Don Milton, MD, DrPH
Professor of Environmental Health, Applied Environmental Health (MIAEH)
Affiliate in Cell Biology and Molecular Genetics; Professor, Internal Medicine, University of Maryland School of Medicine
Other Affiliations: Epidemiology and Biostatistics, UMD Prevention Research Center
Campus: UMD | Building: School of Public Health | Room: 2234V
Phone: 301-405-0389 | |
Laboratory Website: 
Public Health Aerobiology, Virology, and Exhaled Biomarker Laboratory (PHAB Lab)
Website: 
Catch the Virus Study
Office Hours: 

By appointment

Biography
I earned a BS in Chemistry from UMBC, MD from Johns Hopkins, and an MOH and a DrPH (Environmental Health) from Harvard. I am currently Professor of Environmental Health, University of Maryland School of Public Health, with a secondary appointment in the Department of Medicine, School of Medicine. I am board certified in Internal and Occupational and Environmental Medicine and have 20 years of experience in environmental and occupational medicine referral practice. I have served on the editorial boards of Applied Environmental Microbiology, Indoor Air, and BMC Public Health, and on the NIOSH NORA Indoor Environment Team and chaired the ACGIH Bioaerosols Committee. 
 
My work focuses on the interrelated areas of infectious bioaerosols, exhaled breath analysis, and development and application of innovative methods for respiratory epidemiology. My insights on aerosol transmission lead to an innovative model of airborne infection transmission risk estimated from simple CO2 measurements (Rudnick & Milton). My work on exhaled breath has contributed to understanding how the lung generates particles and how best to sample these particles while preserving their biological properties for analysis (e.g. infectiousness and immunological epitopes). I lead development of a novel exhaled breath sampler (G-II, US patent no. 8,250,903, McDevitt et al. 2013; Milton et al. 2013) that allows collection while the subject breaths normally (i.e. no breathing or coughing into a tube). Using this device we recently reported analysis of 142 PCR confirmed influenza infection case with complete data on 218, 30-min breath samples collected on up to 3 consecutive days following onset of symptoms (Yan et al. PNAS 2018). Archived samples from this study form the basis for this project. I am currently leading a DARPA funded project titled "Contagious Phenotypes of Acute Respiratory Infection: Identification, Characterization, and Biomarkers" in which we are tracking respiratory infections in freshmen dorms, collecting swabs and breath samples, and identifying chains of transmission using phylogenetic analysis working in close collaboration with a team of virologists, bioinformaticists, biostatisticians, immunologists, biophysicists, engineers, and aerosol scientists. 
  1. Yan J, Grantham M, Pantelic J, Bueno de Mesquita PJ, Albert B, Liu F, Ehrman S, Milton DK. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci U S A. 2018 Jan 30;115(5):1081-1086. PubMed PMID: 29348203; PubMed Central PMCID: PMC5798362. 
  2. Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog. 2013 Mar;9(3):e1003205. PubMed PMID: 23505369; PubMed Central PMCID: PMC3591312. 
  3. McDevitt J, Milton D, Koutrakis P, Ferguson S, Wolfson J. , inventors. Biological particle collector and method for collecting biological particles. United States of America US8250903 B2. 2012 August 28. 
  4. Fabian P, Brain J, Houseman EA, Gern J, Milton DK. Origin of exhaled breath particles from healthy and human rhinovirus-infected subjects. J Aerosol Med Pulm Drug Deliv. 2011 Jun;24(3):137-47. PubMed PMID: 21361786; PubMed Central PMCID: PMC3123971. 

