Airway diseases

1. Basic principles of rehabilitation programmes
2. Role of exercise training programmes in COPD
3. Identification of COPD patients who may benefit from rehabilitation
4. Assess physical de-conditioning, symptoms of depression and poor quality of life
5. Exercise training, nutritional and psychosocial counselling, behavioural change, occupational therapy and progressive relaxation techniques in selected patients with lung cancer
6. Participate in a multidisciplinary team (MDT) with other specialists in the specific field
7. Patient/family communication – advantages of participating in rehabilitation programmes

1. 1. End-of-life relief for patients with dyspnoea by:
      1. Drug administration
      2. Non-invasive ventilation (NIV)
   2. Pain relief
   3. End-of-life decision-making with patients and their relatives
   4. Early integration of palliative care, multidisciplinary care and communication

1. Weight reduction
2. Exercise
3. Influenza vaccination
4. Pneumococcal vaccination
5. Other vaccines
6. Smoking cessation
7. Allergen avoidance
8. Specific preventative management in each disease (asthma, COPD and others)
9. ENT part

1. Smoking cessation
   1. Effects of smoking on the health of the individual in relation to lung and other diseases. Beneficial effects of smoking cessation for preventing lung and other diseases
   2. Smoking cessation therapy (pharmacological and non-pharmacological) in groups and individuals
2. Tobacco risk factors and epidemiology
   1. Current epidemiology of active and passive smoking worldwide and nationally
   2. Pathogenic mechanisms of lung cancer associated with tobacco
   3. Nicotine addiction and withdrawal symptoms
   4. Plan smoking cessation for an individual patient
   5. Refer patients to a tobacco cessation specialist
   6. Communicate the effects of tobacco consumption to patients and their families in a clear and understandable manner
   7. Encourage and support individuals to quit smoking
   8. Discourage passive smoking
   9. Specific risk and management of vaping (E-cigarettes), Vaping-induced lung injury

1. Modes and principles of non-invasive MV
   1. Indications for NIV in patients with acute COPD exacerbation, chronic respiratory failure in COPD and acute severe asthma
   2. Appropriate time and location (ward, intensive care unit (ICU), etc.) to start NIV
   3. Risks and benefits of NIV to the patient
   4. Identify situations where NIV is contraindicated or expected to be unsuccessful
   5. Alternative treatment modalities
   6. Communicate the limitations of NIV to the patient
2. Side effects and complications of NIV
   1. Select appropriate medications to support NIV tolerance without compromising the respiratory status of the patient
3. Continuous positive airway pressure (CPAP)
   1. Functional principle of CPAP
   2. Role and function of CPAP in hypoxemic respiratory failure due to other causes
   3. Select the correct CPAP/expiratory positive airway pressure settings to treat functional upper airway collapse and hypoxaemia/hypercapnia when indicated
   4. Choice and application of the appropriate interface
   5. Monitor results following a change in settings
   6. Willingness to explain CPAP to the patient and to illustrate which responses can potentially be achieved with this treatment
4. Withdrawal of NIV
   1. If, when and how NIV can be withdrawn after successful treatment
   2. Monitoring/follow-up process in these patients
   3. Rationale to switch patients to chronic/continuous NIV
   4. Circumstances that permit step-down to CPAP or oxygen therapy
   5. Plan to guide withdrawal from NIV
   6. Follow-up plan to promptly detect relapses requiring NIV
   7. Patient communication (discuss the patient approach and instruct him/her how follow-up should occur)

1. Chest tube insertion, maintenance of the tube and drainage systems and insertion of a decompression needle for tension pneumothorax
2. Indications, contraindications and risks of chest tube insertion and needle decompression
   1. Anatomic sites for tube placement or needle insertion
   2. Different thoracentesis systems (open preparation versus trocar tubes)
   3. Drainage and suction systems
3. Perform chest tube insertion and needle decompression
4. Manage complications as appropriate with support from different specialities
5. Discuss the risk, benefits and results of the procedures with the patient and/or his/her family

1. Indications for lung transplantation, e.g. COPD according to severity of illness and bronchiolitis
2. Principles of evaluation for lung transplantation
3. Severity grading of lung diseases with respect to referring a patient to a transplant centre
4. Monitoring and treatment of patients with severe respiratory insufficiency before lung transplantation

