History of the Firestone Institute for Respiratory Health (FIRH)
The Firestone Regional Chest and Allergy Clinic (FRCAU) was established in 1978 at St. Joseph’s Hospital (now part of St. Joseph’s Healthcare Hamilton), and was designated as the Regional Referral Centre by the District Health Council, at that time. The guiding principle behind the formation of the FRCAU was to provide exemplary clinical services and research excellence. Success in this endeavour was key to St. Joseph’s Hospital as Hamilton was re-designated, in 1999, as the regional centre for a coordinated network of respirology services among the area’s hospitals. By 2006, the regional referral centre was serving the Hamilton Niagara Haldimand Brant Local Health Integrated Network, a community of 1.4 million people.
From the outset, FRCAU was the main contributor to McMaster University’s respirology program, which embodied the principles that have characterized McMaster University’s innovative approaches to clinical medicine, education and research. The program was the first clinical subspecialty program to be established in the then-fledgling Department of Medicine, and very early on attracted highly qualified and productive research fellows and clinical trainees from Canada and from across the world. These trainees have made major contributions to research; some joined the clinical staff and academic department at McMaster, while many others achieved clinical and academic distinction elsewhere.
When the respirology program was established, the foundation for a respiratory intensive-care unit, ambulatory clinics for asthma and chronic respiratory disease and a clinical pulmonary-function assessment service was laid. The program allowed the early development of accredited specialty residency training based at St. Joseph’s Healthcare, utilizing the clinical expertise from all the area hospitals. An innovative undergraduate teaching unit was introduced, incorporating problem-based learning, a computer-simulation of cardiorespiratory function and a variety of other learning aids.
Initial research was driven by clinical programs. For example, a system for exercise testing was developed, normal standards were established and studies of inter-laboratory and intra-subject variability led to more-sophisticated quality-control techniques. Access to an established nuclear medicine laboratory and a gamma camera led to studies of aerosol particle distribution in the lung by Dr. Michael Newhouse and Professor Myrna Dolovich. Studies of disordered distribution and clearance in smokers and the factors influencing the distribution of inhaled bronchodilators followed. Dr. Stewart Pugsley and Dr. Gordon Guyatt developed standardized techniques for the assessment of severity and progression of chronic airflow limitation, including the six-minute walk test and assessment of the quality of life in the chronic respiratory care clinic. Other investigations included studies of lung mechanics during exercise, exercise-induced bronchoconstriction and its control and the effects of hypoxia in exercise. An early epidemiological study showed a relationship between hospital admissions for respiratory illnesses and indices of air pollution.
With the arrival of the late Dr. Freddy Hargreave, a number of asthma initiatives began and the succeeding years saw the development of a leading centre for asthma research. Foremost in the early research by his group was the development of histamine and methacholine challenge studies to quantify airway responsiveness, leading to the index of PC20. The technique was especially helpful in patients with asthma symptoms, but normal spirometry PC20 was shown to correlate with measures of variability of airflow limitation and to be clinically useful in indicating the need for escalating treatment modalities. In addition, the first validated Asthma Quality of Life Questionnaire and Asthma Control Questionnaire were developed by Ms. Elizabeth Juniper. The group hosted a conference on airway responsiveness in 1979 and the First Canadian Consensus Conference on asthma management, leading to the publication of first Canadian Asthma Guidelines in 1989, one of the first in the world.
Dr. Hargreave and the late Dr. Jerry Dolovich merged immunological techniques that assessed allergic responses with measures of airway responsiveness in order to quantify factors contributing to asthma severity. The early and late allergen-induced asthmatic responses were studied and shown to represent different immunological mechanisms. Dr. Dolovich’s research on nasal mucosa suggested ways in which the cellular response to antigen challenge might be studied in bronchial mucosa and sputum; the technique of inflammatory cell counts in induced sputum was developed and validated in 1989.
More recently Dr. Paul O’Byrne, as well as members of the Division of Immunology in the Department of Medicine at McMaster University, have expanded the usefulness of sputum induction to include measurement of cell progenitors and mediator concentrations. During the past 10 to 15 years, the FIRH group has standardized techniques related to symptom assessment, physiological impairment, allergen challenge, methacholine responsiveness and the cellular and mediator changes in induced sputum. These techniques have proved to be powerful tools in the investigation of biological mechanisms contributing to asthma, and in selecting management strategies.
FIRH moved into four floors within St. Joseph’s Hospital’s new 10-story Juravinski Innovation Tower, in 2004 and 2005, where modern and expanded clinical and research facilities allow FIRH to continue to move forward with the vision of providing world-class “bench-to-bedside” research.