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BSc Clinical Physiology - Accreditation Checklist - Respiratory

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					Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR ONE

Respiratory anatomy and physiology (level one)

         SUBJECT AREA                     COVERED       COMMENTS
                                           YES/NO
      RESPIRATORY TRACT
    Nasal passages
    Pharynx
    Larynx
    Trachea
    Bronchi
    Bronchioles
    Alveoli
    Alveolar capillary membrane
    Histology (special cell types
     including epithelial cells, goblet
     cells, ciliated cells etc)
    Respiratory defence mechanisms
     (1) mechanical defence (2) non-
     specific immune components (3)
     specific immune components
                 THORAX
   Sternum
   Vertebral column
   Ribs
   Clavicle
   Scapulae
   Mediastinum (containing heart,
    oesophagus, great vessels)
   Pleural membranes
   Lung lobes and
    bronchopulmonary segments
   Diaphragm

Innervation and circulation

 Pulmonary circulation
 Bronchial circulation
 Autonomic nerve supply
  (sympathetic and
  parasympathetic)
 Role of adrenergic and
  cholinergic receptors




                                                                                1
Control of breathing

 Respiratory control centre in
  brain (medulla, pons, higher
  centres)
 Role of chemoreceptors
 Autonomic nervous system
 Reflexes

Gas exchange
 Gas laws
 Anatomical and physiological
  dead space
 Principles of diffusion: partial
  pressures, gas transfer
 Oxygen dissociation curve




                                     2
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR ONE

Respiratory mechanics (level one)

       SUBJECT AREA                  COVERED            COMMENTS
                                      YES/NO
 Inspiratory muscles: diaphragm,
  sternocleidomastoid, external
  intercostals
 Accessory muscles of inspiration
 Expiratory muscles (rectus
  abdominis, external oblique
  muscle)
 Quiet breathing
 Active breathing
 Pressure changes during
  breathing (pleural, alveolar and
  mouth pressures)
 Changes in shape and size of
  thorax




                                                                                3
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR ONE

Pathophysiology (level one)


       SUBJECT AREA                     COVERED         COMMENTS
                                         YES/NO
   Indications for performing lung
    function tests
     assess whether any
       abnormality of lung function
       is present
     assess the severity of lung
       disease and to aid in the
       establishment of a
       differential diagnosis
     To assess the response to
       treatment such as
       corticosteroids and evaluate
       changes in lung function
       occurring over time such as
       the rate of deterioration
     to provide an objective
       measurement of lung
       function for occupational
       health or industrial reasons
     research purposes
     to investigate the presence
       and severity of sleep related
       breathing disorders such as
       obstructive sleep apnoea
     assess exercise tolerance and
       capability of patient in order
       to quantify the limitation
       placed on an individual by
       the lung disease or to
       evaluate the response to an
       intervention such as LVRS
       or pulmonary rehabilitation
     assessment of suitability for
       transplantation or surgical
       interventions that require
       anaesthesia




                                                                                4
   Contraindications for
    performing tests
     recent pneumothorax
     recent myocardial infarction
       or unstable cardiovascular
       status
     poor compliance with tests
       and inability to perform
       measurements (nausea,
       vomiting)
     recent thoracic or abdominal
       surgery
     aortic aneurysm
     active bacterial infection of
       the respiratory tract
     pneumomediastinum
     recent eye surgery
     haemoptysis of unknown
       origin
     specific contraindications
       relating to individual tests eg
       exercise testing, assessment
       for supplementary oxygen
       etc




                                         5
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR ONE

Infection control and laboratory safety (level one)

       SUBJECT AREA                   COVERED              COMMENTS
                                       YES/NO
   Sterilisation/disinfection and
    methods eg steam,
    glutaraldehyde, chlorine
   Viruses/bacteria
   Use of filters
   Aseptic technique
   Special precautions for testing
    immunocompromised patients
    or those with a known infection
    status eg Hep B/C, TB, HIV
    and MRSA
   Handling of fluids – blood,
    sputum
   COSHH
   Handwashing
   Frequency of cleaning and
    sterilising equipment:
    guidelines
   Laboratory safety including
    handling, recognition and
    storage of gas cylinders;
    disposal of clinical waste
   Basic life support
   Fire and electrical safety


