Defining and Promoting Pediatric Pulmonary Health (DAP3H)

March 29 - 30 , 2021
Virtual Workshop


DAP3H.2021 explored the current state of science and future research directions in the definition, standardization, and optimization of metrics and evaluation of pediatric pulmonary and sleep health. The ultimate goal is to enhance respiratory and sleep evaluation in children by pulmonologists, primary care providers, and community pediatricians.


Lung health refers to physical, social and behavioral respiratory well-being, not only the absence of pulmonary disease. This multidisciplinary workshop was conceived by the Division of Lung Diseases, NHLBI, NIH, building upon a previous workshop held in 2012 that had identified the need for better definitions of lung health to facilitate recognition of early warning signs of disease with the goal of enhancing preemption and prevention.

The current workshop, Defining and Promoting Pediatric Pulmonary Health (DAP3H) was organized on March 29 and 30, 2021 to address the following perceived needs.

  • At each stage of life, definitions of ‘ranges of normal lung and sleep health’ are unknown and unexplored.
  • There is a need to test and validate newer metrics of respiratory structure and function and sleep at different ages in the pediatric population.

The goals of the workshop were to elucidate what constitutes pulmonary and sleep health in childhood, identify existing and novel metrics and measures, and describe the challenges and opportunities in widespread implementation and adherence to assessments of pediatric pulmonary health in the community.

The workshop brought together 29 panelists—community pediatricians, pediatric pulmonologists, researchers and experts in patient and family perspectives—to identify gaps and opportunities in defining and promoting pediatric pulmonary and sleep health. In keeping with the need highlighted by the recent COVID-19 pandemic, emphasis was placed on the perspective of underserved communities, inclusion of early stage investigators in the field, and exploration of cross-disciplinary partnerships. The workshop was held as a virtual meeting over two days, and invitees included suggested experts from the Workshop Planning Committee, federal participants and patients and families.

Participants identified the following potential research opportunities.

  1. Build longitudinal cohorts (birth cohorts, interventional cohorts and high risk cohorts) with collection of nested information including radiology, lung function tests, biobanking, and environmental data to:
    • Follow lung function and sleep during infancy, childhood and adolescence (0-21 years)
    • Assess environmental, genetic and metabolic influences on lung structural growth and functional development, and optimal sleep health
    • Better understand normal and aberrant trajectories of development of pulmonary and sleep health
  2. Foster implementation science in the use of:
    • Existing biomarkers in early detection of lung disease
    • Appropriate and timely genetic testing for detecting pulmonary diseases
    • Currently available and validated techniques of pulmonary function testing in primary care settings
    • Screening (questionnaires and metrics) for pediatric pulmonary and sleep health
    • Methods to identify and surmount barriers to employment of the above methods in community pediatric settings, rural and underserved areas
  3. Foster exploratory and innovative research in
    • Development of novel pulmonary and sleep metrics and non-invasive biomarkers that are applicable to younger children and feasible in community and general pediatric practice, pulmonary and sleep specialties
    • Incorporation of patient and parent reported outcomes, electronic health records, school health, research in the home, machine learning, common data elements, big data and mobile/wearable technologies in assessment of primary pulmonary and sleep health
  4. Build cross-disciplinary collaboration and training in
    • Establishment of community-specialty clinical partnerships to enhance early diagnosis by, for example, defining phenotypic information that would warrant genetic testing
    • Establishment of academic institution-practitioner research partnerships, parent and family partnerships with researchers and educator-research partnerships in the school setting that collaborate in pre-award applications, study design, data acquisition, data management and analysis and publication of results
    • Building cross-disciplinary specialist collaboration in the science of sleep to better define optimal sleep health

A common theme was that these potential opportunities should be guided by principles of inclusion of under-represented populations, areas with less research funding and rural communities, with an emphasis on diversity in research teams.

In summary, the workshop participants highlighted the urgency and importance of a multi-disciplinary approach to pressing research questions in the definition of Pediatric Pulmonary and Sleep Health and the recognition of early warning signs of disease. Continued dialogue across specialties, academia and the community will help foster and maintain collaborative team-based research.

Workshop Planning Committee, NHLBI, NIH:
Aruna Natarajan, M.D., Ph.D., FAAP
Koyeli Banerjee, Ph.D.
Josh Fessel, M.D., Ph.D.
Marrah Lachowicz-Scroggins, Ph.D.
Aaron Laposky, Ph.D.
Rhonise Simpson, B.A.

Workshop Panelists

  • Stephanie Duggins Davis, MD - Workshop Chair
    The University of North Carolina at Chapel Hill, North Carolina Children’s Hospital
  • Jim Chmiel, M.D. - Workshop Chair
    Indiana University School of Medicine
  • Steve Allen, M.D., M.P.H., FAAP
  • Sandra Amaral, M.D.
    Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
  • Raouf Amin, M.D. - Session Chair
    University of Cincinnati
  • Leonard B. Bacharier, M.D
    Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center
  • Silvia Carraro, MD
    University of Padova
  • Cara L. Coleman, JD, MPH
    VCU School of Medicine INOVA campus
  • Katherine A. Connor, M.D., M.S.P.H.
    The Rales Health Center at KIPP Baltimore
  • Michael D. Davis, RRT, PhD, FAARC
    Indiana University School of Medicine
  • Emily M. DeBoer MD, MSc
    University of Colorado Anschutz Medical Campus
  • Jonathan Gaffin, M.D.
    Boston Children’s Hospital
  • Benjamin Gaston, MD - Session Chair
    Indiana University School of Medicine
  • Steve Holve, MD
    Tuba City Regional Health Care, Indian Health Service
  • James Kemp, M.D.
    Washington University School of Medicine
  • Lisa Meltzer, M.D.
    National Jewish Health
  • Paul Moore, M.D. - Session Chair
    Vanderbilt University Medical Center
  • Wayne J. Morgan, MD, CM - Session Chair
    University of Arizona
  • Lesliam Quirós-Alcalá, PhD, MSc
    Johns Hopkins University
  • Christian Rosas-Salazar, MD, MPH
    Vanderbilt University Medical Center
  • Margaret Rosenfeld, MD, MPH
    University of Washington
  • Susan Sirota, MD, FAAP
    Northwestern University Feinberg School of Medicine
  • Brandon Smith, MD
    Johns Hopkins University School of Medicine
  • Tyler Smith, M.D., M.P.H., FAAP
    University of Missouri
  • James Stout, M.D.
    University of Washington
  • Ignacio Tapia, MD, PhD - Session Chair
    Children’s Hospital of Philadelphia
  • Meghan Tschudy, M.D., M.P.H. - Session Chair
    Johns Hopkins University School of Medicine
  • Ariel Williamson, Ph.D
    Children’s Hospital of Philadelphia
  • Joe Zein, MD, PhD, MBA
    Lerner College of Medicine, Case Western University

Other Federal Participants

Neil Aggarwal, NHLBI
Karen Bienstock, NHLBI
Carol Blaisdell, OD, NIH
Marishka Brown, NHLBI
Ejigayehu Demissie, NHLB
Shilpy Dixit, NHLBI
Michell Freemer, NHLBI
Sonnie Kim, NIAID
Qing Lu, NHLBI
Emmanuel Mongodin, NHLBI
Robert Tamburro, NICHD
Michael Wolz, NHLBI