Setting

Children are usually defined as individuals who are ≤16 years of age. This age group experiences frequent respiratory symptoms: all children will cough (mostly due to respiratory infections) and up to one half have had wheezing by 5 years of age. Children, in particular those under 5 years of age, have the highest burden of respiratory symptoms of all age groups in the general population. The majority of paediatric respiratory illnesses are mild and resolve on their own or respond to treatment given in primary care. In most small hospitals, all paediatricians care for children with acute respiratory illnesses, although some paediatricians may have a special interest in respiratory paediatrics and work with a PRM team in their regional centre. A small proportion of children with severe and/or persistent respiratory problems will be cared for by a regional PRM team. Referral to the PRM team can come from a general practitioner or a hospital doctor who does not specialise in PRM; in some countries, parents can arrange an appointment with the PRM team directly.

Driver Example
Changing epidemiology Asthma ‘epidemic’ during 1980s and 1990s
Changing expectations Expertise in paediatric respiratory medicine cannot always be provided by general paediatricians
New treatments/interventions Management of sleep breathing disorders
Changes in working patterns EU working time directive
Table 1 - Changes that have an impact on paediatric respiratory medicine. EU: European Union.

Almost all PRM teams are based in large city hospitals; figure 2 indicates where interactions with other specialties may occur. Expertise within the respiratory team includes the following areas: asthma, cystic fibrosis, sleep breathing disorders, intensive care, noninvasive ventilation, bronchoscopy (a flexible telescope used to examine the airways) and research. Individual members within a single PRM team will have expertise in several areas and, depending on the number of individuals within the team, all areas may be covered in one hospital; in some hospitals, certain areas of expertise, such as bronchoscopy and sleep breathing disorders, may not be covered. Very few hospitals demonstrate expertise in certain highly specialised areas; caring for children before and after lung transplantation, for example. Clinical areas such as allergy, neonatology, paediatric intensive care and infectious disease have considerable overlap with PRM but are subspecialties in their own right in many countries (although allergy and PRM are considered a single specialty in some countries).

See the entire Paediatric respiratory medicine Chapter