The Division of Pulmonary & Critical Care Medicine leads through premier clinical care, research, and training by embracing growth, discovery, and innovation. Our mission is to provide exceptional clinical care and advance our field through research and the education of the next generation of leaders.
We’re redefining what comprehensive lung and critical care looks like. Building on a legacy of innovation, we are expanding programs that reach patients earlier, personalize therapies, and translate scientific breakthroughs into better outcomes. We are committed to improving health outcomes and enhancing the well-being of our patients and the community we serve.
A Legacy of Excellence
Founded on academic excellence and intellectual freedom, Washington University established its medical school traditions with the opening of Barnes Hospital in 1914. Pulmonary Medicine emerged as a focused academic discipline in 1919 under the leadership of pioneering surgeon Dr. Evarts A. Graham. The Jewish Hospital’s relocation in 1927 and its eventual merger with Barnes in 1996 further united efforts in pulmonary care and research.
The mid-20th century saw notable advancements, including Dr. J. Roger Nelson’s studies on airway resistance in the 1950s and early leadership transitions involving Dr. Kaye H. Kilburn and Dr. William Danforth. In 1967, Dr. John A. Pierce became Director of the Division of Pulmonary Medicine. Alongside Dr. Robert M. Senior at Jewish Hospital and faculty across Barnes, the VA, and City Hospitals, Pierce helped formalize a fellowship training program in 1970, emphasizing a tripartite model of education, clinical training, and research.
A close research collaboration among Drs. Pierce, Senior, and Charles Kuhn III began in 1969, focusing on alpha1-antitrypsin (AAT) deficiency and emphysema—an early cornerstone of the Division’s scientific output. With sustained support from the American Lung Association of Missouri and competitive NIH funding, including a Program Project Grant in 1973 and a training grant in 1977 (still active under current Dr. Michael J. Holtzman), the division grew rapidly.
During the 1970s and 1980s, the faculty expanded to include clinical leaders Drs. Stephen Lefrak and Peter Tuteur; elastin biochemistry experts Drs. Barry Starcher and Robert Mecham, the latter of whom recognized as a research leader internationally; and Dr. Erika Crouch, who discovered pulmonary surfactant protein D and is widely recognized for her excellence in teaching. Dr. John A. McDonald, a biochemist focused on lung development and fibronectin, joined in 1979 and became Division Director in 1985, ushering in a period of rapid expansion. In 1991, Dr. Holtzman succeeded McDonald and led the Division till 2022, guiding its growth in scope and national impact.
Notable Scientific Contributions during this time include:
- Pulmonary surfactant: Alveolar Type 2 cells identified as the primary source of dipalmitoyl lecithin (DPL) in 1971.
- Emphysema model: Developed using porcine elastase, leading to reproducible lung damage and widespread research use.
- AAT phenotyping: Enhanced through adoption of isoelectric focusing and validated by Dr. Edwin Silverman’s large-scale gene frequency study in 20,000 St. Louis residents.
- Matrix metalloproteinase-12 (MMP-12): Identified via gene isolation techniques and shown to be critical in cigarette smoke–induced emphysema using knockout mouse models.
- Chemotaxis signaling: Elastin fragments shown to attract monocytes and fibroblasts, highlighting a mechanism of injury response.
- Neutrophil elastase inhibition: Discovery that alpha1-antitrypsin breakdown products attract neutrophils, later linked to a feedback loop involving hepatocyte regulation via the serpin-enzyme complex receptor (identified by Dr. David Perlmutter’s lab).
From 1992 to 2022, the division was led by Michael Holtzman, MD. Under his tenure, we underwent remarkable growth in the scope and depth of divisional clinical, research, and teaching activities. This included the development of the multidisciplinary Jacqueline Maritz Lung Center for outpatient care incorporating not only our division, but also the clinical efforts of the section of Thoracic Surgery and the Division of Allergy and Immunology.
This time saw tremendous expansion in our research capabilities with translational research initiatives drawing on the advanced basic science foundation present at our institution. Our research is supported by a strong institutional commitment to research and a history of attracting significant external grants. This includes a long-standing NIH T32 training grant supporting both postdoctoral and graduate trainees, multiple large NIH program project grants (PPGs) and center grants, awards from the National Heart, Lung, and Blood Institute (NHLBI), and investments from philanthropic and commercial partners.
The last two decades have seen continued growth in both clinical and research efforts. Examples include the establishment of a dedicated interventional pulmonology service, expansion of outpatient clinical services to West County and South County, and the addition of several investigator labs exploring novel research ideas in lung biology and respiratory health.
The Division of Pulmonary & Critical Care Medicine is redefining what comprehensive lung and critical care looks like. Under the leadership of Janet Lee, MD since 2023, our division integrates world-class clinical excellence, discovery-driven research, and compassionate, equitable care across the Washington University Medical Campus and our regional health system partners. Building on a legacy of innovation, we are expanding programs that reach patients earlier, personalize therapies, and translate scientific breakthroughs into better outcomes.
The Division laid the foundation for its future through its integrated approach to education, clinical care, and discovery. This legacy of innovation and leadership continues to guide the Division’s mission today.