1. Evaluation, differential diagnosis, immediate management steps, first-line treatment and specific conditions
2. Diagnosis and first-line treatment of:
   1. Severe/life-threatening exacerbation of asthma
   2. Severe exacerbation of COPD
   3. Tension pneumothorax

1. Acute upper respiratory tract infection
   1. Rhinitis/rhinosinusitis
   2. Pharyngitis
   3. Epiglottitis
   4. Laryngitis/laryngotracheitis
2. Persistent rhinitis/rhinosinusitis
   1. Allergic
   2. Non-allergic
   3. Association with lung disease (asthma, cystic fibrosis (CF), ciliary diseases, granulomatosis with polyangiitis and others)
3. Vocal cord dysfunction and paralysis
4. Laryngeal cancer: topics relevant to respiratory physicians (association with smoking/lung cancer and tracheostomy)

1. Epidemiology of asthma (prevalence, mortality, morbidity, burden on society, etc.)
2. Differential diagnosis (DD) Allergic bronchopulmonary aspergillosis
3. DD Differentiation from eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss Syndrome)
4. Risk factors in asthma:
   1. Genetics of asthma
   2. Atopy and bronchial hyper-responsiveness (BHR))
   3. Environmental risk factors
   4. Viral infections
5. Mechanisms in asthma / immunology of asthma
6. Early life risk and protective factors and underlying mechanisms
7. Pathology of asthma
8. Diagnosis of asthma
9. Pheno/endotypes of asthma
10. Evaluation of asthmatic patients
    1. Allergy testing (in vivo and in vitro)
    2. Airway inflammation (NO, blood eosinophils, sputum and exhaled breath)
11. Monitoring of asthmatic patients
    1. Asthma control
    2. Instruments, Patient-Reported Outcome Measurements-PROMS
12. Non-pharmacological treatment
    1. Allergen immunotherapy
    2. Avoidance of allergens/other
    3. Breathing techniques
    4. Psychological support
13. Pharmacological treatment
    1. Principles of inhalation therapy (see above)
    2. Asthma medication (see above)
    3. Principles of asthma treatment (step treatment, change of step, etc.)
14. Patient education
    1. Disease
    2. Treatment
    3. Self-management (written plan)
15. Exacerbation of asthma
    1. Risk of death from asthma
    2. Evaluation: severity assessment
    3. Management
16. Asthma with chronic airway obstruction
17. Definition of severe and difficult-to-treat asthma
18. Evaluation of severe and difficult-to-treat asthma Status asthmaticus – pathophysiology of asthma
19. Principles of recognition of status asthmaticus
20. Indication for oxygen therapy, NIV and intubation
21. Pharmacology and side effects of anti-asthmatic drugs
22. Principles of delivery of and response to aerosol therapy
23. Possible complications of status asthmaticus (e.g. pneumothorax and pneumomediastinum) and their management
24. Indications for non-pharmacological treatment (e.g. oxygen therapy and MV)
25. Providing outpatient and inpatient care as well as emergency and ICU treatment
26. Translation of national and international management recommendations for status asthmaticus to individualised management
27. Recognition and management of patients at risk of life-threatening asthma requiring intubation
28. MV of status asthmaticus patients
29. Willingness to translate guidelines to a customised approach for an individual patient
30. Up-to-date knowledge of emergency therapeutic strategies
    1. Gastroesophageal reflux and asthma
    2. Work-related asthma

1. Epidemiology of COPD (prevalence, mortality, morbidity, burden on society, etc.)
2. factors:
   1. Smoking
   2. Environmental risk factors
   3. Genetic risk factors
   4. α1-antitrypsin deficiency
3. Pathology and physiopathology of COPD
4. Mechanisms of COPD / immunology of COPD
5. Early life risk and protective factors and underlying mechanisms
6. COPD diagnosis (clinical suspicion and spirometry)
7. Evaluation of COPD patients
   1. Pulmonary component
   2. Blood eosinophils
   3. Extrapulmonary effects (comorbidities)
8. Exercise testing in COPD
9. Pharmacological management
   1. Bronchodilators
   2. Other drugs
10. Non-pharmacological management
    1. Oxygen therapy
    2. Pulmonary rehabilitation
    3. Smoking cessation
    4. Long-term NIV
    5. Vaccinations
11. Exacerbation of COPD
    1. Severity assessment
    2. Drug treatment
    3. Oxygen therapy
    4. NIV
    5. Invasive ventilation
    6. Characterisation/aetiology (e.g. bacterial, viral, eosinophilic etc)
12. Depression and anxiety in COPD

