1. Pleura
2. Lungs
3. Bronchopulmonary segments
4. Trachea and bronchi
5. Hila
6. Pulmonary vasculature and lymphatic drainage
7. Mediastinum
8. Diaphragm
9. Development

1. Anatomical barriers including epithelial cell function
2. Reflex mechanisms (sneezing, cough and smooth muscle contraction)
3. Mucociliary clearance and fluid homeostasis

1. Physiology of tidal breathing: active inspiration and passive expiration
2. Relative elastic properties of the lungs and chest wall
3. Lung volumes
4. The Rahn diagram and transpulmonary pressures

1. Normal pulmonary vascular pressures and flows
2. Active hypoxic regulation of the pulmonary circulation
3. Non-invasive evaluation of the pulmonary circulation

1. Control systems
2. Peripheral chemoreceptors
3. Central chemoreceptors
4. Neural organisation in the brain stem for control of respiration
5. Testing the control system
6. Ventilatory responses to CO2
7. The hypoxic ventilatory response
8. Interaction between hypoxic and hypercapnic responses
9. Disturbances in the control of breathing
10. Control of breathing in pulmonary diseases
11. Type 1 respiratory failure
12. Type 2 respiratory failure
13. Respiratory stimulants

1. Airway resistance
2. Lung and chest wall compliance
3. Measurement of respiratory mechanics in mechanical ventilation
4. Respiratory muscle strength: maximum inspiratory pressure, maximum expiratory pressure and sniff nasal inspiratory pressure, Magnetic twitch pressure

1. Transfer factor of the lung for carbon monoxide (TLCO)
2. Definition
3. Technique
4. Calculation of TLCO and measurement of the carbon monoxide transfer coefficient (KCO)
5. Implications of KCO × VA = TLCO
6. Transfer factor of the lung for nitric oxide (TLNO) and TLCO/TLNO measurement

1. ABG:
   1. Step 1: evaluation of the utility of ABG, capillary blood gas and venous blood gas
   2. Step 2: diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and pH
   3. Step 3: more on A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2), the alveolar gas equation and measuring oxygen shunts
2. ABG analysis
   1. Principles of measured and calculated ABG data
   2. Physiology and pathophysiology of oxygenation, carbon dioxide removal and acid-base homeostasis
   3. Assessment and appropriate use of ABG data during the diagnostic process
   4. Calculation of secondary parameters such as the A-aO2 gradient, PaO2/FiO2 ratio and anion gap
   5. Selection of appropriate treatment to correct ABG abnormalities

1. Spirometry interpretation:
   1. Interpret the flow-volume loop (by shape)
   2. Pulmonary function testing to assess respiratory mechanics and gas exchange, including spirometry, flow-volume studies, lung volumes and diffusing capacity
2. Measurement principles of flow spirometry, body plethysmography, gas dilution methods and diffusion capacity including all measured (primary) and calculated (secondary) parameters

1. Sensation of dyspnoea
   1. Pathophysiology of dyspnoea sensation
   2. Quantification of dyspnoea sensation
   3. Treatment for dyspnoea sensation
2. Thoracic pain/tightness
3. Cough and sputum
4. Systemic symptoms

1. Airway secretions
2. Effort of breathing
3. Haemodynamic assessment
4. Systemic signs

1. Differential diagnosis of acute hypercapnic respiratory failure
2. Differential diagnosis of acute hypoxic respiratory failure

1. Different approaches to flexible bronchoscopy in spontaneously breathing patients and those on high-flow nasal therapy, non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV)
2. Bronchoscopy
   1. Goals of bronchoscopy (therapeutic/diagnostic)
   2. Effects and side effects (risks and benefits) of bronchoscopy in secretion management (e.g. risk of atelectasis)
   3. Indications for NIV during bronchoscopy
   4. Monitoring requirements for the procedure
   5. Appropriate setting for bronchoscopy according to the patient’s condition
   6. Patient consent
   7. Selection and application of appropriate topical and systemic medications for the procedure
   8. Selection and mounting of appropriate interface that allows bronchoscopy during NIV
   9. Selection and applying the appropriate ventilator settings to achieve optimal ventilator support and minimise the side effects of bronchoscopy
   10. Set up of the monitoring equipment for bronchoscopy
   11. Performance of bronchoscopy
3. Diagnostic bronchoscopy including airway examination and bronchoalveolar lavage
   1. Indications, contraindications and risks of bronchoscopy and lavage
   2. Principles of patient preparation for bronchoscopy and evaluation prior to bronchoscopy
   3. Principles of sedation management during bronchoscopy
   4. Airway anatomy
   5. Bronchoscopy technique including biopsy and lavage equipment
   6. Different routes to perform bronchoscopy (artificial airway, oral cavity, nasal cavity and during NIV)
   7. Methods to treat endobronchial bleeding during bronchoscopy including the limitations of these measures
   8. Management of sedation during bronchoscopy
   9. Bronchoscopy (pass the upper airway and locate all accessible segmental ostia)
   10. Mucosal biopsy
   11. Bronchoalveolar lavage
   12. Therapeutic bronchoscopy (through an artificial airway) to remove secretions
   13. Indications, contraindications and risks of therapeutic bronchoscopy via an artificial airway
   14. Ventilator management when bronchoscopy is performed during ventilation
   15. Techniques to supply oxygen when bronchoscopy is performed during spontaneous breathing through an artificial airway
   16. Therapeutic bronchoscopy through an artificial airway
4. Foreign body airway aspiration
   1. Pathophysiology and complications of gross and silent aspiration
   2. Indications for flexible or rigid bronchoscopy
   3. Performance of flexible bronchoscopy and recognition of indications for rigid bronchoscopy

1. Diagnostic and therapeutic thoracentesis
   1. Indications, contraindications and risks of thoracentesis
   2. Anatomic sites for thoracentesis
   3. Different thoracentesis systems (closed versus open, cannula, Seldinger technique, etc.)
   4. Performance of thoracentesis
   5. Recognition of appropriate procedure-related complications
   6. Appropriate management of complications with support from different specialties
   7. Chest trauma (e.g. flail chest, pulmonary contusion and rib fractures)
   8. Pathophysiology of the clinical signs of haemothorax/pneumothorax, cardiac contusion and aortic injuries
   9. Indications for chest tube drainage/needle thoracentesis in cases with chest trauma
   10. Principles of pain evaluation and its impact on cough
   11. Indications for mechanical ventilation
   12. Diagnostic work-up in cases with suspected chest trauma
   13. Interpretation of imaging in cases with chest trauma
   14. Insertion of a chest tube in cases with tension pneumothorax or haemothorax
   15. Treatment of pain to avoid sputum retention
   16. Recognition of empyema
   17. Principles of empyema treatment (antibiotics, thoracic drainage and thoracic surgery)
   18. Thoracentesis in cases with empyema
   19. Interpretation of laboratory results of thoracentesis in cases with empyema
   20. Initiation of appropriate antibiotic therapy in cases with empyema
2. Performing thoracentesis in cases with pleural effusion
3. Thoracentesis in cases with suspected haemothorax

1. Radiological correlates of chest organs and bony chest structures
2. Describing radiological findings of a chest radiograph
3. Recognition of abnormal results and formulation of a diagnosis
4. Changes in chest X-rays during mechanical ventilation, recruitment manoeuvres and positive pressure ventilation
5. Position of central venous lines, a endotracheal tube and a nasogastric tube
6. Risks associated with chest radiography (irradiation)

1. Lung ultrasound for differential diagnosis of acute respiratory failure
2. Lung ultrasound for monitoring treatment effects
3. Ultrasound for diaphragm assessment
4. Ultrasound for haemodynamic assessment

1. Identify causes of acute respiratory failure (ARF)
2. Effects of ventilator settings (recruitments) on atelectasis
3. Risks associated with CT in (ventilated) patient (irradiation, transport)

1. Culture, PCR results and ELISA
2. Choose and obtain the appropriate respiratory sample

1. Inhalation therapies and humidification
2. Principles and the physiologic and anatomic basis of airway conditioning
3. Principles of inhaled drug therapy in invasively and non-invasively mechanically ventilated patients
4. Indications, limitations and side effects

1. Basic principles of physiotherapy
2. Physiological rationale and technical issues of non-invasive tools for secretion management and cough assist in spontaneously breathing and non-invasively supported patients
3. Use of devices to train inspiratory muscles
4. Positive expiratory pressure therapy: rationale and devices

1. End-of-life relief of dyspnoea by:
   1. Drug administration
   2. NIV
   3. High-flow nasal oxygen (HFNO)
   4. Discuss end-of-life decisions with patients and their relatives

1. Oxygen transport and utilisation
   1. Mechanisms involved in oxygen transport and tissue oxygenation
   2. Clinical conditions that compromise oxygen transport and utilisation
   3. Diagnostic and therapeutic strategies aimed at improving oxygen transport and utilisation
   4. Physiology oxygen delivery (i.e. cardiac output × arterial oxygen content)
   5. Early recognition and treatment of generalised or local hypoxia/hypoxaemia
   6. Differentiation between oxygen saturation (SaO2) and pO2 in blood gas analysis (BGA)
   7. Proactive attitude in early recognition and management
2. Practical skills: modes and principles of oxygen supplementation
   1. Oxygen uptake and delivery
   2. Indications and contraindications for oxygen therapy
   3. Gas pressure and liquid oxygen systems as well as oxygen blenders
   4. Different probe systems used to administer oxygen during spontaneous breathing, including their impact on FiO2
   5. Oxygen humidification
   6. Appropriate selection of an oxygen system, flow rate and FiO2
   7. Appropriate selection of tests to monitor oxygen supplementation
   8. Selection of appropriate patients for HFNO, excluding patients who require (non)invasive ventilation or low-flow oxygen

1. Indications for NIV
2. Contraindications for NIV
3. Side effects and complications of NIV
4. Continuous positive airway pressure
5. Failure of NIV
6. Humidification during NIV
7. Circuits
8. Synchronies/dyssynchronies during NIV
9. Ventilator modes and parameters
10. Technical maintenance
11. Withdrawal of NIV
12. Interfaces for NIV

