Overview

The Firestone Institute for Respiratory Health (FIRH) provides comprehensive outpatient and inpatient respiratory care and it provides the regional respiratory service for the City of Hamilton and the Hamilton Niagara Haldimand Brant Local Health Integrated Network.

FIRH has a unique Chest Programme that comprises respiratory medicine, head-and-neck/ENT surgery services and thoracic surgery services; all are located on one site.

The Institute is supported by state-of-the-art pulmonary function and sleep laboratories, an induced sputum analysis laboratory, an aerosol laboratory, a gastrointestinal motility laboratory, the departments of diagnostic imaging, critical care and endoscopy, and a regional laboratory-medicine programme.

The clinical service at St Joseph's has grown from a single specialist in 1968 to its present complement of close to 100 staff members encompassing respiratory physicians, allergists, thoracic surgeons, head and neck surgeons, nursing, respiratory technicians, cardio-pulmonary technologists, polysomnographic technologists, clerical support and additional allied health professionals.

In addition to a number of specialty services, the Firestone Clinic also offers consultation to patients with chronic suppurative lung diseases, pleural diseases and those who require long-term home ventilation. The clinic also houses a treatment facility, minor surgical and phlebotomy rooms and an audiovisual patient-education suite.

Facility

The Institute is supported by state-of-the-art pulmonary function and sleep laboratories, an induced sputum analysis laboratory, an aerosol laboratory, a gastrointestinal motility laboratory, the departments of diagnostic imaging, critical care and endoscopy, and a regional laboratory-medicine programme.

The clinic also houses a treatment facility, minor surgical and phlebotomy rooms and an audiovisual patient-education suite. To get the directions to the clinic, please follow the link.

Firestone Institute for Respiratory Health occupies roughly 24,000 square feet (sf) with 12,600sf for clinic operations and 11,400sf for wet and dry labs.  

The clinical and research areas accommodate the following:

• Methacholine  and exercise challenges;
• Allergen and occupational challenges, which require specific contained facilities;
• Sputum induction;
• Allergy skin testing;
• Minor procedures;
• Interviews;
• Pulmonary function testing and other respiratory testing

Clinical and dry laboratory / office based research areas for chest and allergy research:

• Specialty examination and treatment rooms and cubicles;
• Offices for all clinicians and researchers, including FIRH wet lab researchers, fellows and visiting scientists,
• Bio statistical services for FIRH and other research activities on-site.

Inpatient Respiratory Care Unit

Within St. Joseph's Healthcare, there are acute care beds dedicated to the treatment of patients with complex respiratory diseases, usually those who have not responded to treatment in the outpatient programme for chronic respiratory problems.

These beds are closely aligned with the pulmonary rehabilitation beds housed within the rehab programme. There are also dedicated beds for Thoracic Surgery, including surgical step-down beds. The programme also benefits from an inpatient room constructed solely for the delivery of radiation therapy for the treatment of thyroid disorders.

The programme committee structure supports a close co-operation between physicians, surgeons and the members of the multidisciplinary care team in what are usually complex clinical problems.

Outpatient Clinics

The clinics accommodate more than 36, 000 patient-visits yearly. In addition to clinics for general respiratory disease and asthma, clinics for allergic disorders, pulmonary fibrosis, sleep disorders, tuberculosis and thoracic surgery are held in the Firestone Institute.

The organization of the clinics ensures the complete investigation of patients in a timely fashion. The clinic has recently developed a dedicated Diagnosis Assessment Programme to provide rapid diagnosis for patients with suspected lung cancer.

This programme is unique in its relationship to Niagara Health System, providing care for patients closer to home.

Asthma Clinics

This ambulatory programme is organized to provide for optimal assessment and management of patients with asthma symptoms. Clinical consultation, spirometry, methacholine challenge and allergy skin-testing can be carried out at one sitting, and arrangements for an occupational asthma assessment, induced sputum examination, and diurnal peak flow and symptom diaries are made in appropriate situations.