1. Subtypes of bronchiolitis
2. Diagnosis and treatment
3. Macleod syndrome
4. Causes of bronchiolitis obliterans

1. Causes
2. Mechanism underlying the development of bronchiectasis
3. Diagnosis of bronchiectasis
   1. CT
4. Microbiological assessment
5. Aetiological diagnosis
6. Exacerbation
7. Management
   1. Antibiotics (systemic and inhaled)
   2. Physiotherapy/pulmonary rehabilitation
   3. Vaccinations
   4. Oral/inhaled mucolytics
   5. Allergic Broncho-Pulmonary Aspergillosis (ABPA)
   6. Other

1. Diagnostic criteria of severe sepsis and septic shock including the causative disease and laboratory and other tests necessary to assess severity
2. Clinical implications and therapeutic support measures for these conditions
3. Detection of patients that potentially have these conditions and the causative disease
4. Choosing the most appropriate tests to assess severity and to implement therapeutic support measures
5. Willingness to respond immediately and to identify appropriate diagnostic and therapeutic measures
6. Systemic inflammatory response syndrome (SIRS)
   1. Diagnostic criteria of SIRS, the causative disease, clinical implications and treatment of this condition
   2. Detection of patients with SIRS and the causative disease
   3. Implementation of therapy
   4. Willingness to differentiate SIRS from sepsis

1. Hospital-acquired and opportunistic infections in critically ill patients in the ICU
2. Predisposing factors including immunosuppression
3. Diagnostic criteria
4. Most frequent etiologic pathogens and recommended empiric treatment for each infection
5. Detection and diagnosis of these patients
6. Implementation of appropriate diagnostic methods
7. Appropriate selection of empiric treatment
8. Willingness to detect hospital-acquired and opportunistic infections in critically ill patients and to implement diagnostic tests and therapy

1. Pathology, biology and immunology
2. Anti-TB agents
   1. Different anti-TB agents and their spectrum of activities in different mycobacterial infections
   2. Prescribing anti-TB agents in first-line combinations
   3. Recognition of the adverse effects of anti-TB agents
   4. MDR- and XDR-TB

1. Epidemiology of lung cancer
2. Aetiology and risk factors of lung cancer
3. Personalised treatment of lung cancer (radiotherapy, (personalised/targeted) chemotherapy, immunotherapy and their interactions)
4. Side effects of lung cancer treatment
5. Staging
6. Management options
7. Preoperative evaluation for lung resection
8. Paraneoplastic syndrome
9. Identification of immunotherapy and diffuse metastasis as causes of respiratory failure

1. Sleep-disordered breathing (SDB)
   1. Physiology and pathophysiology of sleep apnoea syndromes relevant to ARF
   2. Diagnosis and screening of OSA, upper airway obstruction and hypoventilation
   3. Interpretation of blood gases and other tests for SDB
   4. Recognition of obesity as a cause of weaning failure in obese patients
2. OSAS
   1. Definitions of SDB (OSA, OSAS, central sleep apnoea (CSA), CSA syndrome (CSAS), Cheyne-Stokes respiration (CSR), obesity hypoventilation syndrome (OHS), upper airway resistance syndrome (UARS) and snoring)
   2. Define SDB and discuss the definitions (e.g. OSA, OSAS, CSA, CSAS, CSR, OHS, UARS and snoring)
3. OSA
   1. Diagnostic evaluation of patients presenting with SDB
4. Clinical aspects of OSA
   1. Describe the characteristics of subjective impairment and signs
   2. Describe the characteristics of the mouth, throat and craniofacial configuration
   3. List the cardiovascular signs
   4. Clinical examination of the mouth and throat
5. Comorbidities of OSA
   1. Summarise cardiovascular disease
   2. List the metabolic consequences
6. Treatment and follow-up
   1. Treatment of respiratory sleep disorders
   2. OSA
   3. Treatment pathways including:
      1. Review of treatment modalities
      2. CPAP