1. Principles of IVM in the general intensive care unit (ICU) population
2. Principles of IMV in ICU patients with specific pulmonary conditions (e.g. acute respiratory distress syndrome (ARDS))
3. Modes of ventilation and their indications and principles of intelligent modes of ventilation.
4. Effects of positive airway pressure on gas exchange, respiratory mechanics and haemodynamics
5. Ventilation modes (e.g. assist versus assisted modes, and auto-modes)
6. Interpretation of flow and pressure curves
7. Types of humidification systems and their indications
8. Indications for nebulisation of bronchodilators and mucolytic drugs
9. Nebulisation systems and their advantages and disadvantages
10. Adjustment of ventilator settings to:
    1. Optimise gas exchange according to BGA
    2. Prevent haemodynamic compromise
    3. Minimise the risks of ventilator-induced lung injury (VILI)
11. Titrate positive end expiratory pressure (PEEP) according to different methods
12. Initiate and set the right level of PEEP
13. Diagnosis and recognition of barotrauma
14. Management of barotrauma (pneumothorax)
15. Effectively communicate with patients about the risks and benefits of invasive ventilation versus NIV
16. General principles of monitoring
17. Pressure and volumes (applied)
18. Hazards of mechanical ventilation
19. Patient-ventilator interaction
20. Rescue
21. IMV in specific patient groups
22. Weaning
23. Long-term complications

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
3. Anatomic sites for tube placement or needle insertion
4. Different thoracentesis systems (open preparation versus trocar tubes)
5. Drainage and suction systems
6. Perform chest tube insertion and needle decompression
7. Manage complications as appropriate with support from different specialties

1. Evaluation, differential diagnosis, immediate management steps, first-line treatment and specific conditions
2. Diagnosis and first-line treatment of:
   1. Massive pulmonary bleeding
   2. Massive pulmonary embolism
   3. Acute pulmonary oedema
   4. Acute respiratory distress syndrome
   5. Tension pneumothorax
   6. Tracheal stenosis

1. Pathophysiology of asthma
2. Status asthmaticus
3. Principles of recognition of status asthmaticus
4. Indications for oxygen therapy, NIV and intubation
5. Pharmacology and side effects of anti-asthmatic drugs
6. Principles of delivery of and response to aerosol therapy
7. Possible complications of status asthmaticus (e.g. pneumothorax and pneumomediastinum) and their management
8. Indications for non-pharmacological treatment (e.g. oxygen therapy and mechanical ventilation)
9. Provision of outpatient and inpatient care as well as emergency and ICU treatment
10. Translation of national and international management recommendations for status asthmaticus to individualised management
11. Recognition and management of patients at risk of life-threatening asthma requiring intubation
12. Mechanical ventilation of status asthmaticus patients
13. Knowledge of emergency therapeutic strategies

1. Hospital-acquired and opportunistic infections in critically ill patients
2. Most frequent infections acquired in the ICU, their predisposing factors including immunosuppression, their diagnostic criteria, the most frequent etiologic pathogens and recommended empiric treatment for each infection
3. Detection and diagnosis of these patients
4. Implementation of appropriate diagnostic methods
5. Appropriate selection of empiric treatment
6. Most frequent support measures in critically ill and immunosuppressed patients, including haemotherapy, antimicrobial treatment and life support measures such as mechanical ventilation, vasoactive drugs, renal replacement therapy and immunostimulation
7. Establishment of indications for each support measure and selection of the most appropriate measure in each clinical condition

1. Detection and diagnosis of these patients
2. Implementation of appropriate diagnostic methods
3. Selection of empiric treatment

1. Identify immunotherapy and diffuse metastasis as causes of respiratory failure
2. Discuss the appropriateness of mechanical ventilation for patients with lung cancer during the diagnostic process

1. Physiology and pathophysiology of sleep apnoea syndromes relevant to ARF
2. Diagnosis and screening of obstructive sleep apnoea, upper airway obstruction and hypoventilation
3. Interpretation of blood gases and other tests for sleep-disordered breathing
4. Recognition of obesity as a cause of weaning failure in obese patients

1. ARF
   1. Physiology and pathophysiology of ARF
   2. Respiratory pump function and dysfunction
   3. BGA
   4. Difference between hypoxia and hypoxaemia
   5. Imaging (e.g. chest X-ray)
   6. National and international guidelines for treatment of ARF
   7. Evaluation, performance, interpretation and reporting of BGA, O2 saturation, transcutaneous CO2 measurement, chest X-ray (imaging) and lung/chest wall mechanics
2. Hypoxemic respiratory failure including ARDS
   1. Causes of hypoxemic ARF
   2. Definition and classification of ARDS
   3. Ventilator and tube-associated complications
   4. Intubation-associated pneumonia (IAP)
   5. Protective mechanical ventilation and VILI
   6. Identification and management of hypoxemic ARF
   7. Indications for NIV in patients with hypoxemic ARF
   8. Risk assessment and management of NIV failure and indications for intubation
   9. Intubation and IMV
3. Acute and chronic hypercapnic respiratory failure
   1. Causes of respiratory failure
   2. Principles of interpretation of BGA
   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) mechanical ventilation
   6. Management of patients with prolonged weaning
   7. Non-IVM
   8. Care for patients that are highly dependent on mechanical ventilation, e.g. those with a tracheostomy
4. Pleural diseases in patients with severe respiratory failure
   1. Pathophysiology of restrictive thoracic/pleural diseases that cause severe respiratory failure
   2. Various types of chest tubes and insertion techniques
   3. Recognition of pleural diseases as a cause of severe respiratory failure
   4. Performance of ultrasound examination of the pleural space
   5. Interpretation of pleural pathology on chest X-rays
   6. Chest tube insertion: technical issues must be considered to drain located effusions in some cases with organising parapneumonic pleural effusions
   7. Interpretation of laboratory findings in patients with pleural effusion

1. Identify acute ILD as a cause of ARF
2. Differential diagnosis and optimal testing
3. Choose the optimal treatment
4. Prognostication of the identified ILD
5. Hypersensitivity pneumonitis
6. Sarcoidosis
7. Idiopathic interstitial pneumonias
8. Cryptogenic organising pneumonia of unknown ethology/bronchiolitis obliterans organising pneumonia
9. Connective tissue disease related to ILD
10. Langerhans cell histiocytosis
11. Amyloidosis
12. Lymphangioleiomyomatosis
13. Pulmonary alveolar proteinosis
14. Drug-induced disease
15. Radiation-induced disease
16. Non-asthmatic eosinophilic bronchitis
17. Acute and chronic eosinophilic pneumonia
18. Hypereosinophilic syndrome
19. Identification of exacerbation of idiopathic pulmonary fibrosis as a cause of ARF and provide differential diagnosis as well as optimal treatment

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. Insertion of pulmonary artery catheter and interpretation of wave-forms.
5. Translating national and international management guidelines to an individual patient
6. Appropriate decisions for referral and transfer to specialised referral centres
7. Prognosis of patients with pulmonary hypertension in acute care settings

1. Differential diagnoses, diagnostic steps and therapeutic options for pulmonary haemorrhage and haemoptysis
2. Triage by severity
3. Localisation of haemorrhage by bronchoscopy
4. Performance of bronchoscopic interventions
5. Initiation of ventilatory assistance
6. Recognition of the technical limitations of bronchoscopic interventions and immediate referral of patients to the appropriate specialty

1. Symptoms of AV malformation
2. Diseases associated with AV malformation
3. Diagnostic strategies when AV malformation is suspected
4. Therapeutic interventions

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

1. Neuromuscular conditions associated with respiratory muscle weakness
2. Symptoms and signs of nocturnal hypoventilation and the probability of respiratory failure
3. Role of NIV versus invasive ventilation and cough augmentation (cough assist) techniques
4. Assessment of respiratory muscle strength (e.g. vital capacity)
5. Assessment of non-invasive respiratory muscle strength (e.g. mouth pressures and sniff inspiratory pressure)
6. Measurement of cough peak flow
7. Use of NIV
8. Clinical assessment of bulbar function
9. Causes, assessment and prognosis of coma
10. Principles of the assessment of coma severity (i.e. Glasgow coma scale)
11. Clinical assessment of coma
12. Differential diagnosis of coma
13. Indications for airway protection and mechanical ventilation
14. Guillain-Barré syndrome
    1. Causes, subtypes, pathophysiology and natural history
    2. Diagnostic methods and treatments (plasmapheresis and immunoglobulin)
    3. Amyotrophic lateral sclerosis (ALS)
    4. Different presentations of the motor neuron disease ALS: types (bulbar/non-bulbar), diagnosis (electromyography and nerve conduction studies) and natural history
    5. Role of riluzole and symptom palliation
    6. Respiratory muscle strength and bulbar function assessment
    7. Careful handling of symptom palliation and discussion of advance directives
15. Myasthenia gravis
    1. Pathophysiology of acquired myasthenia and congenital variants, diagnostic methods and therapies including anticholinesterases
    2. Assessment of respiratory muscle strength
    3. Myopathies and muscular dystrophies (Duchenne, etc.)
    4. Understanding the classification of common myopathies (e.g. nemaline, Pompe disease and myotubular), muscular dystrophies (Duchenne and limb girdle) and neuropathies
    5. Natural history of disorders such as cardiomyopathy in some conditions and the likelihood of respiratory failure
    6. Assessment of respiratory muscle strength
    7. Performance of sleep studies and NIV
    8. Effective communication with patients and their families
    9. Establish effective interactions with the multidisciplinary team of health professionals
16. Postoperative phrenic nerve dysfunction
    1. Types of phrenic nerve dysfunction (nerve transection and paresis)
    2. Predisposing surgical procedures
    3. Natural history and clinical features
    4. Assessment of respiratory muscle strength
    5. Referral for phrenic nerve conduction studies
17. Principles of sedation
    1. Diagnostic and therapeutic procedures for sedation and analgesia
    2. Pharmacological basis of sedative agents
    3. Indications for sedation and analgesia
    4. Scores and scales for assessment of sedation in conscious and unconscious patients
    5. Sedation and pain management including treatment of delirium and anxiety in critically ill patients using both pharmacologic and non-pharmacologic methods
    6. Use of sedative drugs and reversal drugs

1. Identify diaphragm weakness as a cause of acute respiratory failure and weaning failure
2. Differential diagnosis of diaphragm weakness
3. Therapeutic options for diaphragm weakness
4. Pathophysiology of critical illness associated respiratory muscle weakness
5. Prevention of critical illness associated respiratory muscle weakness

1. Pathophysiology of pleural effusions (exudates versus transudate)
2. Differential diagnosis of pleural effusion
3. Laboratory diagnostic tests for pleural effusion
4. Principles of therapy for pleural effusion (diuretics and thoracic drainage)
5. Various drainage devices for use as chest tubes
6. Translating national and international guidelines for diagnosis and treatment of pleural effusion to individualised management
7. Performing ultrasound of the pleural space to establish the diagnosis of pleural effusion
8. Performing thoracentesis in patients with pleural effusion
9. Inserting a drainage tube

1. Pathophysiology of pneumothorax
2. Diagnosis and treatment of pneumothorax
3. Recognition of pneumothorax using imaging techniques
4. Treatment of pneumothorax according to national and international guidelines