Specific Research Contributions and Selected Publications

  • INFECTIOUS DISEASE AEROBIOLOGY AND INDOOR AIR QUALITY: An inadequate theoretic framework has hampered understanding of the aerobiology of certain infectious diseases in which aerosols may play a role in transmission. The concepts that I introduced in 2004 (obligate, preferential and opportunistic aerosol transmission) and recently updated in 2012 with the broader concepts of isotropic and anisotropic infection have received broad acceptance. I extended the Wells-Riley equation to allow airborne transmission risk to be quantified using simple CO2 measurements even in low ventilation and highly dynamic environments. We validated the model in field studies of human rhinovirus. It has subsequently been applied in TB studies to identify high risk environments for intervention to prevent multi-drug resistant TB transmission in South Africa. We also demonstrated that there is a relationship between office worker sick leave and ventilation that extends to much higher ventilation rates than previously thought. These data are being used to set new standards for healthy buildings.
    • Milton DK. What was the primary mode of smallpox transmission? Implications for biodefense. Front Cell Infect Microbiol. 2012;2:150. PubMed PMID: 23226686; PubMed Central PMCID: PMC3509329. 
    • Myatt TA, Johnston SL, Zuo Z, Wand M, Kebadze T, Rudnick S, Milton DK. Detection of airborne rhinovirus and its relation to outdoor air supply in office environments. Am J Respir Crit Care Med. 2004 Jun 1;169(11):1187-90. PubMed PMID: 14754759. 
    • Roy CJ, Milton DK. Airborne transmission of communicable infection--the elusive pathway. N Engl J Med. 2004 Apr 22;350(17):1710-2. PubMed PMID: 15102996. 
    • Milton DK, Glencross PM, Walters MD. Risk of sick leave associated with outdoor air supply rate, humidification, and occupant complaints. Indoor Air. 2000 Dec;10(4):212-21. PubMed PMID: 11089326. 
  • EXHALED BREATH ANALYSIS: The key problem limiting the utility of exhaled breath condensate (EBC) analysis is poor collection efficiency for exhaled aerosols. We resolved this issue by creating two new systems (one patented and the other pending) for highly efficient collection of exhaled breath aerosols (EBA) while preserving biological activity. We used these systems to study infectious aerosol. We have also shown that the source of EBA is a result of deep lung processes, implicating transient airway closure, and not dependent on cough. Our newest instrument, developed with funding from IARPA, concentrates exhaled droplets into <500 µL of ice allowing preservation of labile biomarkers, collects all droplets > 0.005 µm in diameter and avoids problems associated with liquid impingement and extraction from solid impaction surfaces. It is being interfaced with microfluidic lab on a chip for rapid detection of infectious agents and biomarkers (e.g. miRNA) -- it is covered in a recent US Patent Application (15/490,591).
    • McDevitt J, Milton D, Koutrakis P, Ferguson S, Wolfson J. , inventors. Biological particle collector and method for collecting biological particles. United States of America US8250903 B2. 2012 August 28. 
    • Shorter JH, Nelson DD, McManus JB, Zahniser MS, Sama SR, Milton DK. Clinical study of multiple breath biomarkers of asthma and COPD (NO, CO(2), CO and N(2)O) by infrared laser spectroscopy. J Breath Res. 2011 Sep;5(3):037108. PubMed PMID: 21757803; PubMed Central PMCID: PMC3169766. 
    • Fabian P, Brain J, Houseman EA, Gern J, Milton DK. Origin of exhaled breath particles from healthy and human rhinovirus-infected subjects. J Aerosol Med Pulm Drug Deliv. 2011 Jun;24(3):137-47. PubMed PMID: 21361786; PubMed Central PMCID: PMC3123971. 
    • Shorter JH, Nelson DD, Barry McManus J, Zahniser MS, Milton DK. Multicomponent Breath Analysis With Infrared Absorption Using Room-Temperature Quantum Cascade Lasers. IEEE Sens J. 2009 Dec 11;10(1):76-84. PubMed PMID: 20697459; PubMed Central PMCID: PMC2917122. 