Basic Statistics and use of reference values (level one)

        SUBJECT AREA                   COVERED             COMMENTS
                                        YES/NO
   Normal distribution
   Standard deviation
   Standardised residuals
   Uses and limitations and
    derivation of reference values
   Correction for adolescence and
    non Caucasion populations


                                                                                6
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR ONE

Pharmacology (level one)

        SUBJECT AREA                      COVERED       COMMENTS
                                           YES/NO
   Bronchodilators: mode of action
    (adrenergic, anticholinergic types)
   Uses and indications for
    administration of bronchodilators
   Contraindications, side effects
    and interactions of common
    bronchodilator drugs
   Methods of delivery- metered
    dose inhaler, dry powder inhaler,
    volume spacing devices,
    nebulisers (jet nebuliser and
    ultrasonic nebuliser)
   Aerosol kinetics




Therapeutics (level one)

        SUBJECT AREA                      COVERED       COMMENTS
                                           YES/NO
   Bronchodilators
   Types of inhalation device:
    limitations and advantages of
    each




                                                                                7
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR ONE

Physiological Measurement Theory (level one)

         SUBJECT AREA                     COVERED       COMMENTS
                                           YES/NO
Spirometry

    Measurements: FEV1, FVC, VC,
     PEFR, maximal flow volume
     curves
    Equipment: flow and volume
     measuring devices. Laboratory
     based vs portable handheld
     (including wedge bellows, flow
     turbine, pneumotachograph, dry
     rolling seal, water sealed
     spirometers, peak flow meters)
    Limitations, advantages and
     disadvantages of each device and
     principles of measurement
    Calibration and equipment
     specification
    Quality control
    Guidelines for the measurement
     of respiratory function: technical
     acceptability of tests, pre test
     requirements, correction to BTPS
    Use of MDIs, volume spacing
    devices and nebulisers
    Assessment of the response to
    bronchodilator therapy in the
    laboratory and guidelines for
    reversibility testing




                                                                                8
Lung volumes
 Measurements: FRC, TLC, RV,
   ERV, IVC, EVC
 Equipment: helium dilution,
   nitrogen washout, body
   plethysmography
 Limitations, advantages and
   disadvantages of each device and
   principles of measurement
 Calibration and equipment
   specification
 Quality control
 Guidelines for the measurement
   of respiratory function: technical
   acceptability of tests, pre test
   requirements, correction to BTPS

Transfer factor

   Measurements: Tlco, Kco, EffVa
   Awareness of different
    components of transfer factor
   Equipment: single breath-breath
    holding technique for carbon
    monoxide; rebreathing technique
   Limitations, advantages and
    disadvantages of each method and
    principles of measurement
   Calibration and equipment
    specification
   Quality control
   Guidelines for the measurement
    of respiratory function: technical
    acceptability of tests, pre test
    requirements, correction to BTPS




                                         9
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR TWO

Respiratory physiology (level two)

         SUBJECT AREA                     COVERED       COMMENTS
                                           YES/NO
Exercise physiology
 Normal cardiorespiratory
   response to exercise
 Cardiac response to exercise –
   heart rate, stroke volume
 Ventilatory response to exercise –
   breathing frequency, tidal volume
 Limitations to exercise in normal
   subjects
 Anaerobic threshold – definition
 Maximal oxygen uptake
 Exercise induced asthma –
   physiology of response, airway
   reactivity
 Use of pulse oximetry in exercise,
   sleep and principles and
   limitations of the measurement
   (advantages and disadvantages of
   different probes ie finger vs ear
   probes)
Respiratory muscle physiology
 Anatomy of respiratory muscles:
   inspiratory and expiratory
   muscles
 Pressure changes and pressure
   volume changes during
   ventilation (relationship of pleural
   pressure, alveolar pressure and
   mouth pressure to airflow)
 Airway resistance and work of
   breathing




                                                                                10
Sleep physiology
 Circadian rhythm, diurnal rhythm,
    melatonin
 Effects of shift work and jet lag
    on diurnal rhythm
 Respiration and gas exchange
    during sleep
 Use of pulse oximetry in simple
    sleep studies and overnight
    oximetry




                                      11
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR TWO

Respiratory pathophysiology (level two)