1. Differentiate between cardiac and pulmonary disease as a cause of ARF
2. Describe the differential diagnosis of cardiac causes of ARF
3. Basic principles of invasive cardiovascular monitoring (e.g. pulmonary artery catheter)
4. Cardiovascular effect of positive pressure ventilation

1. Sleep-disordered breathing
   1. Physiology and pathophysiology of sleep relevant to ARF
   2. Diagnosis and screening of obstructive sleep apnoea, upper airway obstruction and hypoventilation
   3. Interpretation of blood gases and other tests for sleep-disordered breathing
   4. Recognition of obesity as a cause of weaning failure in obese patients
2. 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 morbidly obese patients
   3. Recognition of obesity as a reason for respiratory impairment
   4. Interpretation of BGA and polysomnography results
   5. Initiation of non-invasive respiratory treatment
   6. Initiation of therapy in obese patients
   7. Associated respiratory problems

1. Identify acute ILD as a cause of ARF
2. Differential diagnosis and optimal testing
3. Choose the optimal treatment
4. Prognostication of the identified ILD

1. Identify smoke inhalation 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. Identify acute ILD as a cause of ARF
2. Differential diagnosis and optimal testing
3. Choose the optimal treatment
4. Prognostication of the identified ILD

1. Integration of physiological and biological data in the ICU
2. Automated interpretation of big data in the ICU

1. Anatomical barriers
2. Reflex mechanisms (sneezing, cough and dyspnoea)
3. Mucociliary clearance and fluid homeostasis
4. Innate defence molecules
5. Professional phagocytes/antigen-presenting cells
6. Adaptive immunity and cytokine/chemokine production
7. Granuloma formation

1. Control systems
2. Peripheral chemoreceptors
3. Central chemoreceptors
4. Testing the control system
5. Ventilatory responses to CO2
6. The hypoxic ventilatory response
7. Interaction between hypoxic and hypercapnic responses
8. Disturbances in the control of breathing
9. Control of breathing in pulmonary diseases
10. Type 1 and type 2 respiratory failure
11. Respiratory stimulants

1. Ventilatory response to inhaled carbon dioxide
2. Estimation of the ventilatory response to hypoxia
3. Respiratory muscles

1. Airway resistance
2. Body plethysmography
3. Interrupter technique
4. Forced oscillation technique
5. Lung compliance
6. Measurement of respiratory mechanics (total lung capacity with He (TLC He), total lung capacity with plethysmography (TLC pleth) and total lung capacity with N2 (TLC N2)) and the usefulness of the alveolar volume (AV)/total lung capacity (TLC) ratio
7. Respiratory muscle strength: maximum inspiratory power, maximum expiratory power and sniff nasal inspiratory power

1. Transfer factor of the lung for carbon monoxide (TLCO)
2. Definition
3. Technique
4. Calculation of TLCO and measurement of the carbon monoxide transfer coefficient (KCO)
5. Transfer factor of the lung for nitric oxide (TLNO) and TLCO/TLNO measurement

1. Step 1: evaluation of the utility of ABG and capillary blood gas
2. Step 2: diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and pH
3. Step 3: more on A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2) the alveolar gas equation and measuring oxygen shunts

1. Exercise protocols
2. Maximal incremental text
3. Constant work rate tests
4. Walking tests
5. Indications for and basic interpretation of cardiopulmonary exercise testing
6. Exercise variables and indexes

1. Interpreting lung volume
2. Grading the severity of airflow obstruction or restriction after adoption of Z scores

1. General symptoms of interstitial lung disease (ILD) and extrapulmonary involvement in some ILDs such as sarcoidosis and connective tissue disease (CTD)-associated ILD (CTD-ILD)
2. Vasculitides, extrapulmonary involvement and ILDs
3. CTD
4. Rare lung diseases such as lymphangioleiomyomatosis (LAM)

1. Velcro and extrapulmonary signs/symptoms
2. Signs of right heart failure and pulmonary hypertension

1. Diagnosis and differential diagnosis (i.e. Hepato-pulmonary syndrome, telomeropathies, sarcoidosis aspects, Hermansky-Pudlak syndrome, Niemann-Pick disease and Gaucher disease)
2. CTD features
3. Haematological diseases
4. Occupational disease
5. Kidney-pulmonary syndromes

1. Bronchoalveolar lavage/bronchial biopsy and regular transbronchial lung biopsy
2. Cryobiopsy technique
3. Complications of cryobiopsy

1. Indications and contraindications for EBUS and EUS
2. Sample processing and rapid on-site evaluation

1. Indications
2. Contraindications
3. Complications

1. Limitations and indications of chest X-rays
2. Basic interpretation of chest radiographs
3. Radiological correlates of chest organs and bony chest structures
4. Describing radiological findings of a chest radiograph
5. Recognition of abnormal results and formulation of a diagnosis

1. Early detection
2. Ultrasound appearance

1. Patterns and differential diagnosis
2. Computer-based quantification (CALIPER software)

1. Steroids and immunosuppressors used to treat ILD
2. New medications for idiopathic pulmonary fibrosis (IPF)

1. Indications, limitations and role of respiratory physiotherapy in ILD

1. Indications, limitations and role of pulmonary rehabilitation in ILD

1. Principles of palliative care
2. Early integration of palliative care, multidisciplinary care and communication

1. Prescription according to current statements and guidelines
2. Oxygen toxicity
3. Criteria for long-term oxygen therapy (LTOT) in patients with ILD
4. Ambulatory oxygen

1. General aspects of preventative measures (vaccination, sports, etc.)
2. Weight reduction
3. Exercise
4. Influenza vaccination
5. Pneumococcal vaccination
6. Specific preventative management

1. Smoking cessation
2. ILD and emphysema
3. ILD and lung cancer

1. Limitations of assisted ventilation in advanced cases
2. High-flow oxygen
3. Extracorporeal membrane oxygenation
4. High-frequency oscillatory ventilation

1. Indications and contraindications for lung transplantation
2. Indications for early referral
3. Indications for lung transplantation in patients with systemic diseases

1. Differential diagnosis of respiratory emergencies
2. IPF exacerbation
3. Acute exacerbation of ILDs

1. Early referral to a specialist ILD centre
2. Multidisciplinary diagnosis for ILD

Diffuse parenchymal lung disorders manifesting with acute lung injury

1. Acute exacerbation of IPF in patients already known to be affected by IPF
2. Identification of patients with IPF and significant emphysema
   1. CT scan features
   2. Pulmonary function tests focusing on the discrepancy between volume preservation and significant reduction of carbon monoxide diffusing capacity (DLCO)

1. Co-existence of both diseases

1. Pleural infections
2. Lung abscesses and other infections
3. Infections in an immunocompromised host
   1. Pneumocystis pneumonia
   2. Viral infections
   3. Fungal infections
4. Aspiration pneumonitis

1. High risk of TB in patients treated with biologicals

1. General aspects of lung cancer
2. Lung cancer in the context of ILD
3. Immunotherapy and ILD

1. ILD appearing with acute respiratory failure
2. Differential diagnosis
3. Diagnostic approaches
4. Treatment

1. Cor pulmonale in patients with advanced ILD
2. Treatment of hypercapnia in patients with ILD
3. Indications for O2 supplementation including LTOT and other forms of O2 delivery (e.g. non-invasive ventilation)

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

1. Idiopathic interstitial pneumonias including cryptogenic organising pneumonia of unknown aetiology/bronchiolitis obliterans organising pneumonia
2. Smoking-related idiopathic interstitial pneumonia
3. Pleuro-parenchymal fibroelastosis
4. Non-specific interstitial pneumonia

1. Of known causes
2. Of unknown causes
3. High-resolution computed tomography (HRCT) scan features
4. Pulmonary function tests
5. Diagnostic work-out
6. Treatment

1. CTD-ILD: a clinical overview

1. General clinical overview
2. Pathogenesis
3. Treatment

1. General clinical overview
2. Pathogenesis
3. Treatment

1. General clinical overview
2. Pathogenesis
3. Treatment

1. Knowledge of existence
2. General clinical aspects
3. Pathogenesis
4. Treatment

1. General aspects of drug-induced disease
2. Pathogenesis
3. Treatment

1. Radiation-induced disease

1. Clinical aspects
2. Pathogenesis
3. Treatment

1. Definition
2. Clinical aspects
3. Pathogenesis
4. Treatment

1. Pathophysiology of pulmonary hypertension
2. Pharmacological treatment of pulmonary hypertension according to the underlying disease
3. Diagnosis of pulmonary hypertension
4. Translating national and international management guidelines to an individual patient
5. Appropriate decisions for referral and transfer to specialised referral centres

1. Definition of the main entities
2. Granulomatosis with polyangiitis (GPA)
3. Eosinophilic granulomatosis with polyangiitis (EGPA)
4. Microscopic polyangiitis

1. Pleural disease may be associated with autoimmunity

1. Aspects of primary immunodeficiency syndromes
2. Differential diagnosis

1. Secondary immunodeficiency syndromes/immunosuppression

1. General aspects of cardiac disease
2. Differentiation between cardiac and pulmonary diseases as a cause of acute respiratory failure
3. Differential diagnosis of the cardiac causes of acute respiratory failure
4. Invasive cardiovascular monitoring (e.g. Swan-Ganz catheterisation)
5. Cardiovascular effect of positive pressure ventilation

1. General aspects of lung damage related to gastrointestinal and liver diseases and renal failure in the context of ILD

1. General aspects of haematological disease

1. General aspects of Birt-Hogg-Dubé syndrome
2. Clinical, radiological and histopathological features
3. Genetic background and biology
4. Detection of tumours during follow-up
5. Treatment modality, including participation in clinical trials, and genetic counselling

1. General aspects of respiratory hazards associated with occupational factors

1. General aspects of acute inhalation injuries and their possible sequelae
2. Identification of smoke inhalation and burns as causes of respiratory failure
3. Assessment of the degree of severity of pulmonary involvement
4. Optimal treatment of inhalation injury, including systemic effects

