Paediatric respiratory disorders account for approximately 25% of acute paediatric hospital admissions and Ireland is now ranked 4th highest in the world for paediatric asthma. Allergic disorders in Paediatrics are an increasingly more recognised entity with recent advances in patient care in Neonatal Intensive Care units internationally. Neonates of younger gestational age are surviving but with significant chronic lung disease because of prematurity. Ireland has one of the highest incidences of Cystic Fibrosis worldwide and newer treatments are ensuring improved survival and quality of life. Paediatric flexible bronchoscopy with broncho alveolar lavage, lung function and allergy testing are available at tertiary Paediatric Respiratory Centres.
There are in the order of 1,700 new cases of lung caner each year in the Republic of Ireland. Virtually all of these cases present in the first instance to a primary care practitioner. Areas of respiratory medicine such as sleep apnoea represent a large under-diagnosed pool of cases in primary care, often only presenting when medical or occupational issues arise. Better awareness, early diagnosis and referral for simple and effective treatment can have a major impact.
Diseases of the lung parenchyma are common but are often under-diagnosed. They now represent a major group requiring treatment, palliative care and consideration for lung transplantation. While there is a reduction in prevalence, tuberculosis still represents a threat which, because of the primarily hospital based care, is a concern to general practitioners. Education in this area will allay fears and allow more useful and efficacious referral patterns.
Course Modules
This programme comprises four modules which are directed at areas of respiratory medicine of particular relevance to primary care and care in the community. Disease entities are dealt with from the point of view of overlap between the Hospitals and the community service. The role of the primary care team in early diagnosis, preventative approaches and early initiation of appropriate treatment will be a major focus.
Paediatric Respiratory and Allergic Disorders
Airways centred disease is a major aspect of respiratory medicine. Asthma and chronic obstructive lung disease together contribute at least 50% of the overall respiratory disease burden. It is estimated that there are 440,000 individuals with COPD in Ireland and a further 470,000 with asthma.
Cystic Fibrosis is another major disease, primarily of the lung, which has an airway focus. Cystic fibrosis being a genetic disease with particular relevance to the Irish population is of particular importance in many areas of respiratory medicine including infectious disease, hospital based care, community and family based care the use of devices such as home Nebulizers and ultimately in the field of lung transplantation. In addition less common diseases of the airways, both as stand alone conditions and as part of systemic diseases, are an important component of the overall spectrum of airways disease.
Airways diseases including Cystic Fibrosis
The upper airway in respiratory disease both benign and malignant, with an emphasis on sleep related disorders
Cancer affecting the lung is a major aspect of respiratory medicine. Primary carcinoma of the lung is responsible for, on average, 1,600 deaths per year in Ireland with roughly a similar number of new cases annually. Secondary lung involvement from cancers of organs such as, Breast, Renal, and Lymphoma present commonly as issues in pulmonary medicine.
Disease of the pleura is a common issue in respiratory medicine and may represent malignant (as in primary disease such as mesothelioma) or secondary disease as commonly occurs in e.g. breast cancer or benign entities such as systemic disease involvement, infectious disease (pleurisy and emphysema) or pneumothorax. Lung cancer is the commonest cause of cancer death in Ireland with in excess of 1,700 new cases per year nationally. Recent developments have focused on the TMN staging system, rapid access clinics nationally, use of diagnostic modalities of increasing sophistication including PET/CT scans, EBUS and EUS mediastinal evaluation, and molecular diagnostic techniques.
The upper airway is an important component of the respiratory system. It provides conditioning and filtering of inspired air, the sinus are important in voice quality and nasal function and are important sites of disease which impact heavily on the lower respiratory tract. The upper airway is also subject to the ill effects of inhaled toxins, notably tobacco smoke, and is also fundamentally important in maintaining airway patency during sleep.
The vocal cords and surrounding muscle, cartilage, neurological connections and mucosa are important in protecting the lower respiratory tract from aspiration of acid oesophageal secretions and from foreign bodies.
Lung Cancer and sleep-related disorders
Disease of the lung parenchyma is a major element of respiratory disease and the term is used here in the sense of non-airways disease. Thus, affecting primarily alveolar structures as against airways or other lung/chest components. This category of disease includes the interstitial lung diseases (e.g. sarcoidosis, idiopathic pulmonary fibrosis), which are increasingly important in respiratory medicine.
Diseases more specific to the alveolar sacs themselves include entities such as alveolar infection and non-infectious entities such as eosinophilic pneumonia. Pneumonia, in its simplest form being community-acquired pneumonia, is a major cause of in-hospital and out-of-hospital death and disability. More complex infectious processes affecting the lung parenchyma are also a major aspect of respiratory medicine with major implications for illness, death and consumption of medical resources. Tuberculosis, one such complex disease, is still a common problem in clinical practice and there is a large overlap between hospital-based practice, community based practice and public health medicine in TB management. This is one of the many overlaps between hospital based care and primary care which will be stressed in this and other modules in the course. Pulmonary hypertension either as a primary condition or secondary to existing diseases of the lung, are important and rapidly developing parts of respiratory medicine.
Parenchymal lung diseases and lung infection/tuberculosis
Paediatric respiratory disorders account for 25% of acute paediatric hospital admissions. Ireland is now ranked 4th highest in the world for paediatric asthma. The number of children with asthma in Ireland has increased significantly over the last decade, with no obvious cause. While the vast majority of children with asthma are treated by general practitioners acute exacerbations of asthma account for a significant proportion of winter hospitalisations in paediatrics. Recent studies in the literature examine the role of the newer treatments available for asthma, the most common chronic lung disease in children.
Ireland has one of the highest incidences of cystic fibrosis (CF) worldwide, yet is one of the last countries to introduce newborn CF screening. Newborn CF screening is planned to be introduced in 2011 in the Republic of Ireland and will provide both new challenges and opportunities for all doctors caring for children and their families.
Paediatric allergic disorders are increasingly more commonly seen both in general practice and hospital medicine. Bronchiolitis is the most common cause of acute paediatric hospitalisation in children <1 year of age and may have significant and long term complications. Bacterial pneumonia continues to remain a significant cause of morbidity and incorrectly treated may lead to significant complications e.g. empyema requiring surgery etc. Laryngo tracheo bronchitis, gastro-oesophageal reflux, foreign body aspiration, congenital airway and lung lesions, chronic lung disease of prematurity and sleep disordered breathing are disorders seen regularly in a paediatric population requiring specific treatment and referral pathways. More recently, a wide range of specialised tests are available for investigation of paediatric respiratory and allergic disorders: from lung function testing to paediatric flexible bronchoscopy.
