Curriculum standards: LG17: Chronic respiratory care

Knowledge guides

LG17: Chronic respiratory care

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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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Presentations

Apnoea
Chest pain
Concerns about breathing during sleep
Cough
Dyspnoea
Haemoptysis
Slow weight gain / Poor weight gain
Stridor
Syncope
Tachypnoea
Wheeze

Conditions

Chronic airway disease:
- asthma and related conditions
- cystic fibrosis and related conditions
- primary ciliary dyskinesia (PCD)
- protracted bacterial bronchitis and chronic suppurative lung disease / bronchiectasis
Chronic lung disease of prematurity
Congenital diaphragmatic hernia
Conditions relating to acute and chronic aspiration syndromes:
- feeding and swallowing disorders
Conditions relating to lung injury
Conditions relating to lung transplantation
Conditions relating to stem cell transplantation
Congenital lung malformations, including:
- bronchial atresia
- bronchogenic cyst
- bronchopulmonary sequestration
- congenital cystic pulmonary airway malformation
- congenital lobar emphysema
Diseases of the chest wall, spine, and respiratory muscles, including neurodisability
Disorders of breathing during sleep:
- non-obstructive
- obstructive
Disorders of the pleural space, including (but not limited to):
- chylothorax
- pneumothorax
Disorders of the pulmonary circulation, including (but not limited to) pulmonary hypertension
Environmental lung diseases
HIV / AIDS and its pulmonary manifestations
Interstitial and diffuse lung disease of childhood (chILD)
Newborn respiratory disorders
Obliterative bronchiolitis
Other orphan lung diseases
Paediatric thoracic tumours
Pleuropulmonary manifestations of systemic disease and extrapulmonary disorders
Pulmonary complications on the intensive care unit
Pulmonary conditions relating to hypereosinophilia
Pulmonary disorders in the immune-compromised host (excluding HIV / AIDS)
Pulmonary infections:
- bacterial
- fungal
- mycobacterial
- parasitic
- viral
Pulmonary haemorrhage syndromes and venous thrombo-embolic disease
Respiratory complications of congenital heart disease
Respiratory disorders related to syndrome / genetic conditions (e.g., Down syndrome, VACTRL)
Tracheoesophageal fistula

Investigations

Capnography
Longitudinal monitoring of chronic respiratory disease
Lung function testing (all the different modalities in clinical practice)
Overnight oximetry
Sleep study

Procedures

Aerosol delivery systems:
- correct use of different aerosol delivery systems
Airway management:
- indications
- management risks and benefits
- potential complications
- procedural skills required (e.g., nasopharyngeal airways)
- strategies for decannulation
- tracheostomy care
Chest physiotherapy and airway clearance techniques:
- basics of the different airway clearance techniques
- different airway clearance devices
- indications for chest physiotherapy / airway clearance
- medications which improve mucociliary clearance
- potential complications
- risks and benefits, including infection control consideration
- the role of exercise, vibrating vest devices, and cough-augmentation devices
Long term venous access:
- indications, benefits, and risks of long-term venous access
- long lines, central venous lines, peripherally inserted central catheters, and total implanted venous access devices
- management of complications
- management of long-term venous lines
- potential complications
- risks and benefits of long-term venous access
Lung transplant (with appropriate lung transplant physician support):
- absolute and relative contra-indications for referral
- indications for, and interpretation of, transbronchial biopsy
- indications for referral for consideration of lung transplantation
- issues relating to lung transplantation, including immunosuppression and complications (such as infection, malignancy, and renal disease)
Oxygen therapy
Smoking / vaping cessation (or appropriate referrals):
- concept of motivational interviewing techniques
- potential complications principles of smoking / vaping cessation for adolescents and adults
- risks and benefits of various strategies
- strategies to minimise exposure to environmental tobacco smoke / vapes
- understanding different smoking / vaping cessation strategies (pharmacological and non-pharmacological)
Ventilatory support in the chronic setting:
- different ventilatory strategies
- how to apply a mask and head gear to a child
- how to apply the principles of ventilation and adjustment of non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) settings
- how to monitor patient progress including compliance
- indications and limitations for ventilatory support interventions
- initiation, monitoring, and weaning
- intervention risks and benefits
- invasive ventilation
- NIV:
  - bi-level non-invasive ventilation (Bi-level NIV)
  - CPAP
  - high flow nasal cannula oxygen therapy (HFNC)
- potential complications
- the functioning of, and indications for, a variety of face masks use and management of humidification circuits in NIV

Consideration of cultural safety, and advocating for promotion of culturally safe health practices and management
Cystic fibrosis modulator therapies, and potential alternative therapies for those not eligible for modulator therapies
Impact of climate change on respiratory health, including:
- directly promoting or aggravating respiratory disease, such as asthma and respiratory infections
- increasing exposure to risk factors for respiratory diseases, such as chemical air pollutants and effect on aeroallergens
Increased life expectancy of patients with cystic fibrosis, and hence consideration of potential complications in people with cystic fibrosis, such as:
- cardiovascular complications
- gastrointestinal cancer
- impacts of cystic fibrosis on pregnancy and fertility
- mental health and wellbeing
Radiation dose related to CT scans and other imaging modalities, and variation between different equipment and scanning protocols
Smoking and vaping cessation strategies and interventions, including management of nicotine withdrawal in young people (both in hospital and community settings)
Use of biological agents in asthma and other respiratory diseases