1. General aspects of occupational respiratory infections including those affecting healthcare workers

1. General aspects of ILD caused by dusts of biologic origin

1. General aspects of asbestos-related conditions other than bronchopulmonary cancer (but including mesothelioma)

1. General aspects of epidemiological and statistical methods for critical appraisal

1. Anatomy and development
   1. Surface anatomy of lung lobes and basic bronchial and lung anatomy
2. Applied respiratory physiology and pathophysiology (including common respiratory symptoms)
   1. Physiological principles underlying flow-volume curves, measurement of lung volumes and bronchial lability
   2. Physiology of breathing
   3. Ventilation, perfusion, gas exchange and oxygen transport and how these relate to clinical findings and management
   4. Pathophysiology that explains wheeze, stridor, snoring, airway tone, cough and crackles
   5. Physiology of sleep: basic respiratory physiological changes during rapid eye movement and non-rapid eye movement sleep
3. Immunology and defence mechanisms
   1. Adaptive immunity and hypersensitivity reactions
   2. Innate immunity and mucosal defence mechanisms in the respiratory tract
4. Environmental determinants of respiratory health and disease in childhood
   1. Environmental effect on respiratory health, particularly cigarette smoke exposure, indoor and outdoor air pollution and the early-life environment

1. Acute and chronic cough
   1. Current published guidelines
   2. Clinical evaluation of isolated cough and knowledge of when to refer a patient for specialist assessment
2. Stridor, wheezing and other respiratory noises
   1. Distinguish different forms of noisy breathing
   2. Undertake clinical evaluation of noisy breathing in different age groups
   3. Know when to suspect functional stridor/vocal cord dysfunction and when to refer a patient
3. Assessment and management of a breathless or dyspnoeic child
4. Respiratory distress and respiratory insufficiency
   1. Clinical signs of respiratory insufficiency in children with and without underlying disorders
   2. Detailed interpretation of blood gas analysis
5. Common causes of haemoptysis and the diagnostic approach
6. Questionnaires in clinical assessment
   1. Validity and reliability of questionnaires as clinical, epidemiological and research tools
   2. Application of questionnaires in clinical practice
   3. Comprehension of reasons why some parents and patients may have difficulties in completing questionnaires

1. Volume-time and flow-volume curves in school-age children
   1. Reversibility testing in school-age children
   2. Awareness and application of American Thoracic Society (ATS)/European Respiratory Society (ERS) standards
   3. Recognise disease-specific abnormalities in the flow-volume curve
   4. Recognise technical limitations in the performance of spirometry
2. Bronchial provocation testing: referral of school-age children for bronchoprovocation testing
3. Indications for cardiopulmonary exercise testing (CPET)
4. Performance, supervision and interpretation of blood gas analysis and pulse oximetry
5. Hygiene and infection control during test procedures
   1. Understands how to avoid cross-infection during spirometric testing
6. Definitions of measured indices
   1. Definitions and significance of spirometric lung function indices
   2. Integration of the test results for diagnosis and management of a patient
7. Choice and appropriate use of reference values
   1. Basis of reference equations for lung function and the concept of z scores
   2. Importance of reference values for the correct interpretation of results
8. Exhaled nitric oxide measurements
   1. Understands how measurements of exhaled nitric oxide contribute to diagnosis and management
9. Assessing the respiratory risk of air travel, high altitude and diving (knowledge only)
   1. Principles of fitness-to-fly (FTF) testing
   2. Knowledge of which patients should be referred for FTF testing
10. Awareness of the role of specialist tests
    1. Multiple breath washout test
    2. Transfer factor
    3. Impedance oscillometry
    4. Body plethysmography
    5. Lung clearance index

1. Identification of when to refer a patient for airway endoscopy

1. Principles of conventional radiography and ultrasonography
   1. Indications for and advantages and limitations of different imaging methods and ability to select the most appropriate imaging method for different clinical problems
   2. Interpretation of imaging findings in relation to the clinical respiratory presentation
2. Comparative radiation burden of commonly used imaging methods in children, and the ability to balance the risks and benefits

Epidemiology, diagnosis, management and complications of respiratory infections, including recognition of long-term effects of common infections.

1. Acute upper respiratory tract infections
2. Acute lower respiratory tract infections
3. Pleural infections
4. TB and non-TB mycobacterial diseases
5. Recognition of high-risk situations and appropriate referral
6. Recognition of protracted bacterial bronchitis and non-cystic fibrosis (CF) bronchiectasis and knowledge of when to refer a patient for further investigation
   1. Aetiology and pathophysiology of bronchiectasis
7. Lung involvement in an immunocompromised host
   1. Recognition of possible complications of immunodeficiencies and indications for referral
8. Immunisations for respiratory pathogens
   1. Local availability of immunisations
   2. Local and international guidelines for use and administration of immunisations
   3. Advise families and healthcare workers about the need for and timing of immunisations
   4. Ability and willingness to communicate the benefits, risks and limitations of immunisations
   5. Understanding of the perceived risks of immunisations
9. Accuracy and interpretation of microbiological tests
   1. Diagnostic accuracy of available tests
   2. Optimal methods for collection and processing of specimens
   3. Ability to advise healthcare workers about collection and processing of specimens
   4. Management of unexpected results

1. Phenotypes and their different pathologies and long-term outcomes (including underlying pathophysiology and basic epidemiology)
   1. Asthma syndrome and its complexity, including the difference between allergic and non-allergic asthma and the various types of recurrent wheezing in preschool children
   2. Changing patterns of recurrent wheeze and asthma across children of different ages
2. Environmental factors relevant to asthma and other wheezing disorders
   1. Controversies surrounding allergen avoidance measures
   2. Interaction of physical activity, sports and asthma
   3. Gene-environment interactions, including the role of viral infections and their effect on the airways
   4. Influence of passive smoking and air pollution on asthma morbidity
3. Atypical wheezing and knowledge of when to refer a patient
4. Management of uncomplicated asthma and wheezing at different ages, including age-related pharmacology, and pharmacological and non-pharmacological management
5. Difficult-to-treat asthma and when to refer patients with difficult and severe asthma

1. Anaphylaxis
   1. Current guidelines for diagnosis, differential diagnosis and treatment
   2. Risks of anaphylaxis
   3. Management of an acute reaction
   4. Prescription of epinephrine appropriately and explain its correct use
2. Allergic rhinitis
   1. Current guidelines for diagnosis, differential diagnosis and treatment
   2. Evaluation of the anterior portion of the nasal cavities
   3. Prescription of oral and topical treatments according to current guidelines
3. In vivo and in vitro testing for allergic disorders
   1. Normal values and the diagnostic accuracy of tests
   2. Physiological, technical and methodological aspects of these tests
   3. Performance of a skin prick test
   4. Supervision of others who perform tests
   5. Interpretation of results, including IgE values
4. Preventative measures
   1. Value of avoidance measures
   2. Current guidelines
   3. Appropriately prescribe or advise on avoidance measures
5. Diagnosis and basic management of associated allergic conditions
   1. Current guidelines for diagnosis, differential diagnosis and treatment
   2. Initiation of topical treatment according to current guidelines
   3. Recognition of a child with a suspected food allergy
   4. Differentiate food sensitivity across different age groups
   5. Initiation of appropriate investigations and knowledge of when to refer a patient
6. Difficulties and complications of exclusion diets

1. Epidemiology, genetics, pathophysiology and prognosis (for paediatricians who perform shared care; be able to provide counselling)
   1. Genotype identification, its relevance to basic cellular abnormalities and its relationship with structural and functional pathology Epidemiology, diagnosis, management and complications of:
2. CF lung disease
   1. Principles of drug treatment, aerosol therapy and physiotherapy
   2. Nutritional requirements
   3. Recognition of possible pulmonary complications of CF lung disease and appropriately refer a patient
   4. Psychosocial and developmental issues related to CF
   5. Interpretation of clinical features and clinical test results
   6. Burden of disease and treatment on the child and his/her family
   7. Indications for the use of CF transmembrane conductance regulator modulators
3. Extrapulmonary manifestations of CF including nutrition
   1. Range of presentations of CF
   2. Recognition of extrapulmonary manifestations of CF
   3. Holistic approach for clinical care
4. Microbiology relevant to CF, including cross-infection
   1. Knowledge of the relevant respiratory pathogens
   2. Problems associated with cross-infection from respiratory aspects in CF
5. Collection of appropriate respiratory specimens from children of all ages

1. Presentation of common congenital malformations that affect the respiratory system
2. Antenatal diagnosis and management
   1. Basic knowledge of options for antenatal diagnosis and management of congenital thoracic malformations
3. Follow-up and long-term outcomes. Basic knowledge of:
   1. Long-term outcome and possible late complications of congenital thoracic malformations
   2. Advantages and disadvantages of surgical versus “watch and wait” approaches
   3. Assessment and management of thoracic cage deformities

1. Basic knowledge of epidemiology, aetiology, prevention, diagnosis, management and complications of BPD
   1. Current published guidelines and evidence on the management of BPD
   2. Principles of drug treatment and aerosol therapy in different age groups
   3. Comorbidities associated with BPD
   4. Acute and chronic problems including non-pulmonary comorbidities associated with BPD
2. Follow-up and long-term outcomes
   1. Respiratory and non-respiratory consequences of BPD during infancy and adolescence
   2. Communication of management and prognosis in a language that the family can understand

1. Recognition of aspiration due to feeding and swallowing disorders
2. Anatomical and functional aspects of gastro-oesophageal reflux disease
3. Possible foreign body inhalation and knowledge when to urgently refer a patient

1. Recognition of disease and knowledge of when to refer a patient with:
   1. Primary ciliary dyskinesia
   2. BO
   3. ILDs
   4. PVDs
   5. Pulmonary haemorrhage
   6. Pleural diseases including spontaneous pneumothorax (initiate emergency treatment when needed)
   7. Drug- and radiation-induced lung diseases
   8. Other rare lung diseases

1. Basic pathophysiology of sleep-disorder breathing (SDB)
2. Recognition of clinical situations where sleep studies may be appropriate
3. Obstructive sleep apnoea syndromes
   1. Presenting symptoms of SDB in different age groups and when to refer a patient for further assessment
4. Central sleep apnoea/hypoventilation
   1. Presentations of congenital central hypoventilation syndrome
5. Dysfunctional breathing/hyperventilation syndromes
   1. Recognition of dysfunctional breathing/hyperventilation and appropriate referral

1. Patient education and self-management
2. Conduct appropriate two-way communication with patients and their parents
3. Nutritional management
   1. Nutritional requirements of children with chronic respiratory diseases
4. Psychological support for children and families
   1. Awareness of and recognition of psychosocial and developmental problems associated with chronic illness in children
   2. Referral of children and their families for help with psychological or developmental problems

1. Basic science of aerosol production and delivery including principles and objectives
2. Indications for inhalation therapy
   1. Appropriate aerosol therapy in various forms of respiratory disease
   2. Choice of appropriate aerosol therapy and devices for children with different conditions and at different ages
   3. Ability to teach patients, their families and allied health professionals about aerosol therapy

