• Home/
• Chapters/
• Paediatric respiratory medicine/
• Keeping up with developments

Keeping up with developments

Changes in the conditions that affect children, new therapies and societal expectations mean that PRM is constantly moving forward. Table 4 presents examples of the way in which changing attitudes to paediatric conditions have revolutionised treatment and improved survival for many. Ensuring that children with life-limiting conditions, such as cystic fibrosis and muscular dystrophy (a condition causing weakness of the muscles, including the muscles of breathing), survive into adulthood is one of the successes of PRM, and liaison with colleagues in adult respiratory medicine has been important and successful. One emerging subspecialty in adult cardiac medicine is care for adults born with congenital heart conditions; in future, there is likely to be more demand for adult respiratory physicians with expertise in conditions such as cystic fibrosis and bronchopulmonary dysplasia (a condition in infants born very prematurely and caused partly as a side-effect of being on a ventilator and partly due to the lungs having to develop outside the womb). In future, a better understanding of the treatment of rare but serious conditions in PRM (often termed ‘orphan lung diseases’), such as bronchiolitis obliterans, will emerge as colleagues in PRM across Europe collaborate.

Table 3 – Guidelines for diagnosis, testing and management of paediatric respiratory conditions. The list is not exhaustive. Guidelines in Europe and the USA are very similar. BTS: British Thoracic Society; SIGN: Scottish Intercollegiate Guidelines Network; GINA: Global Initiative for Asthma; iCAALL: International Collaboration in Asthma, Allergy and Immunology; PRACTALL: Practicing Allergology or Practical Allergy; ATS: American Thoracic Society; ERS: European Respiratory Society.

A final aspiration is that in the future, children with and without respiratory problems will be able to breathe better-quality indoor and outdoor air. It is hoped that this will be achieved through legislation aimed at reducing children’s exposure to second-hand smoke and car exhaust fumes. The poet William Wordsworth observed that ‘The child is the father of the man’ and we know that the origins of many adult chest conditions, including asthma and chronic obstructive pulmonary disease, are determined in early life. Improving the quality of air entering children’s lungs every time they breathe has to be a priority.

Table 4 – Conditions in which expectations have changed with implications for paediatric and adult respiratory medicine. ^#: assuming 5 million deliveries per year in Europe. ^¶: assuming 1 per 1000 born at ≤28 weeks’ gestation and one-third of these have bronchopulmonary dysplasia.

