Improving Respiratory Care Where Most Needed

Eric McCollum’s first job after his pediatrics residency was with the Baylor Pediatric AIDS Corps, where he spent time at a government hospital in Malawi helping to initiate antiretroviral therapy for HIV-infected children. But over the course of that four-year stint he became aware of an equally pressing problem: respiratory illnesses.

“Pneumonia alone is the leading infectious cause of death in children under 5 globally,” he says. “Depending on where you look, up to one million children a year die from pneumonia, and 85-90% of them live either in Sub-Saharan Africa or in South Asia.”

Children living in these areas are vulnerable to respiratory illnesses for several reasons. Malnutrition is a concern and contributes to immunosuppression, so children have less ability to fight infection. In addition, McCollum says, “There’s a lack of resources and trained health care personnel, and not a lot of investment into supportive care such as oxygen. When kids come into the hospital and need more than antibiotics, often they’re not going to do well.” Compounding the situation, nurse-to-patient ratios at hospitals in Malawi can be as high as 1:40, so it’s more difficult for them to monitor patients.

Now McCollum, who joined the Johns Hopkins faculty in 2015 after completing a pediatric pulmonary medicine fellowship there, spends his time trying to improve respiratory care for children in the nations where children are at the highest risk of pneumonia deaths. As a pediatric pulmonologist, he also sees patients at Johns Hopkins Children’s Center several weeks each year.

Through one project in Nigeria, Africa’s most populated nation, McCollum and international colleagues are performing a comprehensive study of pneumonia care. This includes providing pulse oximeters — medical devices that measure oxygen levels in the blood — and related training to about 30 primary care clinics. The goal is that providers can test children coming in with possible signs of pneumonia for hypoxemia (low oxygen in the blood), one of the most important markers for severe pneumonia, and quickly triage them to a hospital for oxygen treatment.

A series of papers on the research, cofunded by pharmaceutical Glaxo SmithKline and the international nonprofit Save the Children, was published in January in Pediatric Pulmonology. Key findings discovered by the group include an urgent need to train and mentor health care providers and provide community health education for caregivers.

Based in Lesotho, Africa, with his family, McCollum also has overseen projects in Bangladesh examining pulse oximetry in children with pneumonia and studying the effectiveness of the pneumococcal vaccine, and in Malawi investigating bubble continuous positive airway pressure in children hospitalized with severe clinical pneumonia.

“I’m following a passion, so I’m grateful for that,” he says. “Although the research projects don’t go on forever, they leave behind improved capacity to manage children with respiratory illnesses.”

McCollum also was part of an international team studying the effects of high altitude on respiratory rate and oxygen saturation in healthy children 0-23 months in India, Guatemala, Rwanda and Peru. Results, published in March in The Lancet, Global Health, suggested that higher altitudes can impact these values to the point that physicians who use the World Health Organization definitions for fast breathing could potentially misdiagnose pneumonia in children.

McCollum is preparing a webinar on childhood pneumonia in low-income and middle-income countries for the International Union Against Tuberculosis and Lung Disease to broadcast this summer. Additionally, he promotes his efforts through teaching. Two years ago, he started the Global Program in Pediatric Respiratory Sciences at Johns Hopkins, which brings residents to low-income and middle-income countries to help care for children and train health care providers. The program has hosted three pediatric residents from Johns Hopkins in Malawi, two of whom are now working in the hospital where McCollum started.