1. Physiological, technical and methodological aspects of long-term oxygen therapy
   1. Current national and international guidelines regarding long-term use of home oxygen in children
   2. Local protocols for prescribing and delivering home oxygen
   3. Performance and interpretation of an overnight oximetry recording
   4. Organisation and prescription of home oxygen for a child
2. Knowledge of when to refer a patient for non-invasive ventilation

1. Epidemiological principles
   1. Difference between local and international epidemiology
   2. Interpretation of the relevance of published data
   3. Ability to audit local prevalence data and monitor international data
2. Impact of indoor and outdoor air pollution on respiratory health
   1. Effects of particulate and non-particulate matter on respiratory health
   2. Effects of tobacco smoke and other pollutants on patients’ health
   3. Advise effectively about avoidance
   4. Provide non-judgemental advice about lifestyle modifications
3. Impact, prevention and cessation of smoking including the initiation and support of effective smoking cessation interventions
4. Burden of paediatric respiratory diseases on healthcare resources
   1. Local costs of hospital and community care
   2. Ability to minimise unnecessary costs
   3. Evaluation of the cost-effectiveness of care

1. Literature search strategies
2. Critical evaluation of published research

1. Pulmonary vasculature and lymphatic drainage
2. Anatomy of the cardiovascular system
3. Right ventricular anatomy

1. Immunology

1. Physiology of tidal breathing
2. Active inspiration and passive expiration
3. Relative elastic properties of the lung and chest wall
4. Understanding lung volumes
5. Transpulmonary pressures and breathing
6. Changes in intrathoracic pressure
7. Disease-specific effects on ventilation
8. COPD and interstitial lung disease (ILD)

1. Normal pulmonary vascular pressures and flows
2. Effects of exercise
3. Active hypoxic and neurohumoral regulation of pulmonary circulation
4. Pulsatile flow pulmonary haemodynamics
5. Non-invasive evaluation of pulmonary circulation
6. Invasive evaluation of pulmonary circulation
7. Interpretation of pulmonary vascular resistance
8. Components of pulmonary vascular load, right ventricular function (systolic and diastolic)

1. Transfer factor of the lung for carbon monoxide (TLCO)
2. Definition
3. Technique
4. Calculation of TLCO and measurement of carbon monoxide transfer coefficient (KCO)
5. Implications of KCO × alveolar volume (VA) = TLCO

1.Field tests versus ergometer/treadmill tests

1. Maximal incremental test
2. Walking tests: 6-minute walking distance (6MWD) and incremental shuttle walk test (ISWT)
3. Indications for cardiopulmonary exercise testing (CPET)
4. Exercise variables and indexes
5. Maximal V'O2, heart rate (HR) and ventilation
6. Lactate threshold/ventilatory thresholds
7. Oxygen pulse-HR reserve and maximum predicted HR: V'E-V'CO2 slope and ventilatory equivalent
8. Carbon dioxide-breathing reserve
9. Dynamic hyperinflation
10. Arterial oxygen desaturation
11. Tolerable limit of exercise and “isotime” measurements
12. CPET response patterns
13. Ventilatory response
14. Pulmonary gas exchange
15. Cardiovascular response
16. Exercise testing in prognostic evaluation
17. Evaluation of the effects of therapeutic interventions
18. Somnography/polygraphy
19. Activity monitoring
20. Evaluation of psychological and social status: SYMPACT and EMPHASIS10 questionnaires

1. Evidence of right heart failure
2. Dyspnoea
3. Reducing exercise tolerance
4. Presyncope
5. Syncope
6. Chest tightness

1. Connective tissue disease (CTD)
2. Congenital heart disease
3. Hepatic disease
4. HIV
5. ILD including sarcoidosis
6. COPD including emphysema
7. Lung hypoventilation
8. Pulmonary embolic disease
9. Left heart failure
10. Genetic causes of PVD (i.e. BMPR2, EIF2AK4 and HHT genes)
11. Haematological diseases (e.g. polycythaemia rubra vera)
12. Portal hypertension

1. Acute pulmonary embolism
2. Chronic thromboembolic disease
3. Evidence of congenital heart disease
4. Abnormal pulmonary venous return
5. Enlarged pulmonary arteries
6. Dilated right heart
7. Right ventricular hypertrophy
8. Mosaicism 9.Pulmonary arteriovenous malformations
9. Pulmonary vein stenosis

1. Use of right heart catheterisation
2. Definition of pulmonary hypertension (PH)
3. Indications, physiologic considerations and interpretation of exercise haemodynamic testing

1. Therapy
2. Different types of delivery
3. Medical management of right heart failure
4. Non-medical therapies
5. Surgery/balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH)
6. Pulmonary artery denervation

1. Indications for pulmonary rehabilitation

1. Indications for institution of palliative care
2. End-of-life relief of symptoms by:
3. Pharmacological interventions
4. High-flow nasal oxygen
5. Discussing end-of-life decisions with patients and their relatives

-

1. Indications for assisted ventilation
2. Effects of mechanical ventilation on pulmonary haemodynamics and heart function

1. Principles of evaluation for lung transplantation
2. Risk and particularities of lung transplantation in patients with PVD
3. Severity grading of lung diseases with respect to referring a patient to a transplant centre 
4. Extracorporeal membrane oxygenation/right ventricular assist device

1. Management of right heart failure
2. Management of cardiac arrhythmias
3. Management of acute pulmonary embolism (PE), pulmonary embolism response team (PERT)
4. Cardiopulmonary arrest in a patient with pulmonary arterial hypertension (PAH)

1. Differential diagnosis of PVD and PE
2. Haemoptysis
3. Dyspnoea
4. Thoracic pain
5. PE
6. Haemoptysis
7. Dyspnoea
8. Thoracic pain
9. Massive acute pulmonary embolism
10. Management of shock related to right heart failure
11. Early identification of chronic thromboembolism

1. Severe PH sub-phenotypes in COPD
2. Polycythaemia
3. Management of cor pulmonale

1. Signs and symptoms associated with sleep-disordered breathing
2. Recognition of sleep-disorder breathing as a cause of moderate PH
3. Physiology and pathophysiology of sleep apnoea syndromes relevant to acute respiratory failure

1. Recognition of Sarcoidosis and its association with PH
2. Recognition of PH as a poor prognostic factor in sarcoidosis
3. Effects of drug therapy on PH

1. Prognostic factors associated with ILD and PVD
2. Classification of ILD
3. Limitations/dangers of PAH therapies in ILD

1. ILD associated with CTD
2. Prognostic factors associated with ILD
3. List treatment choices

1. Identification of causes of PVD from drug history
   1. Anorexigens
   2. Amphetamines
   3. Selected tyrosine kinase inhibitors
   4. Interferon
   5. Chemotherapeutic agents (alkylating agents)

1. Identification of PE
2. Differential diagnosis of PE
3. Aetiology of PE
4. Pulmonary Embolism Severity Index score and risk stratification of PE
5. Management of PE without acute hemodynamic compromise
6. Conditions/diseases associated with an increased risk of thromboembolic disease
7. Current indications for prophylaxis against thromboembolic disease
8. Adverse effects associated with anticoagulation therapy
9. Interpretation of blood cell counts and coagulation laboratory tests
10. Drug indications and their appropriate dosages
11. Willingness to consider potential candidates for prophylaxis against thromboembolic disease
12. Prophylaxis against thromboembolic disease
13. Conditions/diseases associated with an increased risk of thromboembolic disease
14. Adverse effects associated with anticoagulation therapy
15. Interpretation of coagulation laboratory tests
16. Drug indications and their appropriate dosages
17. Genetic risk factors for thrombosis and their impact on clinical decisions
18. Indications for targeted thrombosis (interventional radiology) and embolectomies
19. Diagnosis and management of CTEPH
20. Indications for thrombophilia screening
21. ndications for inferior vena cava filter placement
22. Follow-up after PE presentation, e.g. risk scoring (such as DASH) to discuss the risks/benefits of anticoagulation therapy
23. Pancreatic enzyme replacement therapy

1. Pathophysiology of PH
2. Pharmacological treatment of PH according to underlying disease
3. Diagnosis of PH and cor pulmonale
4. Risk stratification
5. Translating national and international management guidelines to an individual patient
6. Appropriate decisions for referral and transfer to specialised referral centres
7. Prognosis of patients with PH in acute care settings
8. Indications for systemic pharmacotherapy
9. Indications for combination therapy
10. Indications for intravenous therapy
11. Chronic monotherapy or combination systemic therapy
12. Institute general therapeutic and supportive measures

1. Pulmonary haemorrhage and haemoptysis
2. Differential diagnoses, diagnostic steps and therapeutic options for pulmonary haemorrhage and haemoptysis
3. Triage by severity
4. Indications for radiological evaluation
5. Indications for bronchoscopic evaluation

1. Symptoms of AV malformation
2. Diseases associated with AV malformation (e.g. hereditary haemorrhagic telangiectasia)
3. Diagnostic strategies when AV malformation is suspected
4. Therapeutic interventions

1. Differentiate between cardiac and pulmonary disease as a cause of acute respiratory failure
2. Recognition of cardiac disease as an aetiology of PH
3. Monitoring cardiac dysfunction in PVD patients via clinical, laboratorial, functional, echocardiographic and radiological means
4. Principles of invasive cardiovascular monitoring (e.g. Swan-Ganz catheterisation)
5. Cardiovascular effect of positive pressure ventilation
6. Congenital heart diseases and Eisenmenger syndrome

1. Portopulmonary hypertension
2. Hepatopulmonary syndrome

1. PVD in patients with past or current haematological conditions
2. Thrombophilia as a potential sign of PVD

1. CTD as a cause of PH
2. Symptoms and clinical presentation
3. Pathophysiology of CTD and PH
4. Differential diagnosis and optimal testing
5. Optimal treatment
6. Prognostication of identified CTD

1. Familial occurrence of PH

1. High-altitude as a cause of pulmonary oedema (HAPE)
2. Pathophysiology, symptoms and clinical presentation of high-altitude sickness
3. Performance of tests to establish the diagnosis
4. Preventive measures

1. Pleura
2. Lungs
3. Bronchopulmonary segments
4. Trachea and bronchi
5. Hila
6. Pulmonary vasculature and lymphatic drainage
7. Mediastinum
8. Diaphragm
9. Pulmonary lobules (site of infections can be lobar or segmental specific)

1. Ciliary mechanisms
2. Anatomical barriers (including epithelial barrier function and how this is influenced by pathogens)
3. Innate immune defence mechanisms, e.g. recognition of pathogen-associated molecular patterns by structural cells (airway epithelium) and subsequent anti-microbial and pro-inflammatory responses
4. Reflex mechanisms (sneezing, cough and dyspnoea)
5. Mucociliary clearance and fluid homeostasis
6. Innate defence mechanisms (broad outline): professional phagocytes
7. Acquired immune reactions with immunoglobulin and the role of IgM, IgG and IgA
8. IgG subclasses and IgE
9. Type 1 and type 2 inflammation
10. Granulomatous inflammation/fibrosis induced by the cell-mediated immune response

