Knowledge guides

LG13: Scientific foundations of paediatric respiratory medicine

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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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.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management and outcomes.

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  • Abnormal lung development:
    • congenital lung disease
  • Aerosol drug delivery:
    • aerosol delivery through different interfaces, such as:
      • endotracheal tubes
      • facemasks
      • spacers
      • tracheostomies
    • aerosol delivery through high flow, positive pressure (CPAP and BIPAP), and ventilator circuits
    • mechanisms and adverse effects of aerosol treatments
    • principles of aerosol delivery to the lungs
    • principles of infection control in aerosol therapy
    • principles of pressurised metered dose inhalers, dry powder inhalers, and nebulisers
  • Air pollution, including active and passive smoking / vaping
  • Biochemical abnormalities relevant to respiratory disease (e.g., pleural disease)
  • Cellular and molecular biology as it pertains to respiratory disease
  • Developmental immunology, immunology, and host defence mechanisms:
    • acquired immunity
    • antibody classes and function
    • atopy
    • cell mediated immunity
    • humoral immunity
    • hypersensitivity reactions
    • innate immunity
    • pulmonary defence mechanisms, particularly the role, makeup, and function of cilia, cough, and mucus
    • vaccines and vaccine responses
  • Developmental physiology of the respiratory system:
    • infant pulmonary physiology
    • physiology and development of the lung in the pre-term infant
    • pulmonary physiology and pathophysiology
    • the effects of early life lung disease on long term health
  • Effect of altitude on lung disease
  • Environment / Air quality and its impact on respiratory health outcomes
  • Fluid and caloric requirements, including alternative types of feed (e.g., Monogen)
  • Genetics of both common and rare but important respiratory conditions, such as cystic fibrosis and interstitial lung disease (ILD), and conditions that have comorbidities with respiratory disease, such as spinal muscular atrophy and Trisomy 21
  • Influence of upper airway disease on the lower airway
  • Methods for screening for exposure to environmental tobacco smoke, including urinary / salivary cotinine
  • Microbiology and infectious disease as it pertains to respiratory disease
  • Normal lung development:
    • alveolisation, airspace septation, and microvascular maturation
    • braking, grunting and lung protection strategies, airway closure and determination of end-expiratory level
    • developmental changes in chest wall compliance
    • developmental strategies, including the Hering–Breuer inflation reflex and preferential nasal breathing
    • dysynaptic lung growth
    • embryologic development
    • growth factors
    • maturation of control of breathing
    • mechanics of breathing in an infant
    • ongoing developmental changes throughout childhood, including the effect of puberty and ageing
    • vasculogenesis
  • Nutrition / Fluid management:
    • normal growth
  • Pharmacology:
    • biologics in respiratory disease
    • dosing and side effects
    • drug-drug interactions / contraindications of medications
    • effects of non-respiratory medications on the respiratory system
    • formulations of medications
    • mechanisms of action, including antibiotics, and recent therapeutic advances in respiratory health, such as biologics and CFTR modulators
    • monitoring of drug levels
    • pharmacodynamics
    • screening for adverse effects
  • Smoking and vaping:
    • adverse effects on health
    • specific effects on respiratory health
  • Structure and function of the respiratory system
  • The normal and abnormal structure and function of the components of the respiratory system:
    • airways (upper and lower)
    • alveoli (including type 2, Clara and goblet cells)
    • chemoreceptors
    • chest wall
    • interpretation of oxygen saturation and blood gases
    • interstitium
    • physiology of ventilatory drive and gas exchange
    • pulmonary vasculature
    • respiratory control centres
    • neural pathways (upper motor neuron and lower motor neuron)
    • respiratory muscles
    • smooth muscle and receptors
    • the oxygen-haemoglobin dissociation curve
Investigations
  • Altitude simulation tests and assessment of fitness to fly
  • Basic lung function tests, such as DLCO, lung volumes, and spirometry:
    • clinical implications of test results
    • clinical versus research role of the above investigations
    • operator-dependant and patient-related issues
    • reference values, including impact of reference values used on interpretation of results
    • role of sedation in infant lung function testing
    • technical aspects of tests, including limitations and data
  • Blood gas and measures of gas exchange
  • Cilia investigations, including:
    • cilial function testing
    • electron microscopy for cilial ultrastructure
    • nasal nitric oxide
    • primary ciliary dyskinesia (PCD) genotype
    • newborn screening test
  • Lung function tests that can be used in younger patients, such as multiple breath washout and forced oscillation testing
  • More complex lung function tests, such as bronchial challenge tests and cardiopulmonary exercise tests
  • Other tests:
    • allergy and delayed hypersensitivity tests (in conjunction with allergy team)
    • genetic investigations as pertains to respiratory conditions such as bronchiectasis, cystic fibrosis, ILD, and PCD
    • immunological investigations
    • sweat test and other functional tests for cystic fibrosis, such as faecal elastase
  • Polysomnography, including diagnostic and pressure titration studies:
    • the nature and limitations of abbreviated or limited channel sleep studies / gas exchange monitoring
  • Radiological tests:
    • bronchography
    • chest CT scan
    • chest x-ray
    • contrast swallow tests
    • echocardiography
    • fluoroscopy
    • MRI of the chest / dynamic imaging
    • oesophageal manometry and pH monitoring
    • scintigraphy / nuclear medicine tests
    • ultrasonography, including point of care ultrasound
  • Tests of respiratory muscle function (including maximal inspiratory and expiratory pressures, cough peak flow, and sniff nasal inspiratory pressure)
Procedures
  • Bronchoscopy (flexible):
    • anatomy of the lower airway
    • anatomy of the upper airway
    • bronchial anatomy, including lobar
    • cytology and microbiology from bronchoalveolar lavage fluid
    • management of intra- and postoperative complications
    • normal anatomical variants of airway anatomy
    • process of bronchoscopic intubation
    • segmental anatomy including 3D anatomy
    • the anaesthetic process and drugs used during bronchoscopy
    • the processes for sterilisation and maintenance of bronchoscopic equipment
    • visual appearance of congenital upper and lower airway lesions, such as bronchitis, haemangiomas, and tumours
  • Pleural:
    • diagnostic and therapeutic indications for pleural procedures
    • indications for pleural procedures
    • normal and abnormal anatomy of the pleura
    • physiology and biochemistry of pleural fluid
    • pleural anatomy and physiology
    • potential complications
    • procedural skills required
    • procedure risks and benefits
    • risks and benefits of each of the diagnostic / therapeutic interventions
    • sedation, topical anaesthesia, and analgesia
    • selection and assessment of patients for procedural intervention
  • Consideration of research / education opportunities
  • Critical analyses of literature relating to scientific foundations of paediatric respiratory medicine
  • Keeping up to date with current literature and guidelines and advanced technology (including potential implementation of AI, recent advances in imaging and microbiomes as pertains to respiratory health) in paediatric respiratory medicine