         SUBJECT AREA                       COVERED     COMMENTS
                                             YES/NO
Obstructive ventilatory defects
(including causes, consequences,
morbidity, natural history,
predisposing factors, therapeutic
interventions)
 COPD: definition, Venn diagram
 Emphysema
 Alpha 1 antitrypsin deficiency
 Chronic bronchitis
 Asthma: peak flow monitoring,
    diurnal variation
 Cystic Fibrosis
 Bronchiectasis
Restrictive ventilatory defects
(including causes, consequences,
morbidity, natural history,
predisposing factors, therapeutic
interventions)
 Pulmonary fibrosis: idiopathic,
    drug induced
 Cryptogenic Fibrosing Alveolitis
 Sarcoidosis
 Occupational lung disease:
    silicosis, coal dust, berylliosis etc
 Neuromuscular lung diseases:
    muscular dystrophy, Guillain
    Barre syndrome
 Kyphoscoliosis
 Respiratory muscle disease:
    diaphragmatic paralysis, polio




                                                                                12
Others (including causes,
consequences, morbidity, natural
history, predisposing factors,
therapeutic interventions)
 Primary pulmonary hypertension
 Cardiac disease
 Obesity
 Extrinsic allergic alveolitis: bird
    fanciers lung, farmers lung
   Goitre




                                        13
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR TWO

Pharmacology (level two)

         SUBJECT AREA                      COVERED      COMMENTS
                                            YES/NO
    Airway reactivity with relation to
     exercise induced asthma testing
    Hypersensitivity – types 1 and 3
    Inflammation
    Bronchodilators: action of
     bronchodilators, mediators of
     response, theophyllines, long
     acting bronchodilators,
     cromoglycate therapy
    Distribution of receptors in the
     airways
    Steroids: steroid inhalers and oral
     corticosteroids
   Drugs that may affect lung
    function: amiodarone


Therapeutics (level two)

         SUBJECT AREA                      COVERED      COMMENTS
                                            YES/NO
   Bronchodilators (**more detail):
    short and long acting
    bronchodilators; beta agonists;
    anticholinergic agents
   Steroid inhalers/oral
    corticosteroids
   Drug interactions and side effects




                                                                                14
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR TWO

Physiological Measurement Theory (level two)

        SUBJECT AREA                     COVERED        COMMENTS
                                          YES/NO
Lung function tests
 Microbiological techniques
 Nebuliser assessment
 Steroid assessment
Field exercise tests
 6 minute and 12 minute walking
   tests
 Incremental and endurance shuttle
   walking tests
 assessment of desaturation during
   exercise
 assessment of supplementary
   oxygen requirements
 objective measure of exercise
   tolerance
 Use of measurements of symptoms
   (Borg scale, Visual Analogue
   Scale, Rating of Perceived
   Exertion) and pulse oximetry
 Indications and contraindications
   for performing field exercise tests
   and indications to terminate the
   test procedure
 Practical experience at performing
   tests, obtaining measurements and
   reporting results
Exercise induced asthma
 indications for tests and
   contraindications
 pre test requirements and
   precautions during test procedure
 measurements obtained during
   tests interpretation of results
 guidelines for the performance of
   the test
 practical experience and
   observation of tests including
   obtaining measurements and
   reporting of the observed response



                                                                                15
Respiratory muscle function
 Simple respiratory muscle
   strength assessment: including
   mouth pressures (MIP and MEP)
   using hand held mouth pressure
   meter; sniff pressures; vital
   capacity (seated and supine).
 Normal values and interpretation
   of results - common diseases in
   which respiratory muscle
   weakness may occur - muscular
   dystrophy, diaphragmatic
   paralysis, polio

Sleep studies
 Use of domiciliary sleep
    screening
 Pulse oximetry in detecting
    abnormal sleep disorders
 Recognition of obstructive sleep
    apnoea
 Interpretation and limitations of
    overnight sleep screening using
    pulse oximetry and recording of
    snoring


Skin prick testing
 Indications and contraindications
    for performing skin prick tests
 Procedure for performing tests
    and safety precautions
 Interpretation of results of skin
    prick tests
 Allergens commonly used to
    perform tests
 Limitations of measurements
 Patch tests, RAST tests and
    allergen challenge testing (eg
    peanut)