1. Physiology of tidal breathing: active inspiration and passive expiration
2. Relative elastic properties of the lungs and chest wall
3. Lung volumes
4. Transpulmonary pressures and breathing

1. Step 1: Evaluate the utility of ABG, capillary blood gas and venous blood gas
2. Step 2: Diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between arterial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PCO2) and pH
3. Step 3: A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2), the alveolar gas equation and measuring oxygen shunts
4. Management of clinical diseases, e.g. COPD and sepsis with A-B disorders in ABG
5. Ventilation-perfusion defect

1. Cough
2. Colour and nature of sputum (clear mucoid, purulent, haemoptysis, etc.)
3. Pleuritic chest pain
4. Fever versus night sweats
5. Wheezing
6. Haemoptysis (streak/blob, associated sputum, quantity and massive haemoptysis)
7. Chest wall pain
8. Fatigue/malaise
9. Dyspnoea
10. Weight loss

1. Temperature
2. Finger clubbing
3. Cyanosis
4. Respiratory rate
5. Saturation
6. Heart rate
7. Hypotension and shock 
8. Consolidation 
9. Pleural effusion
10. Accessory muscle use
11. Wheezing and stridor

1. Common upper respiratory tract syndromes (including acute infective rhinitis, sinusitis, pharyngitis, epiglottitis and laryngotracheitis)
2. Acute bronchitis
3. Exacerbation of asthma
4. Exacerbation of COPD
5. Community-acquired pneumonia (CAP) including nursing home-acquired pneumonia (NHAP)
6. Nosocomial pneumonia
7. Seasonal influenza
8. Acute bronchiolitis
9. Exacerbation of bronchiectasis
10. Pulmonary TB

1. Bronchoalveolar lavage (BAL)
2. Brushing samples
3. Protected sampling in an intensive care unit (ICU) to prevent upper airway contamination
4. Biopsy for culture

1. Transbronchial lung biopsy cultures, and culture and analysis of transbronchial needle aspirates (for differential diagnosis)
2. GeneXpert

1. Indications
2. Knowledge of indications for thoracentesis and biopsy
3. Thoracentesis
4. Interpretation of results
5. Biochemical analysis for differential diagnosis

1. Indications
2. Medical thoracoscopy with biopsy: indications
3. Pleural fluid and pleural biopsy samples for culture

1. Miliary TB pattern
2. Mediastinal lymph nodes
3. Lung cavities
4. Halo-sign
5. Septic emboli
6. Abscess
7. Hydatid cyst
8. Sequestrum
9. Signs of pleural infection/parapneumonic effusion
10. Atelectasis signs
11. Signs of bronchiectasis
12. Consolidation and air bronchogram sign
13. Ground glass opacities
14. Solitary nodule

1. Thoracic ultrasound to guide thoracentesis/aspiration
2. ICU patients that cannot be moved
3. Pneumonia diagnosis
4. Empyema diagnosis
5. Complicated parapneumonic effusion

1. Aspergillus-related appearances
2. Tree-in-bud sign and infections
3. Bronchiectasis
4. Non-resolving pneumonia 
5. Cryptogenic organising pneumonia 
6. Empyema 
7. Mediastinal lymph nodes
8. Bronchopleural fistula
9. Radiological signs of:
   1. Diseases associated with Aspergillus
   2. Non-tuberculous mycobacteria (NTM)

1. Common pathogens and their antibiotic sensitivities
2. Samples and specific pathogens
3. Acid-fast bacilli: number, interpretation of quality, sputum induction indication and culture versus immunofluorescence (IF) versus PCR
4. Likelihood of a laboratory report being correct (e.g. Gram-negative pathogens or gonococcal pharyngitis); Nocardia as an acid-fast organism
5. Whole-genome sequencing (WGS) and targeted next-generation sequencing of Mycobacterium tuberculosis and other mycobacteria
6. GeneXpert

1. Conventional microbiological methods such as Gram staining, culture and sensitivity testing for different pathogens, such as atypical bacteria, viruses and fungi, and for Pneumocystis jirovecii pneumonia (known in the past as Pneumocystis carinii pneumonia (PCP))
2. Indications for and collection of biological specimens, Gram staining, culture, molecular methods, IF and genetic testing
3. Interferon gamma release assay, interpretation of microbiological results provided by BAL, quantitative culture, particularities in immunocompromised patients, particularities in nosocomial infection and types of sputum harvest (spontaneous, induced and bronchial aspirate)
4. Airway microbiome in relation to relation to epigenetic and transcriptomic profiles in lung tissue
5. Microbiologic diagnosis of TB (smear examination, liquid and solid culture media, molecular study of resistance and phenotypic/genotypic methods)

1. Problems with inhaled therapy
2. When to use inhaled drugs, e.g. amikacin in bronchiectasis
3. Delivery modules
4. Indications and application at an ICU

1. Interpreting laboratory results and choosing antibiotics 
2. Use of antivirals in flu epidemics
3. Antibiotic stewardship and adherence to guidelines
4. Place of corticosteroids
5. Pharmacokinetics and pharmacodynamics

1. Role of physiotherapy in sputum induction
2. Postural drainage in bronchiectasis
3. Muscle strengthening
4. Aerobic exercise as a method for airway clearance

1. Rehabilitation and airway clearance to help reduce exacerbations of chronic respiratory diseases such as COPD and bronchiectasis
2. Prevention of infections

1. Oxygen therapy 
2. Sedation 
3. Pain therapy

1. Vaccination
   1. Influenza
   2. Pneumococcal
   3. Bacillus Calmette–Guérin (BCG)
   4. Other vaccinations
2. Smoking cessation
3. Dental care
4. Aspiration management
5. Infection control
6. Cough hygiene
7. Infection surveillance
8. Universal precautions for respiratory isolation
9. Isolation and reverse isolation, including specific microbes in cystic fibrosis (CF) and bronchiectasis (e.g. Pseudomonas)
10. Infectious risks to healthcare workers (HCWs): control and elimination of TB including the BCG vaccine
11. Segregation under infection control and relevance to CF and TB
12. Study of TB patient contacts, TB isolation criteria and indications for diagnosis and treatment of TB
13. Role of air pollution

1. Empyema
2. Indications for and management of chest tube insertion
3. Endopleural lysis

1. Course of opportunistic infections after lung transplantation
2. Differentiation between organ rejection and infection
3. Prophylaxis
4. Post-transplant management

1. CAP
2. Hospital-acquired pneumonia (HAP)
3. Sepsis
4. Bioterrorism

1. Differential diagnosis using clinical and radiological findings of infectious diseases (i.e. those caused by bacteria, viruses, fungi, mycobacteria and other difficult-to-treat microorganisms) in contrast with those of non-infectious disorders

1. Time to first intravenous antibiotics
2. Use of oxygen (pneumonia versus COPD)
3. Sepsis

1. CAP
2. HAP
3. Ventilator-associated pneumonia (VAP)
4. NHAP

1. Common upper respiratory tract syndromes (including acute infective rhinitis, sinusitis, pharyngitis, epiglottitis, laryngotracheitis and tonsillitis)
2. Allergies and the upper respiratory tract

1. Molecular mechanisms of exacerbation
2. Infectious management of exacerbation
3. Allergic bronchopulmonary aspergillosis
4. Infectious causes of eosinophilia

1. Acute bacterial and viral bronchitis

1. Molecular mechanisms of exacerbation
2. Infectious management of exacerbation, i.e. viral and bacterial
3. Immunomodulatory therapy
4. Risks associated with inhaled corticosteroids
5. Vaccination
6. Bacterial colonisation
7. Long-term macrolides

1. Respiratory syncytial virus
2. Differential diagnosis
3. Other viruses and bacteria

1. Diagnostic and aetiological work-up
2. Management of exacerbation
3. Bacterial and non-bacterial surveillance
4. Eradication
5. Long-term antibiotic and immunomodulatory therapy
6. Vaccination
7. Rehabilitation
8. Respiratory physiotherapy
9. Classification severity
10. Haemoptysis and management

1. CAP (including NHAP and HCAP)
2. Nosocomial pneumonia
3. Specific risk factors

1. Diagnostic methods in radiology and ultrasound parapneumonic effusion and empyema pleuritis
2. Indication for large-bore pleural drainage
3. Indication for medical and surgical thoracoscopy
4. Evaluating the accuracy of microbiological methods

1. Choice and duration of antibiotic treatment in particular situations, such as intravenous drug users, and aspiration
2. Surgical intervention

1. Population groups with a worse prognosis
2. Infection control
3. Medical treatment

1. PCP
2. Empirical antibiotic selection and treatment particularities in patients with acquired immunodeficiency, neutropenic patients, patients with solid organ malignancy, lung and other solid organ transplant recipients, haematopoietic cell transplant recipients, patients with other haematological conditions, patients with secondary immunodeficiency induced by drugs and biologicals and patients with primary immune deficiency syndromes
3. Antibiotic prophylaxis
4. Indication for immunoglobulins
5. Role of invasive diagnostic testing
6. Diabetes
7. Lupus
8. Fungal infections
9. Pulmonary TB

1. Choice of antibiotics
2. Prognosis
3. Supportive care
4. Preventative measures
5. Risk factors for aspiration pneumonitis

1. Consideration of TB in the differential diagnosis of respiratory infections
2. Epidemiology, burden of disease and risk factors: know when to investigate and what tests to ask for
3. Indication for isolation and discontinuation of isolation
4. Risk factors for MDR/XDR TB
5. Drug susceptibility and treatment
6. Directly observed therapy (DOT) / Video observed therapy (VOT)
7. Miliary TB
8. Adverse events (AEs)
9. Diagnostic tests
10. Molecular tests
11. WGS

1. Differential diagnosis
2. Diagnosis of lymphatic TB and indication for EBUS
3. Rate of associations with pulmonary TB
4. Role of immunological tests for increasing the probability of diagnosis in patients with relevant risk factors and symptoms
5. Pleural TB

1. Diagnosis
2. Contact investigation
3. Treatment
4. Surveillance of side effects
5. Alternative regimens in case of AEs
6. Treatment of latent TB infection in immunocompromised patients
7. Selection of candidates to treat

1. Adherence to diagnostic criteria
2. Indication for treatment
3. Treatment
4. Monitoring of drug responses including relapse, re-infection and cure
5. Epidemiology and risk factors for NTM
6. Clinical presentation of NTM diseases
7. HIV co-infection
8. Immunosuppression