1. Central hypoventilation syndrome
   1. Evaluate and diagnose daytime hypercapnia by control of blood gases, transcutaneous capnography and body weight/clinical muscle assessment
   2. Assess indications for NIV; application or supervision of a mask and interface
   3. Explain the illness and risk of obesity and offer advice about how to decrease body mass index (BMI) through physical activity, training and diet
   4. Teach the patient how to use a NIV device
2. Obesity hypoventilation syndrome
   1. Recognise the symptoms and clinical presentation
   2. Understand the pathophysiology of obesity hypoventilation syndrome
   3. Explain the consequences (polyglobulia and cor pulmonale)
   4. Define hypercapnic respiratory failure
   5. Explain OSA
3. Treatment
   1. Treatment pathways
   2. Compare different methods of NIV and additional indications for oxygen supply
   3. Select treatment methods including changing inappropriate lifestyles and reducing body weight
   4. Recognise the advantages and disadvantages of different treatment options according to the patient’s tolerance
4. NIV
   1. Explain different NIV methods applied using various interfaces
   2. Review indications for CPAP, bilevel pressure, adaptive servo ventilation and pressure support
   3. Classify ventilatory modes (spontaneous S, time T and ST)
   4. Apply treatment modalities and set and adjust the device properly
5. Follow-up and compliance
   1. Explain objective and subjective compliance
   2. Discuss side effects
   3. Estimate tolerance
   4. Evaluate the efficiency of the selected treatment method and NIV method (mask comfort etc.) based on patient interviews and polysomnography

1. Causes of respiratory failure
2. Principles of BGA interpretation
3. National and international guidelines for treatment of acute and chronic hypercapnic respiratory failure
4. Indications for additional O2 treatment
5. Indications for long-term (home) MV

1. Clinical aspects
2. Diagnostic modality and treatment of different subtypes, including life-threatening organ involvement (heart, central nervous system and others)

Clinical features

1. Diagnostic approaches and treatment of specific disorders
2. Importance of holding an MDT meeting at least once per month
3. Biological aspects
4. COP of unknown aetiology/bronchiolitis obliterans organising pneumonia
5. Assessment of small airways using a CT scan

1. Entities and network with rheumatologists (MDT)
2. Biological aspects

1. Biology, clinical, radiological and laboratory features
2. Diagnostics and molecular aspects
3. New treatment modalities

1. Biology, clinical, radiological and laboratory features
2. Diagnostics (Vascular Endothelial Growth Factor D – Precursor (VEGF-D), biopsy, etc.)

1. List of drugs that commonly lead to lung disease
2. Knowledge of the Pneumotox website

1. Diagnosis and treatment
2. Differential diagnosis of chronic eosinophilic leukaemia and idiopathic chronic eosinophilic pneumonia

Distinction of different subtypes according to molecular biology

Prophylaxis against thromboembolic disease

1. Conditions/diseases associated with an increased risk of thromboembolic disease
2. Adverse effects associated with anticoagulation therapy
3. Interpretation of coagulation laboratory tests
4. Drug indications and their appropriate dosages

1. Pathophysiology of pulmonary hypertension
2. Pharmacological treatment of pulmonary hypertension according to the underlying disease
3. Diagnosis of pulmonary hypertension and cor pulmonale
4. Translating national and international management guidelines to an individual patient
5. Appropriate decisions for referral and transfer to specialised referral centres
6. Prognosis of patients with pulmonary hypertension in acute care settings

1. Identify chest wall abnormalities as a cause of restrictive lung disease, respiratory failure and weaning failure

1. Neuromuscular disease causing respiratory failure
2. Neuromuscular conditions associated with respiratory muscle weakness
3. Symptoms and signs of nocturnal hypoventilation and the probability of respiratory failure
4. Role of NIV versus invasive ventilation and cough augmentation (cough assist) techniques
5. Assessment of respiratory muscle strength (e.g. vital capacity)
6. Assessment of non-invasive respiratory muscle strength (e.g. mouth pressures and sniff inspiratory pressure)
7. Measurement of cough peak flow
8. Use of NIV
9. Clinical assessment of bulbar function

1. Diaphragm weakness as a cause of respiratory failure and weaning failure
2. Differential diagnosis of diaphragm weakness
3. Therapeutic options for diaphragm weakness
4. Pathophysiology of critical illness associated with respiratory muscle weakness
5. Prevention of critical illness associated with respiratory muscle weakness
6. Ultrasonography as a tool for diaphragmatic assessment

