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Respiratory Medicine

Location:
555 University Avenue, Room 4534, 4th Floor, Hill Wing
Phone:
416-813-6167
Email:
Respiratory.medicine@sickkids.ca
doctor taking heartbeat of young patient smiling in his mom's lap

The Paediatric Respiratory Medicine Service is a modern tertiary service and diagnostic testing centre for the multidisciplinary care of a wide range of conditions including: congenital lung abnormalities, bronchiectasis, severe asthma, rare lung diseases, bronchopulmonary dysplasia, sleep-related respiratory failure and apnoea. 

What we do

The Division of Respiratory Medicine at SickKids provides multidisciplinary inpatient and outpatient services for infants and children with acute and chronic respiratory problems.

Collaborative clinics

Diagnostic services

  • Pulmonary Exercise Lab 
  • Pulmonary Function Lab 
  • Infant Pulmonary Function Lab (new) 
  • Sleep Lab

Our patients receive comprehensive care from our physicians, certified nurse practitioners, nutritionists and social workers. We are committed to providing outstanding patient care, instructing young physicians and nurses and researching pulmonary diseases and treatments. 

Our general referral process for all clinics

All patients require a referral to visit any of our clinics. 

If you are a health-care professional, log in to eCHN to submit your referral. From your eCHN account, you will be seamlessly connected to SickKids e-referral platform, EpicCare Link. 

Learn more about our referral process 

For urgent referrals only (same day referrals), contact eCHN’s Helpdesk directly 416-813-7998 or 1-877-252-9900, or by email at helpdesk@echn.ca. On weekends and after 6 p.m. on weekdays, please contact the Respiratory Fellow on call via SickKids Locating at 416-813-1500. 

If you have any further questions about our clinics, programs or referral services, please contact one of our clinic coordinators at 416-813-5826. 

Programs and services

Below you can click an individual program for clinic details through our Directory. 

Expand the sections below for more Respiratory Medicine program information.

The Chronic Lung Disease of Prematurity clinic is under the Division of Respiratory Medicine. The program is dedicated to providing consultation and support for children with chronic lung disease of prematurity requiring oxygen at home.  

Referral criteria

Children born at 32 weeks gestation and under who require home oxygen therapy.  

The Long-term Ventilation (LTV) program operates under the Division of Respiratory Medicine. The program is dedicated to providing comprehensive consultation and ongoing management for children receiving long-term ventilation at home, as well as for those children who are at risk of requiring long-term ventilation. The aim of our program is to optimize care of these children at home and to support their families in the community. 

What do we offer?
  • Long-term follow up of children receiving long-term ventilation at home  
  • Inpatient and outpatient consultation and support to families who are considering long-term ventilation for their child 
  • Caregiver training for home ventilator equipment and airway clearance therapies 
  • Transition to home planning and care coordination with the intensive care units and Holland Bloorview Rehabilitation Hospital
  • Integration of care with community services including nursing at home and at school 
  • Inpatient collaboration with medical and surgical specialists 
  • Transition program to adult care services developed in partnership with West Park Healthcare Centre and Sunnybrook Health Sciences Centre 
Contact us

Please contact the Long-term Ventilation Program coordinator, at 416-813-6338 if you have any questions about our program or referral process. Referrals must be completed by a physician or nurse practitioner. 

Who we are

The Division of Pulmonary Medicine can provide you and your child with information, support and advanced treatment options for your child’s breathing challenges. We offer inpatient and outpatient services for infants and children with both short-term and chronic respiratory problems. 

While the inpatient Respiratory Medicine is primarily a consulting service, our outpatient service is the division’s main responsibility. In addition, Respiratory Medicine follows patients in hospital requiring complex respiratory care, such as home ventilation, as well as patients with cystic fibrosis and rare respiratory illnesses such as interstitial lung disease. 

Research activities

Some of the major research going on in the Division of Respiratory Medicine is the CHILD Study, led by Dr. Padmaja Subbarao.

Expand each section below to learn more about what our esteemed staff are researching. 

Most recently the CHILD Study was awarded $1.7M to study impacts of COVID-19 on Canadian families

$1.7 million award from the Canadian Institutes of Health Research (CIHR) and Research Manitoba will allow CHILD researchers to study how individuals and families across Canada have been impacted directly by COVID-19 infections, and indirectly by pandemic-related social and economic upheaval. 

DrReshma Amin (nominated PI) received funding (CIHR, Muscular Dystrophy Canada, Boehringer Ingelheim, ProRespMedigas, VHA Home Healthcare) for four years in July 2019 to complete a multi-site clinical trial titled, A Virtual Transition Intervention for Children and Adults Transitioning to Home Ventilation in Ontario: A Pragmatic Randomized Controlled Trial. The trial will evaluate the impact of a multi-component virtual care solution that overcomes distance and time by bringing the “Right People with the Right Expertise at the Right Time” into the home to improve quality of life, reduce family caregiver burden, and prevent unnecessary hospital admissions.

A 12 month, seven-centre, randomized controlled trial with individuals (children and adults) newly transitioning to home ventilation was planned to launch in July 2020. COVID-19 presented an unprecedented need to implement this virtual care platform to all 5,000 individuals using Home Ventilation in Ontario immediately. Funding was secured for a COVID-19 clinical implementation of this virtual care solution and Dr. Reshma Amin and Regina Pizzutimanager of the Ontario Ventilator Equipment Pool (VEP), are the co-directors of this clinical program.  

The team was ready to deploy the virtual care solution because of the research trial groundwork and is positioned to scale to all individuals (children and adults) in Ontario using home mechanical ventilation to support ‘care at home.’ The virtual care platform enables 1) text, phone and videoconference calls; 2) a virtual care plan that is co-developed by the family and the healthcare team; 3) weekly and monthly questionnaires about symptoms and ventilator use to identify issues early; and 4) remote ventilator data downloads for ongoing monitoring of patients at the ease of a button in between clinic visits.  

SickKids is the first hospital to onboard patients with 25 patients enrolled already. The following hospitals are also participating with a plan to launch at their sites shortly: Sunnybrook, London Health Sciences, Ottawa Hospital, West Park, McMaster Children’s Hospital, Children’s Hospital of Eastern Ontario. This was a provincial virtual care strategy for children and adults using Long-term Home Mechanical Ventilation during COVID-19 but this virtual care platform will ideally be sustainable beyond the pandemic and facilitate ongoing care. 

Dr. Felix Ratjen led the Lancet Commission on the global perspective of future care for cystic fibrosis. Decades of progress in the care of people with cystic fibrosis mean that patients are living longer, healthier lives than ever before. However, the disease continues to limit survival and quality of life in high-income countries, and many patients in low-income and middle-income countries do not have access to integrated multidisciplinary care or affordable therapies.  

With a growing population of adult patients, widespread genetic testing for the diagnosis of cystic fibrosis, increased recognition of patient populations of non-European descent, and the development of potentially life-changing therapies that target the underlying cause of cystic fibrosis, an unprecedented opportunity exists for improved health outcomes. Bringing together 30 leaders in the field from all continents, The Lancet Respiratory Medicine Commission, led by Scott Bell and Felix Ratjen, reviewed the latest research advances and identified challenges and opportunities for progress in the care of patients globally. 

L-Arginine / Nitric Oxide Metabolism in Asthma  

One of Dr. Grasemann’s research interests is the role of the L-arginine/Nitric Oxide metabolism for asthma. The Grasemann lab had previously demonstrated in animals and preclinical studies that alterations in the L-arginine metabolism such as increased arginase activity and asymmetric dimethylarginine (ADMA) contribute to reduced Nitric Oxide availability in asthma.  

He is currently pursuing this in two Research Project Grants (R01) by the National Institutes of Health - National Heart, Lung, and Blood Institute (NIH-NHLBI), of which one is a longitudinal lifestyle modification study aiming to unveil metabolic and behavioral pathways in asthma and the other is a randomized controlled clinical trial on the effects of L-citrulline supplementation on pulmonary function and asthma control in obese asthmatics.   

Empty lecture hall of 15 rows and a speaking podium

Education and training opportunities

For over three decades, the Division has graduated numerous trainees from all over the globe through our active postgraduate education programme

We continue to prepare both Canadian and foreign subspecialty residents (formerly known as “Fellows”) for careers in paediatric respiratory medicine. Since the mid-1980s, special expertise in paediatric respiratory medicine has been recognized by subspecialty qualifications in both Canada (1988) and the United States (1986).  