  • INNOVATIVE METHODS FOR RESPIRATORY EPIDEMIOLOGY AND EXPOSURE ASSESSMENT AND OCCUPATIONAL ATTRIBUTABLE FRACTION IN ADULT-ONSET ASTHMA: I developed an early data-mining technology for use in an HMO data warehouse that allowed monthly identification of new-onset asthma cases as well as other medical care events making possible both prospective and retrospective studies. We used the HMO cohort for nested case control studies of adult-onset asthma. For these studies, we developed innovative methods for analysis of expert exposure avoiding the issues with kappa statistics using log-linear models, and developed a method for accurately estimating attributable fraction in the setting of a large nested case-control study. These studies contributed to the consensus statement from ATS recognizing that up to 20% of adult-onset asthma arises out of occupational exposure.
    • Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, Milton D, Schwartz D, Toren K, Viegi G. American Thoracic Society Statement: Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med. 2003 Mar 1;167(5):787-97. PubMed PMID: 12598220. 
    • Houseman EA, Milton DK. Partial questionnaire designs, questionnaire non-response, and attributable fraction: applications to adult onset asthma. Stat Med. 2006 May 15;25(9):1499-519. PubMed PMID: 16220493. 
    • Hunt PR, Friesen MC, Sama S, Ryan L, Milton D. Log-Linear Modeling of Agreement among Expert Exposure Assessors. Ann Occup Hyg. 2015 Jul;59(6):764-74. PubMed PMID: 25748517; PubMed Central PMCID: PMC4506313. 
    • Sama SR, Milton DK, Hunt PR, Houseman EA, Henneberger PK, Rosiello RA. Case-by-case assessment of adult-onset asthma attributable to occupational exposures among members of a health maintenance organization. J Occup Environ Med. 2006 Apr;48(4):400-7. PubMed PMID: 16607195. 
  • ENDOTOXIN EXPOSURE AND RESPIRATORY HEALTH: I developed a method for environmental endotoxin exposure measurements that resolved accuracy issues inherent in the comparative, non-analytical nature of the Limulus assay achieving results with improved consistency with LC-MS/MS measurements. I demonstrated the threshold for acute exposure-response to occupational endotoxin exposure is much lower than previously recognized, that endotoxin effects could be identified in non-agricultural industrial workers, and distinguished from the effects of other airway irritants measured simultaneously. I described the acute and chronic effects of early life endotoxin exposure on childhood asthma, wheeze, and atopy in one of the first birth cohort studies to include endotoxin exposure.
    • Abraham JH, Finn PW, Milton DK, Ryan LM, Perkins DL, Gold DR. Infant home endotoxin is associated with reduced allergen-stimulated lymphocyte proliferation and IL-13 production in childhood. J Allergy Clin Immunol. 2005 Aug;116(2):431-7. PubMed PMID: 16083802. 
    • Milton DK, Wypij D, Kriebel D, Walters MD, Hammond SK, Evans JS. Endotoxin exposure-response in a fiberglass manufacturing facility. Am J Ind Med. 1996 Jan;29(1):3-13. PubMed PMID: 8808037. 
    • Park JH, Gold DR, Spiegelman DL, Burge HA, Milton DK. House dust endotoxin and wheeze in the first year of life. Am J Respir Crit Care Med. 2001 Feb;163(2):322-8. PubMed PMID: 11179100. 
    • Sordillo JE, Webb T, Kwan D, Kamel J, Hoffman E, Milton DK, Gold DR. Allergen exposure modifies the relation of sensitization to fraction of exhaled nitric oxide levels in children at risk for allergy and asthma. J Allergy Clin Immunol. 2011 May;127(5):1165-72.e5. PubMed PMID: 21463890; PubMed Central PMCID: PMC3137133. 
  • CLINICAL OCCUPATIONAL MEDICINE AND OCCUPATIONAL ASTHMA: Over the course of a long clinical career in occupational medicine, I have made a number of contributions to the clinical literature through reporting cases and providing guidelines for diagnosis and treatment.
    • Leffler CT, Milton DK. Occupational asthma and contact dermatitis in a spray painter after introduction of an aziridine cross-linker. Environ Health Perspect. 1999 Jul;107(7):599-601. PubMed PMID: 10379008; PubMed Central PMCID: PMC1566653. 
    • Sama S, Christiani D, Milton D. Diagnosis and management of occupational asthma. Immunology and Allergy Clinics of North America. 2002 November; 22(4):791-806.
    • Solomon GM, Morse EP, Garbo MJ, Milton DK. Stillbirth after occupational exposure to N-methyl-2-pyrrolidone. A case report and review of the literature. J Occup Environ Med. 1996 Jul;38(7):705-13. PubMed PMID: 8823662. 
 
