At a Glance
Name: Catherine Bonham, MD
Title: Assistant Professor
Fellowship: Pulmonary and Critical Care, University of Chicago
Residency: Internal Medicine and Pediatrics, University of Michigan
Medical Degree: University of Michigan
There are more than 200 individual conditions that are classified as interstitial lung diseases (ILDs). Many are extremely rare and some are very unique in terms of their treatment and prognosis. That’s why subspecialty expertise is critical to ensure proper diagnosis and management of these diseases.
The UVA Interstitial Lung Disease Program has expanded since its launch in 2011 to include a dedicated nurse, research coordinator and five physicians, including the most recent addition to the team, Scientific Director Catherine Bonham, MD.
In the Q&A below, she shares more about her background, as well as her clinical and research focus.
Tell us about your early medical training and why you chose to specialize in pulmonology and critical care medicine.
I did a combined residency in internal medicine and pediatrics, so I became board certified in both. After finishing my dual residency and before starting a fellowship, I worked as a hospitalist for one year at University of Michigan. It was a gap year, really, but I managed to complete an interesting project on severe sepsis during this time that was relevant to my later training as a critical care doctor. I showed that physicians who care for patients with sepsis have a wide variety of training and backgrounds, so when we focus on patients with sepsis we need to train all doctors and not just critical care providers.
I attended University of Chicago for my pulmonary and critical care training. I chose this specialty because I enjoy caring for patients with chronic pulmonary disease; I think the quality of life of these patients can be impacted significantly with great care. From the academic research point of view, I found that a lot of these advanced pulmonary diseases are under-researched and not as well understood, so I saw that as an opportunity for me to make an impact as a physician in those fields.
Also, I’m really interested in the lung’s immune system. I found that the lungs, although we think of them as just an organ that allows you to breathe, actually have a complex immune system that has to handle all of the environmental challenges and exposure to air pollution, bacteria and viruses. I became interested in studying that further because at the University of Chicago I saw a lot of people impacted by immune-mediated or autoimmune disease of the lungs, which resulted in problems like pulmonary fibrosis and sarcoidosis.
What is your clinical focus?
I lead the sarcoidosis clinic, so around 75% of what I do is sarcoidosis-focused. This is an interesting disease because it not only affects the lungs, but can be multi-systemic. It can affect all different organs in the body, so it certainly keeps me on my toes. I can’t just focus on lungs. I have to consider the whole person and also work with multiple other providers trained in other specialties.
What are some of the challenges of caring for patients with interstitial lung diseases like sarcoidosis?
One of the greatest challenges is the delay in diagnosis. Patients may have been through the medical system in the past, but are misdiagnosed or not diagnosed at all. A lot of patients will have a cough or shortness of breath that is attributed to other things like heart failure. So one of the challenges is being a detective and sorting out symptoms, imaging and lab results to figure out what is really causing the disease. Then we can design a treatment plan that is more personalized.
The advanced lung diseases I see are relatively rare compared to other lung diseases like COPD or asthma. A pulmonary specialist in the community might only see one or two patients like this so it’s difficult for them to develop expertise in that area. This is where I fit in. Because I am able to see a larger number of these patients, I’ve developed that expertise.
How would you describe your role as scientific director of the ILD Program?
When I’m not in clinic, I’m doing research. That takes up a lot of my time — about 75% officially, although when you have patients every day, working with them takes up more like 300% of your time.
But specifically, I am coordinating some of our research efforts around ILD, which includes streamlining our research efforts between clinical trials and the laboratory bench work that we do. For example, others in our division do pulmonary fibrosis research in genetics and genomics. We’re also doing research in lung transplant. So being scientific director means I am really tasked with pulling together all different arms of research so we have a focused approach to ILD research and care.
On the research side, we started a multidisciplinary lab meeting within the last year that was piloted by one of my co-faculty. It’s an informal setting in which everyone interested in this type of research — both MD-trained and PhD-trained researchers — can get together and discuss recent projects so that we are being as collaborative as possible. This has been a very successful effort. We get immunologists, people from transplant, thoracic surgery and others who attend. It’s a nice forum to get together to share ideas we otherwise may not have thought of because we’re working in different divisions. I think all of us really come away with new ideas and new collaborators, which is nice.
I am also responsible for making sure we are staying abreast of research in the field, so that means doing things like staying in touch and maintaining our status as centers of excellence for the Pulmonary Fibrosis Foundation and Foundation for Sarcoidosis Research.
What research are you most excited about currently?
I’m excited about understanding the role of immune memory in lungs. We often study that which we can sample, so blood for example. But in lungs, you have immune cells that are tissue resident so they live in the lungs. They don’t go into the blood circulation. They develop their own memory of the virus or bacteria that they’ve encountered before and this allows them to respond to future challenges more effectively and quickly.
Some of the research I’ve been doing shows that in patients who have advanced lung disease with lung fibrosis, immune memory is altered. This may be contributing to some of the pathologies behind the disease. One of the ways we understand that is by assessing actual lung tissue samples from patients who have had lung transplants.
Right now, I’m starting a new study with Dr. [Alexander] Sasha Krupnick, a transplant surgeon. I started some of this work at University of Chicago, so we will pair what we learned from those studies with new studies at UVA and we will have a more powerful understanding of how immune function in the lungs affects patients who develop advanced lung diseases like IPF [idiopathic pulmonary fibrosis], ILD and sarcoidosis.
What would you like referring providers to know about the patients you see and the care you provide?
I’m happy to see any patients with sarcoidosis. This is a challenging condition, particularly when patients develop pulmonary hypertension, pulmonary fibrosis or when patients have been refractory to usual treatment. We are a center of excellence for sarcoidosis. We enroll in registries as well as research from my lab, so we have increased opportunities for patients that they may not otherwise have access to.
For sarcoidosis, we offer more advanced treatment options, including infusion therapies and bronchoscopy. We focus on patients with rare complications like airway-based disease or bronchial disease. Of course, for patients with very advanced disease we can handle transplant referral as needed. We also have a pulmonary hypertension center, so we can refer patients who might require PH-specific therapy to PH providers.
We’re making strides in also involving complementary specialties like rheumatology, cardiology, even dermatology and neurology in certain lung diseases where other organs are affected. We have an initiative to reach out to patients as well. We’re coordinating a patient education day in October and we’ll be offering a patient support group every other month. We’re really trying to expand resources for patients, not only increasing clinical capabilities but also doing patient support and education.
To refer a patient to the ILD Program at UVA, call UVA Physician Direct at 800.552.3723.