See the entire Paediatric respiratory medicine Chapter

• Close
• Print
• Easy read

Chapters

• Editors' introduction
• Foreword from the World Health Organization
• Foreword from the European Commission
• Promoting respiratory health in Europe
• The burden of lung disease
  • Introduction: the global perspective
  • Key points
  • Respiratory deaths in Europe
  • Figure 1
  • Figure 2
  • The impact on health services
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • The “iceberg of disease”
  • Figure 7
  • Recent trends
  • Figure 8
  • Figure 9
  • Figure 10
  • Future projections
  • Terminology and data
  • Data sources
• The economic burden of lung disease
  • Background
  • Key points
  • Methods
  • The cost of respiratory disease
  • Figure 1
  • Discussion
  • Further reading
• Genetic susceptibility
  • Introduction
  • Key points
  • Figure 1
  • Figure 2
  • Monogenic diseases
  • Complex diseases
  • Figure 3
  • Complex traits
  • Conclusions and future prospects
  • Further reading
• Early-life events
  • Introduction
  • Key points
  • Abnormal antenatal lung growth
  • Low birthweight
  • Prematurity and BPD
  • Figure 1
  • Tobacco smoke exposure
  • Viral infections in infancy
  • Wheezy bronchitis
  • Conclusion
  • Further reading
• Diet and nutrition
  • Introduction
  • Key points
  • Diet as a risk factor
  • Nutritional status and interventions
  • Clinical recommendations
  • Further reading
• Outdoor environment
  • Introduction
  • Key points
  • Pollution: composition/sources
  • Pathophysiological effects of air pollutants
  • Respiratory health effects
  • Long-term consequences
  • Figure 1
  • Respiratory disease in adults and children
  • Lung cancer
  • Figure 2
  • The importance of susceptibility
  • Relevance and outlook
  • Further Reading
• Occupational risk factors
  • Introduction
  • Key points
  • Figure 1
  • Exposure history and assessment
  • Latency between exposure and disease
  • Figure 2
  • Maximum workplace concentrations
  • Exposures and their effects
  • Further reading
• Passive smoking
  • Introduction
  • Key points
  • Harmful effects of SHS on health
  • Figure 1
  • Estimates of burden of disease due to SHS
  • Measurement of SHS
  • Health benefits of smoke-free legislation
  • Protection from exposure to SHS
  • Further reading
• Tobacco smoking
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Toxic effects of tobacco smoke
  • Disorders induced by tobacco smoking
  • Figure 2
  • Societal costs of smoking
  • Dependence on tobacco
  • Legislation and prevention of smoking
  • Figure 3
  • Pharmacotherapy for smoking cessation
  • Counselling for smoking cessation
  • Benefits of quitting smoking
  • Cost-effectiveness of smoking cessation
  • ERS guidelines on smoking cessation
  • Future developments
  • Conclusions
  • Further reading
• Indoor environment
  • Introduction
  • Key points
  • Indoor pollutants and health effects
  • Figure 1
  • Figure 2
  • Specific pollutants
  • Figure 3
  • Indoor air quality in schools
  • Figure 4
  • Interventions
  • Conclusion
  • Further reading
• Childhood asthma
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Causes/pathogenesis
  • Clinical manifestations and consequences
  • Prevention
  • Management
  • Prognosis
  • Future developments
  • Research needs
  • Further reading
• Adult asthma
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Causes/pathogenesis
  • Clinical manifestations
  • Figure 2
  • Figure 3
  • Prevention
  • Management
  • Prognosis
  • Future developments and research needs
  • Further reading
• Chronic obstructive pulmonary disease
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Figure 2
  • Figure 3
  • Causes/pathogenesis
  • Clinical manifestations
  • Prevention
  • Management
  • Prognosis
  • Future developments
  • Research needs
  • Further reading
• Cystic fibrosis
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Figure 2
  • Causes/pathogenesis
  • Clinical manifestations and consequences
  • Prevention
  • Management
  • Prognosis
  • Figure 3
  • Future developments
  • Research needs and unanswered questions
  • Further reading
• Bronchiectasis
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Causes/pathogenesis
  • Figure 2
  • Clinical manifestations and consequences
  • Prevention
  • Management
  • Prognosis
  • Future developments
  • Research needs
  • Further reading
• Paediatric respiratory diseases
  • Introduction
  • Key Points
  • Figure 1
  • Acute bronchiolitis
  • Figure 2
  • Figure 3
  • Perinatal respiratory diseases and BPD
  • Figure 4
  • Figure 5
  • Severe community-acquired pneumonia in children
  • Figure 6
  • Tuberculosis in children
  • Figure 7
  • Immunisation
  • Figure 8
  • Congenital respiratory disorders
  • General remarks
  • Further reading
• Tuberculosis
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Causes/pathogenesis
  • Clinical manifestations and consequences
  • Prevention and control
  • Management
  • Prognosis
  • Research needs
  • Future developments
  • Further reading
• Acute lower respiratory infections
  • Introduction
  • Key points
  • Figure 1
  • Influenza
  • Figure 2
  • Pneumonia
  • Figure 3
  • Figure 4
  • Figure 5a
  • Figure 5b
  • Figure 6
  • Prevention
  • Future developments
  • Further reading
• Lung cancer
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Figure 2