Clinical Focus
Our faculty are internationally recognized leaders in pulmonary medicine, with a long history of receiving awards and research funding from the American Lung Association and the National Institutes of Health (NIH). We are proud to be selected as a site for the prestigious i-CARE asthma study, funded by the Patient-Centered Outcomes Research Institute (PCORI), aimed at transforming asthma care across the country.
The COPD Foundation has designated our division as a Bronchiectasis and Nontuberculous Mycobacterial (NTM) Care Center, connecting us to a national network of experts dedicated to improving outcomes for patients with these complex conditions. We are also recognized as a:
- Pulmonary Fibrosis Foundation (PFF) Care Center
- LAM Foundation Clinical Center
- Primary Ciliary Dyskinesia Network Care Provider
Additionally, our division has been awarded Centers of Excellence for hereditary hemorrhagic telangiectasia (HHT) and sarcoidosis, demonstrating our leadership in the management of rare and challenging pulmonary disorders.
Because lung disease rarely exists in isolation, our division partners broadly across WashU Medicine and BJC HealthCare to deliver coordinated, multidisciplinary care.
Advanced Lung Failure & Transplant: One of the highest-volume lung transplant programs in the nation, our collaborative transplant team (adult & pediatric) has performed thousands of lung and heart-lung procedures since 1988. Patients with interstitial lung disease, COPD, cystic fibrosis, pulmonary vascular disease, and other advanced disorders receive seamless evaluation, surgical expertise, and long-term follow-up.
Interstitial Lung Disease & Fibrosis: Our PFF Network site connects patients to leading-edge diagnostics, antifibrotic therapies, clinical trials, genetic evaluation, and transplant pathways.
Asthma & COPD Innovation: Through the Airways Clinical Research Unit and practice-embedded clinical trials such as i‑CARE, we test strategies that improve real-world outcomes, adherence, and health system value—especially for populations disproportionately affected by asthma and COPD.
Rare Lung & Multisystem Disease Clinics: LAM, PCD, HHT, sarcoidosis, and other complex conditions benefit from coordinated evaluation across pulmonology, genetics, rheumatology, otolaryngology, interventional radiology, and transplant services.
Pulmonary Rehabilitation & Recovery: We work with hospital- and community-based pulmonary rehabilitation partners to build strength, reduce dyspnea, and support recovery after hospitalization, lung surgery, or transplant.
Advances in Research
We are at the forefront of innovative research advancements, tackling some of the most complex challenges in pulmonary and critical care medicine. Some recent advances include:
- Unraveling the Immune System’s Role. We are exploring immune system dysfunction in cancer patients, particularly those undergoing stem cell transplants. By understanding immune dysregulation and lung injury, we aim to improve recovery and long-term outcomes.
- Harnessing the Power of Big Data. Our team is using advanced data analytics to uncover immune and infectious disease patterns, enabling more precise and personalized treatment strategies.
- Early Detection of Lung Injuries. Research into subclinical lung injuries that can lead to fibrosis allows us to intervene earlier, including performing lung transplant evaluations for high-risk patients.
- Enhancing COPD Care. Through expanded pulmonary rehabilitation programs and a comprehensive COPD clinic, we are focused on managing acute exacerbations, reducing hospital readmissions, and delivering specialized care for complex COPD cases.
- Advancing Lung Cancer Prevention and Treatment. We are leading initiatives in lung cancer screening and therapy, resulting in earlier diagnoses and improved survival rates through the latest therapeutic approaches.
- Leveraging Technology for Complex Lung Conditions. By incorporating state-of-the-art robotics, we are improving diagnostic accuracy and offering advanced treatments for emphysema and other challenging lung diseases.
Transformative Education
We’re shaping the future of pulmonary and critical care medicine through rigorous and comprehensive training programs. Our ACGME-accredited fellowship programs offer extensive clinical rotations, dedicated research training, and a rich array of educational conferences and lectureships, preparing fellows to become leaders in patient care, research, and academia.
Our specialized fellowship programs include:
Pulmonary and Critical Care Medicine Fellowship: This comprehensive, three-year program offers broad pulmonary training combined with multidisciplinary critical care medicine experience. Fellows gain expertise across a wide range of respiratory and critical illnesses, preparing them for diverse careers in academic medicine or clinical practice.
Critical Care Medicine Fellowship: Designed for physicians seeking advanced training specifically in critical care, this program provides an intensive experience in managing complex, life-threatening conditions. Fellows rotate through various intensive care units, developing expertise in resuscitation, organ support, and critical care procedures.
Interventional Pulmonology Fellowship: This specialized one-year program focuses on advanced diagnostic and therapeutic procedures for airway and pleural diseases. Fellows gain hands-on experience with techniques such as flexible and rigid bronchoscopy, as well as other procedures, while participating in groundbreaking research including robotics and advancing knowledge of complex airway disease management
Looking Ahead
Under Dr. Lee’s leadership, we are investing in next‑generation diagnostics, data-driven care pathways, and multi-site clinical networks that shorten the distance between discovery and better breathing. Whether you are a patient, referring provider, trainee, researcher, or advocate—we invite you to partner with us.