Present and future of paediatric interventional pulmonology: addressing global healthcare disparities.

Abstract

Paediatric interventional pulmonology has evolved significantly since the introduction of flexible bronchoscopy in the 1970s, transforming the diagnosis and treatment of paediatric respiratory conditions. This review examines the current state and future directions of the field, emphasising the unique challenges in paediatric airways that necessitate specialised knowledge, instruments and expertise. Recent technological advances in bronchoscopy have expanded both diagnostic and therapeutic capabilities, enabling precise, minimally invasive procedures tailored to paediatric needs. These include airway dilation, stenting, cryotherapy, electrocautery, laser therapy and advanced imaging techniques such as endobronchial ultrasound (EBUS) and robotic navigation systems. However, significant global healthcare disparities persist in access to paediatric bronchoscopy services. While high-income countries offer comprehensive diagnostic and therapeutic capabilities, resource-limited settings face substantial gaps despite often having a higher burden of respiratory diseases, particularly tuberculosis. The review addresses implementation strategies for establishing bronchoscopy services in various resource settings and proposes innovative educational approaches for developing sustainable international training programmes. Future development of the field requires coordinated international efforts, including establishing robust networks between centres, increased funding support and addressing regulatory barriers to facilitate knowledge exchange. The advancement of paediatric interventional pulmonology as a distinct subspecialty, supported by standardised training pathways and international collaboration, is essential for ensuring optimal care for children with complex airway disorders worldwide.