1. Neutropenic patients
2. HIV-infected patients
3. Lung and other solid organ transplant recipients
4. Haematopoietic cell transplant recipients
5. Secondary immunodeficiency induced by drugs and biologicals
6. Primary immune deficiency syndromes

1. Differentiate between cardiac and pulmonary disease as a cause of ARF
2. Differential diagnosis of cardiac causes of ARF

1. Gastroesophageal reflux (asthma, IPF, chronic cough and other) and gastrointestinal management in ARF (ICU or intermediate care and non-invasive or invasive ventilation)

1. Management of obese patients
   1. Pathophysiologic effects of morbid obesity on the respiratory system (upper airways, respiratory mechanics and central respiratory drive)
   2. Principles of drug dosing in morbid obesity
   3. Recognition of obesity as a cause of respiratory impairment
   4. Interpretation of BGA and polysomnography results
   5. Initiation of non-invasive respiratory treatment
   6. Initiation of therapy for obesity-associated respiratory problems
2. SDB
   1. Physiology and pathophysiology of sleep relevant to ARF
   2. Diagnosis and screening of OSA, upper airway obstruction and hypoventilation
   3. Interpretation of blood gases and further tests for SDB
   4. Recognition of obesity as a cause of weaning failure in obese patients
3. Obesity hypoventilation syndrome
   1. Recognise the symptoms and clinical presentation and understand the pathophysiology of obesity hypoventilation syndrome
   2. Explain the consequences (polyglobulia and cor pulmonale)
   3. Define hypercapnic respiratory failure
   4. Explain OSA
   5. Evaluate and diagnose daytime hypercapnia by control of blood gases, transcutaneous capnography and body weight/clinical muscle assessment
   6. Interpret blood gases
   7. Assess indications for NIV; application or supervision of a mask and interface
   8. Explain the illness and risk of obesity and offer advice about how to decrease BMI through physical activity, training and diet

1. Genetics of CF
2. Pathophysiology of CF
3. Systemic effects of CF (diabetes, malabsorption, liver problems, etc.)
4. Infection control
5. Infection surveillance
6. Universal precautions
7. Isolation and reverse isolation, including specific microbes in CF and bronchiectasis (e.g. Pseudomonas)
8. Infectious risks to healthcare workers

1. Genetics
2. Incidence
3. Prevalence
4. Phenotypes
5. Screening
6. Associated diseases (liver)
7. Treatment options (including transplantation and when to initiate an investigation)

1. Inhalation of smoke and chemicals (e.g. chlorine gas and mustard gas) and burns as causes of respiratory failure
2. Assessment of the degree of severity of pulmonary involvement
3. Optimal treatment of inhalation injury, including systemic effects

1. Prevalence and incidence of thoracic malignancies in areas with air pollution
2. Air pollution factors that cause lung cancer
3. Potential mechanisms underlying carcinogenicity of compounds related to air pollution
4. Regulatory issues
5. Relationship between cancer and air pollution
6. Relationship between air pollutants and thoracic malignancies
7. Identify patients with considerable exposure to air pollution carcinogens
8. Identify symptoms caused by a patient’s exposure to air pollution
9. Impact of air pollution in thoracic malignancies to patients and their families in a clear and understandable manner
10. Support campaigns for the prevention of air pollution
11. Feedback to public health authorities regarding concerns about clustering of cases
12. Discourage patients from emitting indoor/outdoor air pollutants
13. Support task forces/initiatives for the elimination of air pollution

1. Epidemiology
2. Pathophysiology; our understanding is evolving at present as it can be seen as a vascular problem as well leading to cardiocerebrovascular complications.
3. Clinical presentation, natural history, sequelae
4. Investigations
5. Treatment; evolving and there are also controversial elements
6. Vaccine development
7. Personal protection for healthcare workers
8. How COVID-19 as affected all aspects of healthcare; precautions that need to be taken when dealing with suspected and confirmed cases
9. Psychosocial, psychiatric, financial, travel implications (not to be emphasised too much in our syllabus but important to recognise them)
10. Medical and technological innovations resulting from the pandemic; avenue for research, development, publications