  • Figure 3
  • Causes
  • Prevention
  • Management
  • Prognosis
  • Figure 4
  • Future developments
  • Research needs
  • Further reading
• Acute respiratory distress syndrome
  • Introduction
  • Key points
  • Definition and diagnosis
  • Pathogenesis
  • Incidence and outcome
  • Treatment options
  • Future developments
  • Further reading
• Pulmonary vascular disease
  • Introduction
  • Key points
  • Figure 1
  • Figure 2
  • Pulmonary embolism
  • Figure 3
  • Figure 4
  • Pulmonary hypertension
  • Further reading
• Interstitial lung diseases
  • Introduction
  • Key points
  • Epidemiology
  • Figure 1
  • Figure 2
  • Causes/pathogenesis
  • Clinical manifestations and consequences
  • Prevention
  • Management
  • Prognosis
  • Financial burden
  • Figure 3
  • Figure 4
  • Research needs
  • Further reading
• Sleep breathing disorders
  • Introduction
  • Key points
  • Epidemiology
  • The pathophysiology of OSAS
  • Figure 1
  • Clinical manifestations and consequences
  • Prevention
  • Management
  • Figure 2
  • Figure 3
  • Prognosis
  • Obesity hypoventilation syndrome
  • Future developments and research needs
  • Further reading
• Occupational lung diseases
  • Introduction
  • Key points
  • Acute inhalation injuries
  • Occupational infections
  • Asthma
  • COPD
  • Interstitial lung diseases
  • Figure 1
  • Types of ILD
  • Lung cancer
  • Pleural disease
  • Figure 2
  • Figure 3
  • Prevention
  • Conclusion
  • Further reading
• Rare and orphan lung diseases
  • Introduction
  • Key points
  • Specific diseases
  • Diagnosis and support
  • Therapy
  • Future developments
  • Further reading
• Immunisation against respiratory diseases
  • Introduction
  • Key points
  • Influenza
  • Figure 1
  • Pertussis
  • Figure 2
  • Streptococcus pneumoniae
  • Figure 3
  • Tuberculosis
  • Figure 4
  • Developments and research needs
  • Further reading
• Principles of respiratory investigation
  • Introduction
  • Key points
  • History
  • Physical examination
  • Laboratory methods
  • Respiratory function tests
  • Figure 1
  • Imaging techniques
  • Figure 2
  • Figure 3
  • Invasive biopsy techniques
  • Figure 4
  • Further reading
• Principles of respiratory therapy
  • Introduction
  • Key points
  • Pharmacological therapy
  • Figure 1
  • Nonpharmacological therapy
  • Figure 2
  • Figure 3
  • Other forms of treatment
  • Further reading
• Pulmonary rehabilitation
  • Background
  • Key points
  • Definition
  • Rationale
  • Application
  • Outcome
  • Setting and content
  • What is needed?
  • Conclusion
  • Further reading
• Paediatric respiratory medicine
  • Introduction
  • Key points
  • Figure 1
  • Setting
  • Figure 2
  • Training
  • Standardisation of care: towards a common goal
  • Keeping up with developments
  • Conclusion
  • Further reading
• Respiratory intensive care
  • Introduction
  • Key points
  • The role of respiratory medicine in intensive care
  • Figure 1
  • Future prospects
  • Figure 2
  • Further reading
• Thoracic surgery
  • Introduction
  • Key points
  • Standards of care
  • Figure 1
  • Figure 2
  • Figure 3
  • Changing roles
  • The future
  • Further reading
• Medical respiratory specialists
  • Introduction
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
• Allied respiratory professionals
  • Introduction
  • Key points
  • Respiratory technologists and clinical scientists
  • Figure 1
  • Figure 2
  • Respiratory physiotherapists
  • Respiratory nurses
  • Further reading
• Primary care practitioners
  • Introduction
  • Key points
  • Primary care practitioners
  • Primary care and chronic lung disease
  • A role for primary care practitioners
  • Conclusion
  • Further reading
• Specialist clinical training (HERMES)
  • Specialist training in respiratory medicine
  • Key points
  • Figure 1
  • Development strategy for educational standards
  • Figure 2
  • The HERMES projects: adult respiratory medicine
  • Figure 3
  • Figure 4
  • The other HERMES projects
  • Conclusion
  • Further reading
• ERS School and postgraduate education
  • Introduction
  • Key points
  • The HERMES projects
  • The ERS School web platform
  • Figure 1
  • ERS School Courses
  • School publications
  • Educational research seminars
  • Skills-based, hands-on learning
  • Strategic developments in the School
  • Further reading
• Respiratory research
  • Introduction
  • Key points
  • Fields of research
  • Advances in respiratory biomedicine
  • Conclusion
  • Further reading
• Respiratory journals and publications
  • Introduction
  • Key points
  • Figure 1
  • General medical journals
  • Types of journal article
  • Peer review in respiratory journals
  • Assessing quality and status of respiratory journals
  • Publication ethics
  • Advances in publishing
  • Open access
  • Publications of the ERS
  • Conclusions
  • Further reading
• Patient organisations and the European Lung Foundation
  • Introduction
  • Key points
  • The role of patient organisations
  • Figure 1
  • Pan-European patient organisations
  • Respiratory diseases
  • Figure 2
  • Challenges
  • The future
  • Further reading
• Recommendations and policy
  • Introduction
  • Key points
  • Approach
  • Policy context
  • Noncommunicable diseases
  • Tobacco
  • Air quality
  • Tuberculosis
  • Conclusion
  • Further reading