1. Management of pneumonia
2. Rationale for the use of guidelines for antibiotic therapy
3. Management of severe exacerbation of COPD

1. Differential diagnosis and testing
2. Treatment
3. Antibiotics
4. When to perform surgery
5. Oesophageal perforations
6. Transoesophageal fistulae

1. Patterns of pulmonary involvement in primary immunodeficiency disorders
2. Recognition, assessment and management of the severity of respiratory disease in patients with primary immunodeficiency disorders
3. Appropriate vaccination and prophylaxis regimens
4. Emphasise the most common primary immunodeficiency syndromes

1. Indications for screening

1. Diagnosis and differential diagnosis
2. Infection control and cross-infection
3. Infection surveillance
4. Microbiological evaluation
5. Universal precautions
6. Isolation and reverse isolation
7. Physiotherapy
8. Particularities in treatment (pharmacokinetics)
9. Immunomodulatory drugs
10. Antibiotic management for eradication
11. Suppression
12. Acute exacerbation 
13. New CF transmembrane conductance regulator (CFTR)-specific medications
14. Non-respiratory management
15. CFTR modulators
16. NTM infections in CF
17. When and how to go for screening

1. Differential diagnosis and recognition of primary ciliary dyskinesia
2. Diagnostic testing
3. Diagnosis of primary ciliary dyskinesia
4. α1-antitrypsin

1. Hepatitis
2. TB screening in HCWs
3. TB prevention in HCWs
4. TB infection control training for HCWs
5. Precautions for pregnant HCWs: measles, influenza and TB
6. Zoonosis
7. Influenza in exposed HCWs

1. Assessment of national TB programme

1. Alcohol abuse
2. Smoking including electronic cigarettes, marijuana and water pipes

1. Regulation of the sleep-wake cycle
   1. Basic neural processes and transmitters that control wakefulness, non-rapid eye movement and rapid eye movement sleep states
2. Sleep architecture in a normal adult
   1. Ageing process from foetal life to old age affects the sleep cycle

1. Factors that control breathing during sleep and wakefulness
2. Ventilatory response to hypercapnia and hypoxaemia (including loop gain), arousal and the apnoea threshold
3. Molecular mechanisms of hypercapnia and hypoxemia e.g. master regulators and signalling pathways involved
4. Functional anatomy of the upper airway
5. Factors that cause upper airway collapse during sleep
6. Relation of control of breathing and upper airway function to the pathophysiology of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA)
7. Influence of respiratory mechanics and ventilation from pathology
8. Sleep-related changes in respiratory mechanics in the aetiology of nocturnal hypoventilation

1. Cardiovascular function (e.g. blood pressure and heart rate) during sleep and arousal from sleep
2. Impact of sleep on autonomic regulation and the consequences of sleep pathology, e.g. in OSA and CSA

1. Utility of ABG, capillary blood gas and venous blood gas
   1. Diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and pH
   2. A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2), the alveolar gas equation and measuring oxygen shunts

1. Obstructive sleep apnoea hypopnoea syndrome (OSAHS), CSA, periodic breathing, Cheyne-Stokes respiration, obesity hypoventilation syndrome (OHS), nocturnal hypoventilation and upper airway resistance syndrome
2. Epidemiology of OSAHS and CSA
3. Clinical phenotypes of OSA and their relationship to the underlying pathophysiology

1. Sleep history including:
   1. Sleepiness and fatigue
   2. Insomnia
   3. Poor sleep quality
   4. Nocturnal choking and gasping
   5. Snoring
   6. Morning headaches
   7. Impotence
   8. Low mood or labile mood
   9. Memory disturbance
   10. Differential diagnosis of sleepiness and insomnia, e.g. consider lifestyle choices, sleep hygiene and medication
2. Signs
   1. Clinical examination of the upper airway, nasal obstruction, tonsils and adenoids
   2. Craniofacial disorders
   3. Hypothyroidism
   4. Obesity
3. Comorbidities, e.g. COPD, chest wall disease, neuromuscular or neurological disorders, cardiovascular disease and endocrine or metabolic disorders

1. Usage of questionnaires: Epworth sleepiness scale, STOP-BANG score, Berlin questionnaire and SF-36
2. Identification of high-risk patients, e.g. those with severe sleepiness, unstable cardiac disease, nocturnal arrhythmia or baseline hypoxaemia or those who drive or have another occupational risk

1. Methodology of different sleep tests (oximetry, respiratory polygraphy and full polysomnography (PSG))
2. Limitations of overnight oximetry, respiratory polygraphy, PSG, and home versus hospital-based sleep studies
3. Appreciation of which patients to refer for PSG, e.g. those with an unclear diagnosis on respiratory polygraphy, a poor treatment response or a suspected non-respiratory sleep disorder such as narcolepsy or restless leg syndrome
4. Identification of cases that require further specialised examinations, e.g. ear-nose-throat (ENT) review of the upper airway
5. Review of cardiovascular, respiratory and metabolic disorders often associated with OSA
6. High cardio-metabolic risks associated with untreated OSA
7. Value of making lifestyle improvements including weight loss, adherence to drug treatment for hypertension or diabetes, smoking cessation and alcohol reduction

1. Role of capnography in patients with nocturnal hypoventilation
2. Limitations of overnight transcutaneous carbon dioxide (TCO2) and end-tidal carbon dioxide (ETCO2) monitoring
3. Use of capnography to establish ventilator settings

1. Distinguish mild, moderate and severe cases of OSA from normal results and upper airway resistance syndrome
2. Lifestyle interventions including weight loss, smoking cessation, alcohol reduction, avoidance of night sedation and sensible sleep hygiene measures
3. Role of ENT intervention
4. Role and types of mandibular advancement splints and other oral devices
5. Definition of positional sleep apnoea and the role of positional devices
6. Indications for continuous positive airway pressure (CPAP) therapy
7. Differences between fixed level CPAP, variable CPAP, and bi-level positive pressure therapy
8. Identification of patients to refer for these interventions depending on local pathways
9. CPAP-related side effects such as interface problems, airway drying and sleep disturbance
10. Issues leading to poor adherence and how these may be addressed
11. Different ways of monitoring positive pressure therapy: clinic visits, data downloads from devices and telemonitoring
12. Follow-up including assessment of the efficacy of therapy in controlling OSA and also the impact on comorbidities and health-related quality of life
13. Importance of explaining the rationale and likely outcomes of treatment to patients and of providing advice about medico-legal aspects such as driving
14. Awareness and importance of following local guidelines on the diagnosis and management of OSAHS

1. Classification of the aetiology of CSA: idiopathic, heart failure-related and induced by a cerebrovascular cause (e.g. a cerebrovascular accident, opioid or other drug use and high altitude)
2. Differential symptoms and signs of OSA and CSA
3. Pathophysiology of different types of CSA
4. Recognition of which patients to refer for sleep studies

1. Impact of CSA on underlying pathology
2. CSA in chronic heart failure:
3. Importance of optimising therapy for heart failure
4. Role of CPAP in specific patients including those with mixed OSA and CSA
5. Adaptive servo-ventilation use in heart failure patients with a left ventricular ejection fraction of <45%
6. Other forms of CSA
7. CPAP or adaptive support ventilation (ASV) in patients with opioid-induced SDB
8. Awareness of trials in progress to assess O2 therapy in patients with CSA and the further role of ASV

1. Pathophysiology
2. Symptoms and clinical presentation
3. Consequences (vascular disease, polycythaemia and cor pulmonale)
4. Indications for CPAP and non-invasive ventilation (NIV); application or supervision of a mask and interface
5. Description of the illness and risk of obesity and offer advice about how to decrease body mass index through physical activity, training and diet
6. Role of bariatric surgery, preoperative assessment surgical risk and postoperative management in OHS patients

1. Neuromuscular diseases that cause respiratory failure
2. Neuromuscular conditions associated with respiratory muscle weakness
3. Methods to assess respiratory muscle weakness: spirometry, mouth pressures, peak cough flow, sniff inspiratory pressure and diaphragm electromyographic studies
4. Symptoms and signs of nocturnal hypoventilation and the probability of respiratory failure
5. Role of NIV versus invasive ventilation
6. Cough augmentation (cough assist) techniques
7. Use of NIV
8. Perioperative assessment and management of neuromuscular disease patients

1. Chest wall deformities that cause respiratory failure
2. Symptoms and signs of nocturnal hypoventilation and the probability of respiratory failure
3. Role of NIV versus invasive ventilation and cough augmentation (cough assist) techniques
4. Use of NIV

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

1. Treatment of ventilatory failure
2. Types of positive pressure ventilation and different modes, e.g. bi-level positive airway pressure, volume ventilation, assured volume ventilation (average volume assured pressure support and intelligent volume assured pressure support) and other NIV modes
3. Principles of therapy titration with sleep studies and ABG measurement
4. Concepts of compliance and adherence
5. Assessment of compliance and reasons for poor and good compliance
6. Indications for tracheostomy ventilation and which patients to refer for this
7. Potential role of NIV in palliative care and the importance of palliative therapy
8. Use of advance directives in end-stage diseases

1. Prevalence of SDB in asthma and COPD
2. Symptoms, clinical presentation, pathophysiology and treatment of asthma, COPD and restrictive lung disorders
3. Influence of comorbid respiratory disorders on breathing during sleep
4. Impact of drug therapy on sleep quality
5. Understand the role of CPAP therapy in overlap syndrome (COPD-OSAHS) and asthma

1. Prevalence of OSAHS in patients with endocrine disorders (e.g. hypothyroidism and acromegaly) and metabolic disorders (e.g. diabetes mellitus and metabolic syndrome)
2. Impact of OSAHS treatment on underlying endocrine/metabolic disorders

1. Consideration of non-respiratory sleep disorders and identify which patients to refer for further investigation
2. Insomnia
   1. Primary and secondary insomnia and management techniques including the role of cognitive behavioural therapy for insomnia and medication
   2. Presence of insomnia in some OSAHS phenotypes and its impact on the choice of and adherence to therapy
3. Other conditions:
   1. Restless leg syndrome
   2. Narcolepsy, benign idiopathic hypersomnolence, parasomnias and associated conditions

1. Principles of the tests for assessing excessive daytime somnolence in patients with respiratory and non-respiratory sleep conditions, their advantages, their imitations and which patients to refer for these, including:
   1. Sleep questionnaires
   2. Sleep diary
   3. Multiple Sleep Latency Test (MSLT)
   4. Maintenance of Wakefulness Test (MWT) OSLER wake test