                                      16
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR TWO

Interpretation of lung function tests (level two)

        SUBJECT AREA                    COVERED         COMMENTS
                                         YES/NO
   Spirometry: obstructive vs
    restrictive lung disease
   Interpretation of response to
    bronchodilator administration
   Recognition of the need to
    administer a bronchodilator
   Interpretation of the response
    during a nebuliser assessment or
    steroid assessment
   Interpretation of flow volume
    curves: obstructive, restrictive,
    extra- and intra-thoracic airflow
    obstruction
   Recognition of the uses and
    limitations of reference values




                                                                                17
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR THREE

Respiratory physiology (level three)

        SUBJECT AREA                   COVERED          COMMENTS
                                        YES/NO
Gas exchange and acid base balance
 processes of gas exchange
 oxygen and carbon dioxide
   transport
 ventilation/perfusion ratio
 effects of shunts
 acid base balance - metabolic
   acidosis, respiratory acidosis,
   metabolic alkalosis, respiratory
   alkalosis
 blood gases - partial pressures of
   oxygen and carbon dioxide, pH
 bicarbonate, base excess, oxygen
   saturation
 hypoxaemia
 hypercapnia
 hyperventilation
 type 1 and type 2 respiratory
   failure
 effects of LTOT - survival and
   mortality, pulmonary
   haemodynamics, lung function,
   polycythaemia, quality of life
   (NOTT and MRC studies)




                                                                                18
Exercise physiology

Normal response to exercise to
include:
 Muscles - structure, metabolism,
    substrates (glycolysis, anaerobic
    metabolism)
 Cardiac response to exercise -
    control of response, cardiac
    frequency and stroke volume,
    cardiac output
 Ventilatory response to exercise -
    control of response, breathing
    frequency, tidal volume,
    ventilation perfusion ratio during
    exercise
 Circulatory response to exercise -
    redistribution of blood flow to
    muscles
 Anaerobic threshold -
    determination of AT (methods to
    include graphical recognition),
    definition of AT, acid base
    balance, respiratory quotient,
    oxygen deficit and oxygen debt
 VO2 max - definition,
    determination
 Limitations to exercise subjects in
    normal subjects
 Recovery from exercise - heart
    rate, stroke volume, cardiac
    output, ventilation
 Effects of exercise training -
    muscles, recovery, substrates and
    metabolism, high vs low intensity
    exercise training
 Exercise prescription




                                         19
Exercise pathophysiology

Exercise response in disease to
include:
 Cardiac and respiratory
   (obstructive and restrictive
   disease) - patterns of response,
   major limiting factors and
   assessments of symptoms
 Other disorders - obesity,
   unfitness, malingering,
   deconditioning,
 Contraindications to exercise
   testing and safety during exercise
   tests
 Recognition of indications to
   terminate the exercise test
   prematurely eg ECG signs,
   symptoms, blood pressure signs

Indications for performing clinical
exercise tests:
 objective assessment of exercise
   capacity
 assessment of symptoms
 unexplained dyspnoea on exertion
 assessment of disability
 desaturation on exercise
 assessment of cardiac vs
   respiratory limitation to exercise
 assessment of intervention
 serial monitoring
 exercise induced asthma
 transplantation assessment
 assessment for surgery eg LVRS
 assessment for ambulatory oxygen
 exercise prescription
 occupational health




                                        20
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR THREE

Respiratory mechanics (level three)

        SUBJECT AREA                    COVERED         COMMENTS
                                         YES/NO
   airways resistance, reactance and
    conductance
   compliance
   work of breathing
   measurements obtained in
    obstructive and restrictive
    ventilatory disorders


Therapeutics (level three)

        SUBJECT AREA                    COVERED         COMMENTS
                                         YES/NO
   Exercise training
   Long term oxygen therapy
   Supplemental oxygen during
    flight or exercise
   Pulmonary rehabilitation
    (including assessment of health
    status and symptoms)
   Nutritional supplementation
   Relaxation
   Hormone supplementation
   Smoking cessation
   Inspiratory muscle training
   Lung transplantation
   Lung volume reduction surgery




                                                                                21
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR THREE

Physiological measurement theory (level three)

