Respiratory Medicine

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. 

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

A $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. 

Dr. Reshma Amin (nominated PI) received funding (CIHR, Muscular Dystrophy Canada, Boehringer Ingelheim, ProResp, Medigas, 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 Pizzuti, manager 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.   

This is a 2-year program that trains residents to become Royal College certified pediatric respirologists. We emphasize both clinical expertise as well as research/scholarly experience. It is the largest pediatric respiratory training program in Canada and provides experience in both common and rare respiratory clinical conditions.

Program Goals and Objectives

The overall objective of this training program is to provide an academic educational opportunity that enables the resident with previous experience in General Paediatrics to obtain the clinical, and laboratory knowledge, skills and attitudes to function as a clinical consultant in Paediatric Respiratory Medicine.

At completion of the two year training period the candidate should be capable of functioning independently as a consultant with a thorough understanding of the fundamental principles of pulmonary physiology and pathophysiology, and a detailed knowledge and experience in the management of paediatric respiratory disorders. The trainee should be capable of supervising a clinical paediatric pulmonary function laboratory, demonstrate scholarship, and have a defined approach toward continuing medical education.

Program Highlights

The training program has Royal College of Physicians and Surgeons of Canada accreditation and is the largest training program for Pediatric Respiratory Medicine in the country. It provides the full range of training that is required for board certification.

Competency By Design (CBD)

Competency By Design (CBD), Competency Based Medical Education (CBME) has officially launched as of July 2021 with our program. 

Over the course of the 24 months, trainees will move through the stages of CBD from Transition to Discipline (TTD), Foundations of Discipline (FOD), Core of Discipline (COD), and Transition to Practice (TTP). Trainees will be assessed using Work Based Assessments (Entrustable Professional Activities). Promotion between stages is reviewed at the Competence Committee and is based on successful completion of EPA's. 

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

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

The training program has Royal College of Physicians and Surgeons of Canada accreditation and is the largest training program for paediatric respiratory medicine in the country. The training program provides broad training in all the major areas of respiratory medicine with opportunities to develop clinical, research and scholarly skills. Our program offers two years of training based in core clinical aspects of respiratory medicine including consults, wards and ambulatory care.

This is a 1–2 year subspecialty program to provide clinical competence in Paediatric Sleep Medicine and/or Long-term Ventilation (LTV). We have the largest Paediatric Sleep and LTV programs in Canada and a well established training program in these respective areas. Eligible candidates are required to have successfully completed a Paediatric Respiratory Medicine residency program prior to the proposed start date.

The content and duration of the training program can be individually tailored to suit the trainee’s interest, including:

• 1 year Clinical in Sleep Medicine
• 1 year, 18 months, or 2 year Clinical in Sleep Medicine and LTV
• 2 year Clinical and Research in Sleep Medicine
• 2 year Clinical and Research in Sleep Medicine and LTV

Sleep and LTV Fellowship applications are due 10 months in advance of the program start date (July 1).

Key dates for the 2025 Sleep/LTV Fellowship Program

Applications will reopen March 1, 2024 and will close on September 1, 2024.

Required documents:

• Letter of intent, stating the applicant's reasons for applying to the fellowship, as well as their academic goals
• A copy of the applicant's medical degree and specialty certification if applicable, with English translation, where applicable
• A complete up-to-date curriculum vitae which includes the applicant’s date of birth, citizenship, clinical and research experience and an email address
• A current passport-size photograph
• 3 letters of reference

Submit required documents via email to:
Dr. Sundeep Bola, Sleep Program Director, and
Dr. Jackie Chiang, LTV Program Director, and
SickKids Respiratory Medicine Training Program, respmed.trainingprogram@sickkids.ca

Medical Students

Electives are accepted for two 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 respmed.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 respmed.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.