Curriculum standards
Knowledge guides
LG17: Chronic respiratory care
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
- Allergy
- Chest pain
- Chest tightness
- Cough (acute and chronic)
- Dysfunctional breathing
- Dyspnoea
- Fatigue
- Fever
- Haemoptysis
- Hypercapnia
- Hypoxia
- Night sweats
- Orthopnoea
- Recurrent infections
- Sleep disruption
- Snoring
- Somnolence
- Sputum production
- Stridor
- Symptoms related to environment or occupation exposures
- Tachypnoea
- Weight loss
- Wheeze
Conditions
Airways disorders
- Asthma
- Bronchiectasis
- Bronchiolitis
- Bronchitis
- Chronic obstructive pulmonary disease
- Cystic fibrosis
- Primary ciliary dyskinesia
Diffuse parenchymal lung disorders
- Granulomatous disorders (e.g., sarcoidosis)
- Diffuse disorders of a known cause:
- connective tissue disease-related lung disease
- drug-induced (medications and drugs of abuse) pneumonitis
- inflammatory bowel disease-related lung disease
- inflammatory myopathy-related lung disease
- organising pneumonia
- Hypersensitivity pneumonitis
- Idiopathic interstitial pneumonias:
- acute interstitial pneumonia
- cryptogenic organising pneumonia
- desquamative interstitial pneumonia
- idiopathic nonspecific interstitial pneumonia
- idiopathic pulmonary fibrosis
- respiratory bronchiolitis interstitial lung disease
- Interstitial pneumonia with autoimmune features
End-stage lung disease and transplantation
- Chronic hypoxic and/or hypercapnic respiratory failure
- Lung transplantation
- Severe pulmonary hypertension with right heart failure / core pulmonale
Environmental and occupational lung disorders
- Pneumoconiosis:
- asbestos-related lung disease
- coal workers’ pneumoconiosis
- farmer’s lung
- silicosis
Pulmonary infections
- Latent tuberculous infection
- Non-tuberculous mycobacterial infections
- Recurrent infections or pathogen colonisation in persons with underlying structural lung or airways disease or underlying immunocompromise
Pulmonary vascular disorders
- Pulmonary embolic disease
- Pulmonary hypertension (as per WHO classification)
- Pulmonary vasculitides
Smoking-related lung disorder
- Lung disease related to:
- marijuana
- tobacco
- vaping
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
Diffuse parenchymal lung disorders
- Alpha-1 antitrypsin disease
- Eosinophilic lung diseases
- Lymphangioleiomyomatosis
- Lymphocytic interstitial pneumonia
- Pulmonary alveolar proteinosis and granulocyte-macrophage colony-stimulating factor auto-antibody disease
- Pulmonary amyloidosis
- Pulmonary Langerhans cell histiocytosis
Environmental and occupational lung disorders
- Indoor and outdoor pollution-related lung injuries
- Other exposure-related lung disease
Large airways disorders
- Subglottic stenosis
- Tracheal stenosis
- Tracheobronchomalacia, including excessive dynamic airway collapse
- Tracheo- and broncho-oesophageal fistula
Pulmonary vascular disorders
- Diffuse alveolar haemorrhage syndromes
- Pulmonary vascular anomalies, including arteriovenous malformations
Systemic disorders with pulmonary overlap
- Chronic liver disease
- Histiocytic disorders
- Nonspecific airway changes, including lymphocytic bronchiolitis, lymphoid hyperplasia, and mild constrictive changes
- Ovarian hyperstimulation syndrome
- Telomere disorders
- Trafficking and lysosomal storage disorders
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
Diffuse parenchymal lung disorders
- Understanding of epidemiology, knowledge of heterogeneity in clinical, radiological, and histological presentations, and appreciation of multimodality assessment and multidisciplinary discussion in appropriate diagnosis and management of interstitial pneumonias
Environmental and occupational lung disorders
- Application of epidemiological risk factors in assessment and screening of persons suspected of having exposure-related or occupational lung disease
Pulmonary infections
- Apply local epidemiology of prevalence of microbes and drug susceptibility patterns in aiding appropriate diagnosis and management avenues, e.g., appropriate antimicrobial treatment for latent tuberculous infections
Small airways disorders
- Epidemiology of airways disorders, and causative risk factors
- Pathophysiology and genetics of cystic fibrosis, including knowledge of systemic manifestations, assessments of severity, and management approaches, including use of CFTR modulators
- Principles of pathophysiological mechanisms and pharmacological management of airways disorders
Investigations
- Blood gas analysis, including interpretation of arterial, venous, and capillary samples