Asthma Education

The importance of patient education in improving clinical outcomes in asthma was recognized early; educational methods such as video presentations and written guidelines were developed, tested and administered by the Firestone Clinic's staff. Diary cards and individualized Action Plans improved patient compliance.

Training of specialist professional staff was incorporated into the Canadian Network for Asthma Care, leading to a designation of Certified Asthma Educator. The Firestone Clinic is now one of the provincial sites participating in association Community Health Centres in the Primary Care Asthma Project. In the Firestone case, the programme is provided at the North Hamilton Community Health Centre.

Linkages to other community services are being actively explored in order to extend the penetration of this innovative programme within the region.

Collaborative Care Program

A dedicated outpatient programme for patients with severe chronic respiratory disease was established early in the life of the Firestone Clinic by Dr Stuart Pugsley and Mrs LA Robinson, clinical nurse specialist.

The clinic has improved care for patients with chronic respiratory disease by reducing the incidence of infective exacerbations and hospitalization. Improvements in home care followed, with a home oxygen and inhalation therapy service, and the ability to administer intravenous antibiotics.

Standardized methods of assessment (including the use of questionnaires and the six-minute walk test) were developed and employed in control trials of rehabilitation. Currently, four physicians work with nurse specialists and other members of the interdisciplinary health care team to care for these patients.

This outpatient programme is an essential component of the interdisciplinary Collaborative Respiratory Care Programme that also includes inpatient and day hospital respiratory rehabilitation and the Breathworks exercise programme at St Peters Hospital in Hamilton.

Adverse Reaction Clinic

At this clinic, Drs Joe Greenbaum, Paul Keith and Susan Wasserman provide assessment and management of drug reactions, stinging-insect allergy and urticaria.

Interstitial Lung Disease Clinic

The interstitial lung disease clinic was initiated by Dr. Michael Newhouse the founder and first Clinical Director of the Firestone Unit. The Alveolitis Clinic as it was called then was founded to provide an option for colleagues to obtain subspecialist review of their patients with these uncommon and complex disorders.

The Alveoloitis Clinic also provided opportunity for clinical research evaluating the role of such technologies as gallium scanning, lung epithelial permeability testing, and high resolution CT scanning. Since joining the faculty in 1992, Dr. Gerard Cox has led this clinic and currently he is joined by Dr. Martin Kolb. In addition to providing clinical care this resource is attended by all trainees in respiratory medicine and is a popular choice for elective rotations.

Patients attending the interstitial lung disease clinic have the opportunity to participate in treatment trials examining novel therapies for pulmonary fibrosis. The clinic provides an essential bridge to assist in the translation of advances in basic science to improved therapeutics.

Tuberculosis Clinic

The Tuberculosis Clinic takes a leadership role in providing screening and/or treatment to more than 350 new patients per year for a tuberculosis-related health issue. Ongoing monitoring of the existing patient base is also an important part of the work of this service.

The TB Clinic exemplifies a strong collaborative relationship with the Department of Social and Public Health (at City of Hamilton).

Lab Services / Sputum Lab

Initial physiological studies included spirometry, lung volumes, arterial blood gases, single-breath CO transfer capacity, and cardiopulmonary exercise testing. Later, methacholine airway responsiveness, lung mechanics, and control of breathing were added, bringing the lung function laboratory up to the highest international standards. In addition, the laboratory now offers sputum induction and cell counting, skin prick testing, and sleep studies. More than 40,000 procedures are carried out annually.

Thoracic Surgery

A strong team of Thoracic surgeons conduct clinics in FIRH, enabling collaborative consultation between medical and surgical teams regarding investigation and treatment of malignancies, emphysema and other conditions.

Pathology

The respirology service has been fortunate to have had the expertise of Dr JM Kay in providing diagnostic pathology services. Dr L Vincic, a recognized authority in pulmonary pathology, now provides this essential service in collaboration with Dr J.C. Cutz.

Please call 905-522-1155 using the following extension: