The division provides high-level pediatric respiratory care through almost 4,000 patient visits per year at the Children’s Hospital of Eastern Ontario (CHEO) which serves 1.5 million in Eastern Ontario, Western Quebec, Nunavut and parts of Northern Ontario. The division also provides sleep laboratory studies to Eastern Canada.

This division is primarily concerned with the care of patients with complex, chronic or rare respiratory illness as well as the more severe spectrum of more common respiratory disease such as asthma.

The division includes five full-time physicians as well as two part-time community physicians, and one member of general pediatrics, general respiratory medicine and cystic fibrosis. There is also one allergist helping with asthma and atopic disease.

Related links

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

Inpatient care

While inpatient Respiratory Medicine is primarily a consulting service, inpatient cystic fibrosis care 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 rare respiratory illnesses such as interstitial lung disease.

Outpatient care

The division members see approximately 80 to 100 patients per week in several half-day clinics, with a total of 3,900 patient visits per year. These visits comprise the full spectrum of pediatric respiratory disease. Ongoing care is provided through CHEO’s outpatient clinic program.

Clinical problems and diseases evaluated and followed

• Asthma
• Cystic fibrosis
• Obstructive sleep apnea and sleep-disordered breathing
• Bronchopulmonary dysplasia
• Tracheoesophageal fistula
• Neuromuscular disease

Clinical areas of specific focus for the division include:

• General respiratory clinics treat a broad spectrum of general respiratory diseases, including asthma, supported by two qualified asthma educators
• Cystic Fibrosis clinic currently follows 100 patients who are seen approximately every three months
• Sleep clinic sees not only patients with sleep apnea and sleep-related hypoventilation but also patients with neurobehavioral issues such as nocturnal parasomnias and insomnia/suspected narcolepsy
• Complex Respiratory Care Service follows a number of patients with complex, chronic respiratory illnesses requiring a variety of technologies such as home oxygen, respiratory support devices including nighttime positive pressure ventilator support or full ventilation for continued survival
• Neuromotor Clinic is held every second Wednesday in a combined clinic with neurology, rehabilitation medicine and orthopedics. This clinic cares for children with a variety of neuromotor disorders, many of whom require partial or full ventilatory support
• Follow-up of patients with repaired tracheoesophageal fistula. This will occur either in the general chest clinic or in collaboration with a gastroenterologist in the gastroenterology clinic
• Complex Airway Clinic occurs once every two months in collaboration with Otolaryngology, following children with complicated upper airway and tracheobronchial disease

Diagnostic services

• Sleep laboratory – a fully equipped four-bed pediatric sleep laboratory currently performing around 480 overnight sleep studies per year, as well as occasional daytime multiple sleep latency test
• Pulmonary function laboratory - a two-room pulmonary function laboratory capable of performing the full range of standard pulmonary function tests
• Exercise laboratory - a full cardiopulmonary exercise laboratory shared with the Division of Cardiology
• Flexible bronchoscopy service - flexible bronchoscopies (40 per year) are performed by the division on all ages from premature infants to adolescents.

Members of the division of respirology are involved in three specific areas of research:

• The impact environment plays on aboriginal health
• Respiratory consequences of neuromotor disease, specifically in attempting to prevent or delay progression of respiratory disease
• Health outcomes research such as the development of systems and yardsticks to measure the impact of changes in health care provision

Undergraduate training opportunities

Respirology is an integral component of pediatrics. The majority of pediatric admissions, even if not directly due to respiratory illness, have a significant respiratory component leading to their admission. Respirology is covered during pre-clerkship training.

Drs. Tom Kovesi and Joe Reisman both contribute to the undergraduate teaching of respiratory disorders, with problem-based learning as a core component of the curriculum. Dr. Kovesi leads the undergraduate respirology curriculum.

Pediatric Respirology is covered to a degree during the pediatric rotations, with many students spending time in the respiratory medicine clinics, learning the spectrum of respiratory disorders seen as outpatients. As Respirology admits its patients to the general medicine wards, the clerks will also see the spectrum of respiratory disorders leading to hospitalization during their inpatient rotations. This will also provide the trainees exposure to teaching on the pathophysiology, diagnosis and management of the common respiratory (and rare) disorders in children.

Elective rotations through Respirology are also available as a subspecialty selective during undergraduate training.

Postgraduate training program

Respirology currently has no subspecialty or certified training programs.  

Additional postgraduate training

Respirology currently has no subspecialty training program. Members of the Division of Respirology do, however, provide postgraduate training to interested trainees, both as an integral part of the General Pediatric Residency training as well as to interested applicants as part of their available electives. Specific areas covered during these rotations include, but are not limited to:

• Cystic fibrosis
• Asthma
• Physiology of respiration (mechanics, control of breathing, hypoxemia and hypercapnoea)
• Sleep medicine, both respiratory (sleep disordered breathing) and non-respiratory (neurobehahavioural such as insomnia, as well as parasomnias)
• Rare pulmonary disorder (such as interstial lung disease)
• Bronchopulmonary dysplasia
• Pulmonary function testing

Interested trainees can apply for electives in general respiratory medicine, during which all of the above areas will be covered in some degree, or in specific areas, such as sleep medicine, where more comprehensive training will be provided.

Additionally, one or two division members typically contribute to the pediatric grand rounds every year on specific areas within Respirology that are worth reviewing in depth.