Paediatric pulmonologist in Latviawhere to get treatment, how to verify certification, what this doctor does

A paediatric pulmonologist treats disease of the airways, lungs, pleura and mediastinum in patients up to 18. In Latvia the field is usually combined with paediatric allergology, since asthma, allergic rhinitis and atopic dermatitis often occur in the same child.

• Asthma and obstructive airway disease
• Persistent or recurring cough with no clear cause
• Repeated pneumonia and bronchitis
• Allergic disease, including food and drug allergy
• Children who fall ill frequently
• Breathing problems during exercise, including in young athletes

A family doctor or paediatrician is enough for one-off respiratory infections. A paediatric pulmonologist is needed when a cough keeps returning or drags on, when treatment is not working, or when lung function and allergy testing are required.

Paediatric pulmonology in Latvia has no separate sub-specialties. In practice some doctors work across both paediatric pulmonology and allergology, and a few also work in paediatric sleep medicine.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Entry to the paediatric pulmonology programme requires a copy of a valid paediatrician certificate, or university confirmation of third-year residency in the base specialty "Pediatrs". For doctors without the paediatrics specialty the programme runs six years.
• Residency in paediatric pulmonology. The RSU programme runs 3 years, 132 credit points or 198 ECTS, tuition 5,120 EUR per year, with 1 state-funded place in the intake. Programme page: RSU residency programme.
• Rotations cover paediatric inpatient and outpatient pulmonology, adult pulmonology, phthisiology, paediatric bronchology, radiology, paediatric resuscitation and intensive care, rehabilitation, and paediatric thoracic surgery.
• The state examination covers theory plus defence of a research project.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points, at least 60 per cent tied to the base specialty, plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• Languages. Consultations run in Latvian and Russian, with some doctors also working in English and French.
• Tests on site. If spirometry, oscillometry or skin allergy testing is planned, check whether the provider performs them and from what age.
• The child's age. Spirometry is usually possible from age 5 and oscillometry from age 4, so the test options differ for younger children.
• Allergy and asthma together. If the child has both respiratory and skin or food symptoms, a specialist working across both fields saves referrals.
• Second opinion. A child's legal representative may freely choose the doctor and institution.

• Bring information on the child's health, the medicines they take, and relevant family health history.
• If spirometry is planned, salbutamol (Ventolin) should be avoided for at least 6 hours before the visit, and combined medicines such as Seretide or Symbicort for 24 hours, where the child's condition allows.
• If skin allergy testing is planned, antihistamines should be stopped at least 5 days before the visit, where the child's condition allows.
• Where food allergy is suspected, keep a food diary recording what the child eats and whether it triggers symptoms. If the baby is breastfed, the mother keeps a diary too.
• At the visit the doctor reviews symptoms, examines the child, and orders lung function tests, allergy testing or imaging as needed.

Children under 18 are among the groups exempt from patient co-payments, so a state-funded paediatric pulmonology consultation on referral costs the family nothing. That also covers state-funded imaging for which adults would pay a co-payment. A private visit is paid by the parents or an insurer, and tests are charged separately from the consultation.

• Patient co-payment for a child under 18Price EUR: 0.00Source: NVD
• State-funded consultation on referralPrice EUR: 0.00Source: NVD, exemption for children under 18
• Private paediatric pulmonology consultationPrice EUR: per clinic price listSource: Premium Medical

The specialty body is the association "Latvijas Bērnu alergologu un pneimonologu biedrība" (Latvian Association of Paediatric Allergologists and Pulmonologists), registration number 40008061291, registered address Vienības gatve 45, Children's Clinical University Hospital, ward 18, Rīga, LV-1004. Contacts: Ineta Grantiņa and Elīna Aleksejeva, emails ineta.grantina@bkus.lv and elina.aleksejeva@bkus.lv.

Certificates in paediatric pulmonology are issued by the Certification Council of the Latvian Medical Association, founded in 1988. The sector regulator is the Health Inspectorate.

If you have doubts about the care a child received, raise them first with the institution's management, which must operate a complaints and suggestions system. If that does not resolve it, the child's legal representative may submit a written complaint to the Health Inspectorate no later than two years after the alleged infringement. It is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site.