For more information about our Royal College accredited Training Programs. Please visit the University of Toronto Website. (Link coming soon!)

Expand each section below to learn about our educational programs in more detail. 

Our program is accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) and is one of the oldest and largest training programs in Canada. It is designed to meet the requirements for subspecialty training in Paediatric Infectious Diseases. This includes 11 blocks of Paediatric ID consult service (divided between the general ID and the immunocompromised ID consult services), 2 blocks of adult ID consult service, 1.5 blocks of infection control, 1.5 blocks of antibiotic stewardship, 3 blocks of microbiology, 1 block of public health and 4 elective blocks.  

The trainees also attend a half-day clinic per week. In first year, this longitudinal clinic experience includes experiences in the congenital infection clinic, auto inflammatory clinic, HIV clinic, tuberculosis clinic, and general ID clinic. In their second year, trainees attend their own individual continuity clinic. 

There is a structured formal paediatric ID academic curriculum that includes on average three hours of protected teaching per week. In addition to strong teaching while on the microbiology rotations, a structured year-long plate rounds series also occurs. Other formal teaching includes the week-long annual National ID fellows’ retreat for which all of our fellows are given protected time to attend. 

The deadline to apply is September for the following July 1st start (10 months in advance).

To apply, please refer to the CARMS Ontario for eligibility criteria and application process. 

In addition to the RCPSC stream of our training program, we offer a two-year clinical fellowship for international trainees who plan to further develop the field of paediatric infectious diseases upon return to their home countries. The rotations and curriculum for this two-year fellowship program are like what is described above for the RCPSC subspecialty residency program. Funding support generally involves sponsorship from the applicant’s home institution or government; however, there are also limited locally funded positions. 

The deadline to apply to the program is September 1 for the start of fellowship the following year July 1 (i.e. 10 months in advance). We are currently accepting applications for July 1, 2021 start of fellowship.

To apply to our clinical fellowship form please complete the Clinical Fellowship Application.

Medical Students

Electives are accepted for three to six weeks in length. The trainee must be in their clerkship year (year three or four of training) and have completed their core paediatrics or core internal medicine rotation. The University of Toronto Visiting International Electives Program offers elective placements between January to June ONLY for a maximum of four weeks. Electives are not offered to students from international medical schools between the months of July and December. 

Please visit the University of Toronto Elective website for information on how to apply.  

Resident Electives

Resident electives are available throughout the year. Please email id.trainingprogram@sickkids.ca to check availability prior to completing the application process. UofT residents are not required to apply through the online application system and can arrange electives directly with the program.  

Please visit the University of Toronto website for information on how to apply. 

International Electives

Please email id.trainingprogram@sickkids.ca to confirm elective availability and application requirements. Documents must be submitted at least 8 months in advance.  

To submit your request, please see the International Medical Observer Application page on the SickKids International website. 

Educational awards

Dr. Reshma Amin - 2010-2011, Subspecialty Faculty Teaching Award for Clinical Excellence, Department of Paediatrics.

Dr. Melinda Solomon - 2011-2012, The Harry Bain Award for Excellence in Academic Teaching.

Dr. Neil Sweezey - 2018-2019, POWER Teaching Award, Department of Paediatrics.

Dr. Indra Narang - 2019-2020, Subspecialty Postgraduate Teaching Award, Department of Paediatrics.

Contact Respiratory Medicine at SickKids

To reach our various clinics or our staff please contact us through one of our main numbers below.

  • Clinic phone: 416-813-7600 ext. 205826 
  • Divisional Main Number: 416-813-6167 (to reach our administrative staff, allied health and faculty)
  • Email: Respiratory.medicine@sickkids.ca   

Address:

Division of Paediatric Respiratory Medicine 

Room 4534, 4th Floor Hill Wing 

555 University Avenue 

Toronto, Ontario 

M5G 1x8  

Direct staff training contacts

Paediatric Respiratory Medicine (Pulmonology) Core Training Program 
Dr. Melinda Solomon, Program Director  

 

Paediatric Sleep & Long-Term Ventilation Training Program 

Dr. Reshma Amin, Program Director 

 

Phone: 416-813-7654 ext. 206248 
Email: respmed.trainingprogram@sickkids.ca

 

Our history

During the early years, clinical and laboratory research performed by the Chest (led by Peter Turner) and Respiratory Physiology (led by A. Charles Bryan) Divisions and their colleagues in other sub-specialties led to a rationalization of mechanical ventilation for acute lung disease, mechanisms and management of respiratory complications during anaesthesia, and the cause and treatment of neonatal apnea. Subsequently, there was a major expansion in the respiratory physiology programme within the Department of Internal Medicine. Close collaborative links resulted in a training programme almost unique in its breadth and depth. 

