50 years of pediatric pulmonology: Progress and future

Abstract

Development of Pediatric Pulmonology as a speciality in India is steadily improving over past few decades. Present profile of Indian pediatric chest services include: asthma, recurrent infections, bronchiectasis, etc. It is expected to change and the emerging pulmonary illnesses include: human immunodeficiency virus (HIV infection) associated pulmonary illnesses, cystic fibrosis, primary ciliary dyskinesia, bronchopulmonary dysplasia, interstitial lung diseases, gastroesophageal reflux diseases, neuromuscular illnesses, sleep disorders, disorders due to malformations and opportunistic pulmonary infections. Respiratory infections constitute major load in pediatric outpatient services and are the leading cause of mortality in under-five children. To reduce morbidity and mortality due to respiratory tract infections, Indian Academy of Pediatrics (IAP) has developed Respiratory Tract Infection Group Education Module (RTIGEMS). After initial increase in prevalence of asthma, it seems to have stabilized now but going by the numbers, it will remain a major health problem in India. Diagnosis of pulmonary tuberculosis was always a challenge to pediatricians and with emergence of drug resistant tuberculosis, it is even more challenging. Presently few centers are providing specialized Pediatric pulmonology services in India. There is a need to develop more centers to enhance services including (a) assessment of pulmonary physiology by performing pulmonary function testing in all age groups, (b) improving diagnostic and therapeutic role of bronchoscopy and bronchoalveolar lavage, (c) sweat testing, (d) molecular diagnostics for various respiratory illnesses, and (e) utilizing advance imaging and minimally invasive technologies for diagnosis and treatment of respiratory illnesses. At present there is no degree course in Pediatric Pulmonology in India. Initially middle level pediatricians wanting to pursue their career in pediatric pulmonology should undergo training in existing centers. Trained persons should develop a network to collect data and answer relevant research questions.

An Infant with Interstitial Lung Disease

“…However, HIV serology was negative and multiple gastric lavage samples for acid-fast bacilli staining were not suggestive. TB would still be a strong possibility as it is endemic in India and pediatric TB is usually paucibacillary [6]. Cytomegalovirus (CMV) infection, either acquired by perinatal transmission or in a setting of primary immunodeficiency (PID), could result in persistent interstitial pneumonia.…”

Cystic fibrosis revisited

“…To be able to diagnose and manage CF, there is a need to develop more tertiary centers to enhance services including provision of resources to undertake assessment of respiratory condition (culture of respiratory secretions for CF-associated pathogens, age-appropriate respiratory function testing and imaging), improve diagnostic and therapeutic role of bronchoscopy and bronchoalveolar lavage, noninvasive evaluation of exocrine pancreatic function (e.g., estimating faecal elastase), along with dietetic, psychology, and physiotherapy support. [727]…”

Pediatric Pulmonology Training in India: Current Status and Future Directions

“…Till 3–4 decades ago, pediatrics was considered one of the super specialty branches in India. However, the development of subspecialties or super specialties in Pediatrics is a felt need because of the significant increase in knowledge that may not be possible for a single specialist to handle [ 4 ].…”