Education and Training
  • Dr.P.H., Environmental Health, Harvard University;
  • M.O.H., Harvard University,
  • M.D., Johns Hopkins University;
  • B.S., Chemistry (Cum Laude), University of Maryland Baltimore County
  • Residency in Internal Medicine: Emory University - Grady Hospital, Atlanta, GA and Boston University Hosptal
  • Residency in Occuapational and Environmental Medicine, Harvard School of Public Health
  • Board Certified in Internal Medicine and Occupational and Environmental Medicine
Honors and Awards
  • 1983 Lloyd Hyde Research Award, Emory University School of Medicine
  • 2002 Best Paper Award 1999-2000, International Society for Indoor Air Quality and Climate, Indoor Air Journal
  • 2005 Best Paper Award 2002-2003, International Society for Indoor Air Quality, Indoor Air Journal
  • 2008 Elected Fellow, International Society for Indoor Air Quality
  • 2009 Harriet Hardy Award , New England College of Occupational & Environmental Medicine
Publications: 

1. Yan J, Grantham M, Pantelic J, Mesquita PJB de, Albert B, Liu F, Ehrman S, Milton DK, Emit Consortium. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. PNAS. 2018 Jan 18;201716561. PMID: 29348203

2. Hunt PR, Friesen MC, Sama S, Ryan L, Milton D. Log-Linear Modeling of Agreement among Expert Exposure Assessors. Ann Occup Hyg. 2015 Jul;59(6):764–774. PMCID: PMC4506313

3. Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog. 2013 Mar;9(3):e1003205. PMCID: PMC3591312

4. Milton DK. What was the primary mode of smallpox transmission? Implications for biodefense. Front Cell Infect Microbiol. 2012;2:150. PMCID: PMC3509329

5. Fabian P, Brain J, Houseman EA, Gern J, Milton DK. Origin of exhaled breath particles from healthy and human rhinovirus-infected subjects. J Aerosol Med Pulm Drug Deliv. 2011 Jun;24(3):137–147. PMCID: PMC3123971

6. 1. Sordillo JE, Webb T, Kwan D, Kamel J, Hoffman E, Milton DK, Gold DR. Allergen exposure modifies the relation of sensitization to fraction of exhaled nitric oxide levels in children at risk for allergy and asthma. J Allergy Clin Immunol. 2011 May;127(5):1165–1172.e5. PMCID: PMC3137133

7. McDevitt JJ, Milton DK, Rudnick SN, First MW. Inactivation of poxviruses by upper-room UVC light in a simulated hospital room environment. PLoS ONE. 2008;3(9):e3186. PMCID: PMC2527528

8. Weller EA, Milton DK, Eisen EA, Spiegelman D. Regression calibration for logistic regression with multiple surrogates for one exposure. J Stat Plan Inference. 2007 Feb 1;137(2):449–461.

9. Sama SR, Milton DK, Hunt PR, Houseman EA, Henneberger PK, Rosiello RA. Case-by-case assessment of adult-onset asthma attributable to occupational exposures among members of a health maintenance organization. J Occup Environ Med. 2006 Apr;48(4):400–407. PMID: 16607195

10. Houseman EA, Milton DK. Partial questionnaire designs, questionnaire non-response, and attributable fraction: applications to adult onset asthma. Stat Med. 2006 May 15;25(9):1499–1519. PMID: 16220493

11. Horick N, Weller E, Milton DK, Gold DR, Li R, Spiegelman D. Home endotoxin exposure and wheeze in infants: correction for bias due to exposure measurement error. Environ Health Perspect. 2006 Jan;114(1):135–140. PMCID: PMC1332669

12. Myatt TA, Johnston SL, Zuo Z, Wand M, Kebadze T, Rudnick S, Milton DK. Detection of airborne rhinovirus and its relation to outdoor air supply in office environments. Am J Respir Crit Care Med. 2004 Jun 1;169(11):1187–1190. PMID: 14754759

13. Sama SR, Hunt PR, Cirillo CIHP, Marx A, Rosiello RA, Henneberger PK, Milton DK. A longitudinal study of adult-onset asthma incidence among HMO members. Environ Health. 2003 Aug 7;2(1):10. PMCID: PMC194432

14. Rudnick SN, Milton DK. Risk of indoor airborne infection transmission estimated from carbon dioxide concentration. Indoor Air. 2003 Sep;13(3):237–245. PMID: 12950586

15. Litonjua AA, Milton DK, Celedon JC, Ryan L, Weiss ST, Gold DR. A longitudinal analysis of wheezing in young children: the independent effects of early life exposure to house dust endotoxin, allergens, and pets. J Allergy Clin Immunol. 2002 Nov;110(5):736–742. PMID: 12417882

16. 1. Park JH, Gold DR, Spiegelman DL, Burge HA, Milton DK. House dust endotoxin and wheeze in the first year of life. Am J Respir Crit Care Med. 2001 Feb;163(2):322–328. PMID: 11179100

17. Milton DK, Glencross PM, Walters MD. Risk of sick leave associated with outdoor air supply rate, humidification, and occupant complaints. Indoor Air. 2000 Dec;10(4):212–221. PMID: 11089326