Curriculum standards
Knowledge guides
LG16: Airways, chest wall, and breathing
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
Lower airways
- Chest pain
- Cough
- Decrease in exercise capacity
- Dyspnoea (at rest and/or with exertion)
- Haemoptysis
- Respiratory distress (including in the newborn)
- Tachypnoea
- Wheeze
Other generalised symptoms
- Fatigue
- Fever
- Slow weight gain
- Syncope
Sleep disorders
- Apnoea during sleep
- Brief resolved unexplained event (BRUE) / Apparent life-threatening events (ALTEs)
- Daytime somnolence
- Disrupted sleep, including concerns about development or academic performance / daytime behaviour in the context of sleep-related symptoms
- Sleep-related hypoventilation, including congenital central hypoventilation syndrome
- Snoring and concerns about obstructive sleep-disordered breathing
Upper airway
- Cough
- Stertor
- Stridor
Conditions
Chest wall and breathing
- Chest wall deformity, including pectus excavatum
- Conditions affecting the chest wall
- Neuromuscular disease
- Scoliosis
Lower airways
- Allergic bronchopulmonary aspergillosis (ABPA)
- Aspiration syndromes
- Asthma
- Churg–Strauss syndrome
- Congenital airway anomalies:
- Suis bronchus
- Cystic fibrosis (CF)
- Drowning / Near drowning
- Eosinophilic pneumonias (acute, chronic, and drug-induced)
- Foreign body inhalation
- Idiopathic hypereosinophilic syndrome
- Inhalation lung disease, including EVALI
- Non-CF bronchiectasis
- Obliterative bronchiolitis
- Primary ciliary dyskinesia (PCD)
- Protracted bacterial bronchitis
- Recurrent aspiration / gastroeosophageal reflux
- Simple pulmonary eosinophilia (Loffler syndrome)
- Trachea / bronchomalacia
- Trachea-oesophageal fistula
Sleep
- Conditions causing central sleep-disordered breathing, including sleep hypoventilation syndromes / obesity hypoventilation
- Conditions causing obstructive sleep-disordered breathing
- Seizure disorders
Upper airways
- Acute conditions
- Adenoid / tonsillar hypertrophy / nasal turbinate hypertrophy
- Allergic rhinitis
- Choanal atresia
- Chronic conditions
- Congenital malformations of the upper respiratory tract
- Croup
- Diphtheria
- Epiglottitis
- Foreign body in airway
- Laryngeal cleft
- Laryngeal web
- Laryngomalacia
- Retropharyngeal abscess
- Sub-glottic stenosis
- Syndromes that affect the upper airway anatomy, such as:
- craniofacial condition
- Crouzon syndrome
- Pierre Robin sequence
- Tonsillitis
- Tracheitis
- Tracheoesophageal fistula
- Tracheomalacia
- Vocal cord palsy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
Chest wall and breathing
- Central respiratory drive:
- congenital or acquired
- Upper motor neuron:
- cerebral palsy
- hemiplegia
- quadriplegia
- Lower motor neuron:
- Guillain–Barré syndrome
- phrenic nerve palsy or paralysis
- poliomyelitis
- spinal muscular atrophies
- tetanus
- traumatic nerve injury
- Neuromuscular junction:
- botulism
- congenital myasthenic syndromes
- drugs
- myasthenia gravis
- Respiratory muscles:
- congenital myopathies
- eventration and other diaphragmatic malformations
- metabolic myopathies
- muscular dystrophy
- steroid myopathy
- Non-muscular, chest wall structures:
- congenital rib cage abnormality
- connective tissue disease
- giant exomphalos
- obesity
- thoracic burns
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Developmental changes in chest wall compliance, and effects of chest wall pathology on respiratory mechanics
- Knowledge of known sudden infant death syndrome risk factors (including social and family factors)
- Mechanics of breathing in an infant, child, and adolescent
- The normal and abnormal structure and function of the components of the respiratory system in relation to respiratory muscles (including neural mechanisms), chest wall, and airways (upper and lower)
Investigations
- Additional investigations for ALTE (non-respiratory):
- assessments for gastroesophageal reflux disorder
- electrocardiography, echocardiography, and Holter monitoring
- electroencephalography
- home apnoea monitors and home oxygen saturation monitoring
- Allergy testing
- Polysomnography (diagnostic and pressure titration study), and measurement of gas exchange
- Radiological imaging studies for assessment of airway (e.g., dynamic imaging and lateral neck x-ray)
- Radiological imaging studies for patients presenting with haemoptysis, including angiography and bronchial artery embolisation
- Respiratory function testing for assessment of airway and functions, such as forced oscillation technique and multiple breath washout
- Respiratory muscle strength testing (non-invasive and invasive), including maximal inspiratory and expiratory pressures and peak cough flow
- Spirometry, plethysmography, exhaled nitric oxide, and bronchial provocation testing
Procedures
- Bronchoscopy (flexible versus rigid) and laryngobronchoscopy
- Corrective surgery for chest wall deformities / spinal deformities
- Non-invasive ventilatory support
- Surgical intervention for airway abnormalities, including adenotonsillectomy
- Evolving treatment for children with neuromuscular disease (e.g., gene therapy and its impact on the respiratory functions of children with neuromuscular disease)
- NIV procedures for sleep-disordered breathing / airway management and utilisation of remote monitoring
- Perioperative multidisciplinary assessment for children requiring surgical intervention for chest wall abnormalities / spinal deformities
- Social and cultural factors that may affect the management of children with these disorders, including cultural safety