The Chest Division rapidly developed an interest and focus on the management of the inpatient and ambulatory asthmatic child. This laid the ground work for the Division’s selection as the only Canadian Centre in an NIH funded multicentre North American asthma research project (Childhood Asthma Management Program) from 1991 to 1999 under the local leadership of Henry Levison (1991-97), Joe Reisman (1991-99), Ian MacLusky (1997-2006) and Padmaja Subbarao (2006-2012). 

Levison succeeded Turner as Chief of the Division in 1985 and broadened its focus by developing an expanded interest in unusual and complicated respiratory diseases. A new dimension was added in 1986 with the recruitment of Hugh O’Brodovich, who brought to the Division an interest in the cellular and molecular mechanisms of lung disease, as well as both training and experience from other renown centers. Following Bryan’s retirement in 1990, O’Brodovich became Head of Respiratory Research Division within the Research Institute. Recruitment of additional fundamental scientists was completed and in 1994, O’Brodovich established and became the Director of SickKids' Lung Gene-Based Therapy research programme. 

In 1994, O’Brodovich succeeded Dr. Levison as the Division Chief, and the Chest Division became known as the Division of Respiratory Medicine. O’Brodovich continued to expand the scope of research expertise within the Division until he became Chairman of the Department of Paediatrics at the University of Toronto and Paediatrician in Chief at SickKids in 1996. Martin Post, an internationally recognized scientist investigating early lung development, became the Head of Respiratory Research at the same time. Subsequent to the restructuring of the SickKids Research Institute, Post became the Director of the Lung Biology Programme. In 1996, Dr Canny left to lead the paediatric respiratory group in Dublin, Ireland. In 2000, Reisman left to become the Chairman of Paediatrics at the University of Ottawa. Those hired both to replace Canny and Reisman, as well as to expand the scope of the clinical practice, resulted in a group of young dynamic and well-trained individuals who added a new dimension to the group. 

Allan Coates, formerly Director of Respiratory Medicine at the Montreal Children’s Hospital of McGill University, was recruited to Toronto in 1997 to assume the position of Division Chief of Respiratory Medicine. A recognized leader in integrative physiology and clinical research, he focuses on enhancing the bedside “half” of the “bench to bedside” research focus that has become part of the Research Institute’s vision of the future for The Hospital for Sick Children. Coates retired from the Division in July 2010. 

Over the past five years, the Division has joined with Respiratory Therapy and has greatly expanded the services of the latter in the Division of Emergency Medicine and on the general hospital wards. The Division has embraced the role of Clinical Nurse Specialist-Nurse Practitioners and several are fully integrated into the group. The Division has expanded its training commitments, its clinical service and its volume of work, establishing itself as the leading Division in Canada and one of the best in North America. 

In April 2005, Felix Ratjen, Professor of Pediatrics, University of Essen, assumed the position of Division Chief of Respiratory Medicine and he holds the Sellers Chair in Cystic Fibrosis. Ratjen obtained most of his medical training in Germany. After a research fellowship at the Children’s Hospital in Boston, he worked at the University of Essen, where he was appointed Deputy Chief of the Department of Pediatrics in 1998 and Professor of Paediatrics in 2001. He assumed the position of Chief Executive of the Scientific Board of the German Cystic Fibrosis Foundation in 2002-05 and was actively involved in activities of the European Respiratory Society activities including paediatric Task Forces on Bronchoscopy, Bronchoalveolar Lavage, Nitric Oxide and Interstitial Lung Diseases.  In addition to Felix’s role as Division Head to Respiratory Medicine he also became the Program Head for Translational Medicine at SIckKids Research Insititute.  

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