- Capnography, including exhaled and transcutaneous samples
- Lung function tests:
- bronchial provocation testing, including direct and indirect methods
- bronchodilator response
- calculations of shunt fraction
- cardiopulmonary exercise testing
- diffusion assessment
- forced oscillometry testing
- fraction of exhaled nitric oxide
- high altitude simulation tests
- lung volume assessment techniques
- respiratory muscle testing, including maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressures, supine spirometry, and cough peak flow
- six-minute walk test
- spirometry, including office / bedside testing
- Oximetry, including continuous / overnight studies
- Polysomnography:
- address the benefits and limitations of different levels of polysomnography testing
- Positive airway pressure device downloads
- Radiological investigations:
- chest CT scan
- chest MRI
- chest x-ray
- contrast swallow tests
- fluoroscopy
- oesophageal manometry and pH monitoring
- right heart catheterisation and haemodynamic measurements (basic knowledge and interpretation)
- scintigraphy / nuclear medicine tests, such as:
- PET with / without integrated CT
- ventilation / perfusion scans
- ultrasonography:
- doppler ultrasound imaging and flow studies
- thoracic and pleural ultrasound
- trans-thoracic echocardiography
- Serological, cytological, histological, and ancillary testing for primary lung disease and systemic disorders with pulmonary overlap
Procedures
- Bronchoscopy, including endobronchial ultrasound (linear and radial modalities), flexible bronchoscopy (including single use), rigid bronchoscopy:
- advanced therapeutic modalities, such as APC, cryotherapy, and Nd-YAG laser
- bronchoscopic drug delivery
- brushings
- collateral ventilation assessment
- cryobiopsy
- cytology and microbiology from washings / bronchoalveolar lavage fluid
- fine needle aspiration
- forceps bronchial and transbronchial biopsy
- large airway debulking or stent placement
- Pleural:
- Procedure techniques:
- ambulatory and underwater seal drainage
- indwelling tunnelled pleural catheter
- large bore drain insertion
- needle thoracentesis
- small bore intercostal catheter insertion
- thoracoscopy
- Therapeutic interventions:
- intrapleural fibrinolysis and irrigation
- pleural fluid drainage
- pleurodesis
- Procedure techniques:
- Apply knowledge of genetics and pathophysiology of cystic fibrosis, and of evidence-based and guideline recommendations in the treatment and management of and in the prescription of CFTR modulator therapy for persons with cystic fibrosis
- Apply national and international evidence-based guidelines towards achieving optimal patient care
- Australian / Aotearoa New Zealand and local context and resource availability for delivering inpatient and outpatient personalised care
- Inter-relationships between systemic disorders, comorbidities, and pulmonary diseases and their impacts on presentation and treatment options
- Provide appropriate evidence-based prescription of preventive inhaler therapy for management of chronic airways disease
- Pulmonary rehabilitation:
- apply knowledge of components of a successful pulmonary rehabilitation program
- apply knowledge of evidence base supporting pulmonary rehabilitation in COPD and other lung diseases
- select patients most likely to benefit from pulmonary rehabilitation
- Role of advanced care planning, multidisciplinary care, pharmacotherapy, supplemental oxygen and positive airway pressure, and transplantation in management of severe or end-stage chronic respiratory disorders
- Role of chest physiotherapy techniques in management of sputum clearance
- Role of community and integrated care pathways in providing integrated care of chronic respiratory disease
- Role of multidisciplinary teams and various subspecialty practitioners in diagnostic and therapeutic elements of patient care
- Role of shared decision making in management of chronic respiratory disorders
- Role of various bronchoscopic techniques and lung biopsies in achieving diagnostic and therapeutic outcomes for undifferentiated and established diagnoses
- Understand the evidence base and provide appropriate prescription of domiciliary oxygen with use of appropriate interface and delivery devices
- Understand the importance of timing, forward planning, and principals of treatments for patients with respiratory disease in relation to palliative care referral. Further understand the indications and importance of patient selection of who will benefit from palliative care involvement.