        SUBJECT AREA                   COVERED          COMMENTS
                                        YES/NO
Lung function tests – transfer
factor
 Measurement of diffusing
    capacity (Dm) and capillary
    blood volume (Vc)
 Rebreathing method for carbon
    monoxide

Respiratory mechanics
   Use of body plethysmography to
    measure lung mechanics
   Measurement of airways
    resistance and conductance
   Measurement of compliance
   Work of breathing

Challenge testing: methacholine and
histamine challenge
 Yan, dosimeter and tidal
    breathing methods of assessing
    airway reactivity
 Indications and contraindications
    for the performance of tests
 Safety precautions during testing
    and safe handling of reagents
 Protocols for challenge testing
    using methacholine, histamine,
    cold air, dry air and others
    including occupational allergens
 Graphical representation of
    results and interpretation




                                                                                22
Invasive and non-invasive
measurement of blood gases
 procedures for the safe handling of
   blood - sharps awareness, safe
   disposal of equipment, infection
   control
 blood gas analysers - principles of
   operation and electrodes,
   calibration and maintenance
 normal values
 Ear lobe capillary sampling,
   venous blood sampling, arterial
   cannular and arterial puncture
 Transcutaneous measurement of
    oxygen and carbon dioxide: to
    include principles of
    measurement and limitations,
    applications in sleep, exercise,
    LTOT and non-invasive
    ventilation
 Indications for measurements of
    blood gases in sleep, exercise and
    LTOT
 Flight assessment: protocol,
    indications and interpretation of
    results
 Assessment for LTOT: protocol,
    indications and interpretation of
    results




                                         23
Introduction to full cardiorespiratory
exercise testing
Exercise protocols:
 Maximal vs submaximal tests
 How to decide the most
    appropriate protocol to use
 Advantages and disadvantages of
    each protocol
 Cycle ergometer testing:
    incremental, Wingate tests
 Treadmill testing:
    Bruce/Modified Bruce,
    Naughton/Modified Naughton,
    Balke, Astrand Ellestad, ramped
    tests
 Steady state exercise tests

Equipment:
 Equipment: Douglas bag systems,
   mixing chamber and gas
   analysers, on line breath by breath
   systems
 Advantages and disadvantages of
   each system
 Essential equipment -
   resuscitation, defibrillator, 12
   lead ECG, ?medical supervision
   of tests
 manual calculation of results and
   predicted values
 graphical representation of results
 quality control and calibration
 maintenance
 biological control

Measurements:
 ventilation, breathing frequency,
   tidal volume, oxygen uptake,
   carbon dioxide output, heart rate,
   oxygen pulse, ventilatory
   equivalents for oxygen and
   carbon dioxide, respiratory
   exchange ratio, oxygen saturation,
   blood pressure, heart rate reserve,
   lactic acid




                                         24
   VO2 time constant/oxygen
    kinetics
   Measurement of ventilation and
    perfusion
   Assessment of symptoms: Borg
    scale, Visual Analogue Scale,
    Rating of Perceived Exertion
   Introduction to 12 lead ECG
    monitoring
   Practical experience and
    observation of full
    cardiorespiratory exercise tests
    including obtaining measurements
    and interpretation of results

Interpretation of results:
 graphs and flow charts
 common patterns of results in
   disease: cardiac vs respiratory
   disease
 symptoms
 breathing reserve
 cardiac reserve
 obstructive vs restrictive lung
   disease
 use of anaerobic threshold in
   interpretation




                                       25
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR FOUR

Respiratory physiology (level four)

        SUBJECT AREA                  COVERED           COMMENTS
                                       YES/NO
Respiratory control centre
 Control of ventilation
 Respiratory centres in the
   brain/medulla
 Innervation of lungs and
   respiratory muscles
 Reflexes
 Chemoreceptors: aortic bodies,
   carotid bodies
 Integration of central drive and
   sensory input
 Dyspnoea: mechanisms and
   assessment
 Respiratory response to hypoxia
   and hypercapnia
 Hyperventilation

Respiratory muscle physiology
 respiratory muscles and the
   breathing cycle
 control of breathing frequency
 pressure volume relationship
 length tension relationship




                                                                                26
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR FOUR

Therapeutics (level four)

