms. Albuterol's effects are short-lived, but it effectively opens up the airways by targeting the smooth muscles.

During emergency room visits, albuterol is often administered to children, either through a nebulizer or an inhaler.

For individuals with exercise-induced bronchospasm, bronchodilators like albuterol can be beneficial before physical activity. However, as a more comprehensive management approach, inhaled corticosteroids play a vital role. They serve as the cornerstone of asthma treatment for individuals with mild, moderate, or severe asthma.

Can my child play sports, exercise or participate in recess if they have asthma?

I want to emphasize that asthma should not deter individuals from engaging in physical activity; however, it's crucial that they exercise comfortably and safely. If they experience breathing difficulties during physical activities, they should stop immediately.

It's essential for schools to be aware of students' asthma conditions. Physicians can provide documentation for this purpose, ensuring that the school is informed. If a young student cannot self-administer medication, school staff should be trained in its proper use.

It's vital that schools avoid pushing asthmatic students through their symptoms. There's a misconception that they should "push harder," but for asthmatics, it's essential to stop, catch their breath, take their prescribed medication, and restore their breathing capacity before resuming physical activities.

Our goal is for students to be active and participate in sports once their asthma is well-controlled.

For students with symptoms during physical activities, we advise taking albuterol 15 minutes before the activity, with teachers and coaches aware of this plan. If symptoms persist during practice, students should know they can take a second dose as needed.

How can parents support children with asthma at home?

There are several steps you can take at home to manage your child's asthma effectively. A knowledgeable healthcare provider, whether a general pediatrician or a pulmonologist, can assist parents in this endeavor to minimize the need for emergency room visits and prevent severe asthma episodes. The primary goal is to maintain optimal asthma control.

First and foremost, ensure that your child is following the appropriate maintenance medication regimen. This step is crucial, especially for children with severe, persistent asthma. Even with meticulous efforts to manage environmental factors at home, it can be nearly impossible without the right medication.

Some factors, like weather changes and the risk of catching viral colds, cannot be entirely controlled. While good hygiene practices can help reduce the risk, children may still contract colds when attending school. Pollution levels, another uncontrollable factor, can also impact asthma symptoms, especially in places like Los Angeles, which presents unique challenges for asthma management.

While certain factors are beyond our control, it's essential to emphasize the importance of being on the correct controller medication to maintain baseline inflammation control, tailored to the child's asthma severity level.

Understanding your child’s asthma triggers is crucial for providing specific assistance.

For example, while weather may not affect one child, dust could be a significant trigger. Therefore, it's essential to adopt a precise approach to household dusting, such as starting with wet dusting before proceeding with dry dusting. Additionally, regularly replacing air filters and monitoring whether activities like using the air conditioner or heating system worsen the child's symptoms are important. It's also necessary to consider the impact of pets in the home—does the child have allergies to specific types of pets, and how severe are these allergies? If the allergies are moderate and manageable, there may still be viable options.

When to seek emergency care?

If a child is breathing rapidly with deep, gasping breaths or exhibiting shallow breathing, and if they're unable to speak in full sentences, these are all concerning signs that warrant immediate attention. I strongly advise against disregarding these symptoms; it's crucial to consider them as indicators for seeking emergency medical care. Additionally, while wheezing can be a common asthma symptom, it's important to recognize that it's not the only factor to monitor. If you observe a combination of frequent wheezing, persistent coughing, and the child struggling to catch their breath, these signs can collectively signal a serious situation. Waiting until the child appears extremely fatigued is a risky delay; instead, it's advisable to call 911 promptly.

Read more on the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

Their findings, published in The Journal of Clinical Investigation, have the potential to change the landscape of treatment for patients with this disease, which most often affects those over age 50.

“This study has the potential to be a game changer,” said Paul Noble, MD, chair of the Department of Medicine, director of the Women’s Guild Lung Institute and co-senior author of the study. “We identified a root cause of IPF-related lung damage and a potential therapeutic target that might restore the lungs’ ability to heal themselves.”

Idiopathic pulmonary fibrosis, or IPF, affects 100,000 people in the U.S. and has no known cause. The condition, which leads to scarring of the lungs, called fibrosis, and progressive breathing difficulty, has no cure, and most patients die or require a lung transplant within three to five years of diagnosis. The incidence of IPF rises dramatically with age and affects men more often than women.

Through this research, Cedars-Sinai investigators found that stem cells lining the air sacs in the lungs of patients with IPF lose their ability to process zinc, which is known to have a role in the growth of cells and healing damaged tissue.

Lack of zinc impairs the ability of the cells—called type 2 alveolar epithelial cells (AEC2s)—to regenerate. Restoring this ability via the molecular pathway the investigators traced in their experiments could lead to therapies that reverse IPF-related lung damage. The research team also generated a model of IPF in laboratory mice that can be used to develop new therapies. 

Investigators first analyzed AEC2s from healthy lungs and also the lungs of patients with IPF. They discovered the cells from IPF lungs were missing a protein called zinc transporter 8 (ZIP8), which draws zinc into the cell.

In experiments with organoids—miniaturized, simplified versions of organs grown in a dish from patients’ tissues—they also observed that cells lacking the ZIP8 protein were unable to regenerate and form colonies as healthy cells should.

“The organoids with AEC2 cells that had the ZIP8 transporter were able to draw zinc into the cells, and then were able to regenerate and form more colonies,” said Carol Liang, MD, MBA, associate professor of Medicine and first author of the study. “The cells without ZIP8 didn’t have a way to draw zinc in, so they formed fewer colonies. This is how we determined that it is ZIP8 that allows the cells to use zinc.”

The investigators also used medication and deletion of the ZIP8 gene in mouse AEC2s to mimic IPF in laboratory mice. When they fed these mice a diet that included zinc supplements, their fibrosis improved.

“There have been few detailed studies of how zinc works in the lungs,” said Dianhua Jiang, MD, PhD, professor of Medicine at Cedars-Sinai and co-senior author of the study. “Ours is the first to identify the detailed function of zinc in lung biology, specifically in IPF. It was particularly exciting to discover that zinc regulates the production of two other key molecules that promote tissue regeneration, nicotinamide adenine dinucleotide (NAD+) and Sirtuin1. These molecules have been implicated in tissue regeneration and aging.”

Additional research is needed to help determine why the loss of ZIP8 occurs in the lung cells, and whether zinc supplements, alone or in combination with NAD+ and Sirtuin1 activators to help activate lung repair response, will reverse lung damage in human patients with this condition, Liang said, adding that answers to these questions could help thousands of patients. The goal is to develop a clinical trial to determine if targeting the ZIP8/NAD+/Sirtuin1 pathway can improve lung function in IPF.

“The cause of IPF is unknown, but aging is a significant factor,” Liang said. “The general population is aging, and the incidence of the disease is increasing. We need to find a cure, because we have more patients every year.”

Funding: This work was supported by National Institutes of Health grant numbers R35-HL150829, R01-HL060539, R01-AI052201, R01-HL077291, R01-HL122068, and P01-HL108793; and European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement 797209.

Read more on the Cedars-Sinai Blog: Cedars-Sinai’s First Minimally Invasive Double Lung Transplant