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
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:
- 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:
- 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