        SUBJECT AREA                  COVERED           COMMENTS
                                       YES/NO
   CPAP: indications for CPAP,
    methods of assessment and
    selection of equipment
   Setting up a domiciliary CPAP
    service
   NIPPV: acute and chronic use of
    non-invasive ventilation
   Requirements to set an acute or
    chronic service for NIPPV
   Selection of equipment and
    consumables for NIPPV




                                                                                27
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR FOUR

Physiological Measurement Theory (level four)

        SUBJECT AREA                     COVERED        COMMENTS
                                          YES/NO
Introduction to impulse oscillometry
 Principles of measurement
 Airways reactance and resonance
    frequency
Uses, indications for measurement
and interpretation of results
Introduction to complex sleep
investigations
 Sleep staging – recognition and
    interpretation of abnormal sleep
    patterns
 Respitrace
 Visilab systems
 Full polysomnography: gold
    standard
 Indications for complex sleep
    studies
 Interpretation of results
 Obstructive sleep apnoea:
    treatment with CPAP, indications
    for treatment, surgery, weight
    loss, pharmaceutical intervention
 Other sleep related breathing
    disorders: narcolepsy, sleep
    apnoea-hypopnoea syndrome,
    restless legs syndrome
 Epworth sleepiness scale
 Sleep latency and wakefulness
    tests
 Knowledge of the DVLA
    regulations
 Practical experience of
    performing complex sleep
    investigations including full
    polysomnography (preparation of
    equipment, patient and analysis of
    the results obtained)




                                                                                28
Introduction to non-invasive
ventilation
 NIPPV: principles and indications
    for acute and chronic use
 Provision of both an acute non-
    invasive ventilation service
 Selection of machine and correct
    adjustment of pressures for
    NIPPV
 Setting up a domiciliary non-
    invasive ventilation service:
    maintenance and servicing of
    equipment and supply of
    consumables
 CPAP: indications for use
 Selection of the appropriate
    pressure for the machine;
    domiciliary CPAP trials; inpatient
    CPAP, autoset and automatic
    titration machines
 Mask fitting and choosing the
    appropriate mask size
 Setting up a domiciliary CPAP
    service – machine and
    consumable supply and
    maintenance
 Practical experience using CPAP
    and NIPPV machines including
    selection of machine and
    consumables and analysis of
    results
Introduction to complex assessments
of respiratory muscle function
(invasive and non-invasive)
 Magnetic stimulation,
    oesophageal balloon, twitch
    diaphragmatic pressures
    (volitional vs non-volitional
    tests), vital capacity, MVV
 Equipment for assessing
    respiratory muscle function:
    limitations and protocols




                                         29
   Indications for assessing
    respiratory muscle function and
    interpretation of results in
    different diseases: polio, phrenic
    nerve palsy, diaphragmatic
    paralysis, Guillain Barre
    Syndrome, muscular dystrophy,
    steroid induced myopathy
   use of EMG
   practical experience and
    observation of test procedures




                                         30
Respiratory Physiology Specialist Modules (theory and underpinning knowledge)

YEAR FOUR

Interpretation (level four)

         SUBJECT AREA                      COVERED      COMMENTS
                                            YES/NO
   interpretation of full lung function
    tests (spirometry, lung volumes
    and gas transfer) and recognition
    of the different pathological
    processes that may contribute to
    the results
   obstructive ventilatory defects:
    asthma, emphysema, cystic
    fibrosis, bronchiectasis
   restrictive ventilatory disorders:
    interstitial lung disease,
    neuromuscular or mechanical
    defects
   effects of drug therapy on
    measured parameters eg
    amiodarone, methotrexate etc
   interpretation of assessments
    performed for LTOT, nebuliser
    and steroid assessment and
    assessment of the requirement for
    supplemental oxygen during
    flight or exercise
   field exercise tests (exercise
    induced asthma, 6 minute walk
    test, incremental shuttle walk test)
   interpretation of pulse oximetry
    (recognition of abnormal results
    in overnight oximetry screening;
    field exercise tests)
   simple tests of respiratory muscle
    function (MIP, MEP, sniff
    pressures, seated and supine vital
    capacity); recognition of
    abnormality and indications to
    perform tests




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