1. Principles of circadian rhythms and their impact on the sleep-wake cycle across a range of ages
2. Molecular basis of the circadian rhythm and its dysfunction in disease
3. Impact of circadian disruption such as shift work and jet lag
4. Interactions between work and SDB e.g. shift work
5. Other circadian disorders such as delayed and advanced sleep phase disorders
6. Role of interventions such as melatonin and bright-light therapy
7. Identification of patients to refer for actigraphy and the advantages and disadvantages of this investigation

1. Medico-legal, social and economic impacts of respiratory sleep disorders

1. Carcinogenesis
   1. Basic principles of carcinogenesis, including the dysplastic lesion-carcinoma in situ-invasive lesion sequence
   2. Tumour immunology
   3. Basic principles related to tumour immunology, including the general structure of innate and adaptive immune recognition and immune responses in humans as well as the elimination-equilibrium-escape sequence
2. Hallmarks of cancer
   1. Self-sufficiency in growth signals
   2. Insensitivity to anti-growth signals
   3. Evasion from programmed cell death (apoptosis)
   4. Limitless replicative potential
   5. Sustained angiogenesis
   6. Tissue invasion and metastasis
   7. Deregulated metabolism
   8. Evasion from the immune system
   9. Genome instability
   10. Inflammation

1. Current epidemiology of active and passive smoking, heated tobacco products and smokeless tobacco products as well as other smoked or vape-related products worldwide and nationally in relation to thoracic malignancies
2. Pathogenic mechanisms of active and passive smoking, heated tobacco products and smokeless tobacco products related to thoracic malignancies
3. Socio-economic and cultural aspects of tobacco consumption related to thoracic malignancies

1. Basic principles of indoor and outdoor pollution related to thoracic malignancies

1. Occupational carcinogens that cause thoracic malignancies; causal relationships

1. Asbestos-related diseases
2. Non-malignant pleural manifestations (acute benign pleural effusions, rounded atelectasis, diffuse pleural thickening and pleural plaques)
3. Malignant pleural mesothelioma
4. Asbestosis
5. Lung cancer related to asbestos

1. Low dose computed tomography (CT) as an evidence-based measure for lung cancer screening in high risk populations

1.Symptoms as potential indicators of thoracic oncological disease:

1. Dyspnoea
2. Dysphagia
3. Chest pain
4. Bone pain
5. Headache
6. Tiredness
7. Cough
8. Haemoptysis
9. Wheezing
10. Stridor
11. Hoarseness
12. Weight loss
13. Diaphragmatic elevation
14. Pleural effusion
15. Pericardial effusion
16. Superior vena cava syndrome
17. Pancoast syndrome
18. Horner syndrome
19. Enlarged, non-moveable and/or indurated cervical, supraclavicular or nuchal lymph nodes
20. Neurological signs or symptoms
    1. Awareness of paraneoplastic syndromes including:
21. Cachexia
22. Hypercalcemia
23. Thromboses and pulmonary embolism
24. Syndrome of inappropriate antidiuretic hormone (hyponatremia)
25. Ectopic adrenocorticotropic hormone syndrome
26. Lambert-Eaton syndrome
27. Clubbing and periostitis

1. Chest X-ray
2. Thoracic ultrasound
3. Computed tomography (CT) scan
4. Positron emission tomography (PET)
5. PET-CT
6. Ventilation perfusion scan
7. Bone scan
8. Octreotide scan
9. Single-photon emission computed tomography (SPECT)
10. Magnetic resonance imaging (MRI)
11. Basic principles of each imaging modality as well as basic radioprotection measures

1. Indications, contraindications, limitations and benefit-risk assessment for diagnostic flexible and rigid bronchoscopy and diagnostic techniques in the context of thoracic oncology
2. Indications, contraindications, limitations and benefit-risk assessment for therapeutic bronchoscopy in the context of thoracic oncology (stents, cryotherapy, laser techniques, argon plasma, brachytherapy, electrocautery and photodynamic therapy)
3. Principles of discontinuation and bridging of anticoagulants
4. Principles of sedation

1. Indications, contraindications, limitations and benefit-risk assessment for each procedure in the context of thoracic oncology
2. Different ranges of the methods
3. Basic lymph node anatomy/stations of the mediastinum
4. Principles of discontinuation and bridging of anticoagulants
5. Principles of sedation

1. Indications, contraindications, limitations and benefit-risk assessment for diagnostic thoracoscopy in the context of thoracic oncology
2. Indications, contraindications, limitations and benefit-risk assessment for therapeutic thoracoscopy in the context of thoracic oncology (talc pleurodesis)
3. Principles of discontinuation and bridging of anticoagulants
4. Principles of sedation

1. Basic principles of diagnostic steps in pathology related to thoracic malignancies
   1. light microscopy: Small cell carcinoma (SCC) vs non small cell carcinoma (NSCLC), squamous vs non-squamous carcinoma, carcinoids
   2. role of immunohistochemistry
   3. molecular pathology: actionable mutations (EGFR, BRAF, MET, NTRK1, Her 2) and gene rearrangements (ALK, ROS1, RET), resistance mutations
2. Basic principles of proper handling of samples in suspected thoracic malignancies
3. Tissue preservation and quality of samples (adequate tumour contents) for light microscopy, immunohistochemistry and molecular pathology (DNA and RNA studies)
4. Liquid biopsy (cell free DNA, circulating tumour DNA)

1. Basic principles of evaluation of patient fitness for diagnostics and therapy

1. Importance of multidisciplinary teamwork throughout the continuum of thoracic malignancies
2. Multidisciplinary team meeting as the hallmark of decision-making in the process of care for patients with thoracic malignancies

1. Basic principles and indications of thoracic surgery in thoracic oncology
2. Types of thoracic surgery
3. Role of thoracic surgery in diagnosis as well as curative and palliative treatment

1. Basic principles and indications of radiotherapy in thoracic oncology
2. Role of radiotherapy in curative and palliative treatment

1. Basis of cytotoxic therapy and biological/targeted therapy
   1. Describe the basic principles of chemotherapy and biological/targeted therapy as well as drug toxicities
2. Indications and contraindications for systemic therapy including chemotherapy and targeted agents
   1. Non-small cell lung carcinoma (NSCLC)
   2. Small cell lung cancer (SCLC)
   3. Mesothelioma
   4. Mediastinal tumours
   5. Basic principles of chemotherapy and targeted therapy planning

1. Basic principles and methods of cancer immunotherapy
2. Indications and contraindications for immunotherapy including combination therapy with chemotherapies
3. NSCLC
4. SCLC
5. Mesothelioma
6. Describe the basic principles of immunotherapy planning

1. Basic principles and indications of rehabilitation programmes
2. Value of rehabilitation programmes in the pre-operative setting as well as after completion of tumour-specific therapy

1. Effects of smoking, heated tobacco products and smokeless tobacco products as well as other smoked or vape-related products on the health of the individual in relation to thoracic oncology
2. Beneficial effects of smoking cessation for preventing thoracic malignancies as well as during and after treatment of thoracic malignancies
3. Treatment modalities for smoking cessation

1. Basic principles of palliative care in thoracic oncology including its early integration as well as end-of-life care
2. Basic principles and options regarding treatment of the following tumour-related symptoms and complications:
   1. Dyspnoea
   2. Pain
   3. Tracheobronchial stenosis
   4. Haemoptysis

1. Teach the patient to recognise early side effects and to contact his/her physician
2. Importance of a multidisciplinary team for both acknowledgement of the patient and provision of care and surveillance

1. Basic principles of management of the following paraneoplastic syndromes:
   1. Cachexia
   2. Hypercalcemia
   3. Thromboses and pulmonary embolism
   4. Syndrome of inappropriate antidiuretic hormone (hyponatremia)
   5. Ectopic adrenocorticotropic hormone syndrome
   6. Lambert-Eaton syndrome
   7. Clubbing and periostitis
2. Awareness that the presence of paraneoplastic syndromes per se does not exclude curative treatment in thoracic oncology

1. Prevention of thromboembolism in thoracic oncology
2. Diagnostic and therapeutic management of thrombosis and pulmonary embolism in thoracic oncology

1. Indications, contraindications, limitations and benefit-risk assessment for thoracentesis including a chest tube and a tunnelled indwelling pleural catheter
2. Principles of discontinuation and bridging of anticoagulants
3. Principles of sedation

1. Side effects of chemotherapy and their management
   1. Haematological side effects: neutropenia, febrile neutropenia, anaemia and thrombopenia
   2. Mucositis/oesophagitis
   3. Alopecia and dermatological toxicity
   4. Nausea, vomiting and diarrhoea
   5. Neurotoxicity
   6. Ototoxicity
   7. Hepatic toxicity
   8. Nephrotoxicity
   9. Cardiovascular toxicity
   10. Extravasation: infertility and teratogenesis
   11. Electrolyte imbalance
   12. Side effect in patients with thoracic oncological disease treated with systemic therapy
2. Side effects of targeted therapy and their management
   1. Dermatological toxicity
   2. Diarrhoea
   3. Hepatic toxicity
   4. Cardiovascular toxicity
   5. Pulmonary toxicity
   6. Nephrotoxicity
   7. Side effect in patients with thoracic oncological disease treated with targeted therapy
3. Side effects of immunotherapy and their management
   1. Pneumonitis
   2. Dermatological toxicities
   3. Hepatic toxicity
   4. Cardiovascular toxicity (e.g. myocarditis)
   5. Endocrinological toxicities
   6. Nephrotoxicity
   7. Neurological toxicities
   8. Side effect in patients with thoracic oncological disease treated with immunotherapy

1. Radiation-induced pneumonitis (short-term) and fibrosis (long-term)
2. Radiation-induced oesophagitis
3. Cardiac toxicity
4. Tracheal complications
5. Skin reactions
6. Secondary malignancy
7. Radiation-induced side effect in patients with thoracic malignancies treated with radiotherapy

1. Basic principles of solitary pulmonary nodule management including radiological characteristics as well as core diagnostic and follow-up strategies
2. Up-to-date guidelines for the management of solitary pulmonary nodules

1. Basic principles of diagnostic (recommended procedures and histopathology) and therapeutic management of malignant pleural mesothelioma including multi-modal treatment modalities

1. Basic principles of diagnostic and therapeutic management of common mediastinal tumours (thymoma and lymphoma)

1. Metastatic pulmonary tumours as a differential diagnosis of pulmonary nodules/masses (e.g. pulmonary metastasis in thyroid, colorectal, prostate, renal or mammary gland carcinoma as well as soft tissue sarcoma and osteogenic sarcoma)

1. Basic principles of diagnostic and therapeutic management of malignant pleural effusion