Paediatric Respiratory Health in Focus: Key Updates from this Issue

Respiratory diseases in children and adolescents remain a significant global health burden. These conditions, whether infectious or non-infectious, chronic or acute life-threatening, require accurate diagnosis and timely intervention to optimize management and improve outcomes. Prevention, early recognition, and prompt treatment are essential in reducing disease burden and mortality. In addition, understanding risk factor and epidemiology is critical for developing effective public health strategies. Four articles in this edition of the journal address different but important aspects of respiratory diseases in children and adolescent. Acute respiratory distress syndrome (ARDS) is a complex condition associated with high mortality rates and long-term complication.[1,2] Historically, paediatric ARDS (PARDS) was diagnosed using adult-based criteria until the Paediatric Acute Lung Injury Consensus Conference (PALICC) established a specific definition in 2015.[3] In this issue, Su et al. presents a comprehensive review of the updated recommendations from PALICC-2, published in 2023.[4] Key updates include refined diagnostic criteria and novel oxygenation indices such as PaO2/FiO2 ratio, SpO2/FiO2 ratio, and the oxygen index. These tools enhance the accuracy or PARDS assessment with various respiratory interventions, including invasive and non-invasive ventilation. The introduction of “possible PARDS” and “at risk for PARDS” facilitates early recognition and timely intervention, which will improve patient outcomes. This comprehensive review deepens our understanding of PARDS and provides valuable insight into diagnostic algorithms, management strategies, and emerging treatment options. Chronic respiratory conditions in children, such as asthma, bronchiectasis, and cystic fibrosis (CF), pose significant challenges due to recurrent exacerbations that contribute to decline lung function and structural airway changes. Azithromycin, a macrolide antibiotic with anti-inflammation and immunomodulator properties, has gained attention for its potential role in reducing exacerbations and improving clinical outcomes. Most of the evidence supporting the prophylactic use of azithromycin in children is derived from studies on CF and bronchiectasis. While clinical trials on the use of azithromycin in asthmatic children are limited, some studies have shown promise in reducing asthma exacerbation rates, particularly in those with neutrophilic airway inflammation.[5,6] In this journal, Tung provides a comprehensive review on this topic; highlighting both the benefit of azithromycin in reducing pulmonary exacerbations and its limited impact on lung function. The review also underscores potential risks, including antimicrobial resistance and adverse effects.[7] These findings encourage clinicians to carefully balance the benefit against the risk, ensuring that therapy is tailored to appropriate patent populations. Ongoing research and antimicrobial stewardship will be key to maximizing its therapeutical potential while mitigating risks. Airway hyper-responsiveness (AHR) is a key physiological feature of asthma, serving as an indicator of disease severity. Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT) are self-reported questionnaire, that has been used widely to assess asthma control. Yeung et al. investigated the relationship between C-ACT and ACT with AHR, finding that these subjective tools did not correlate well with AHR as measured by methacholine challenge test. The retrospective design with its inherent limitation of the study should be taken into account, but a recent cross sectional study in Hong Kong reported similar finding, showing that more than 50% of children who self-evaluated with good asthma control exhibited mild and moderate AHR.[8] These findings suggest that while C-ACT and ACT are useful for symptom monitoring, they may not be sensitive for detecting AHR in children and adolescent. Therefore, additional objective assessment is advised for a comprehensive evaluation of asthma severity. The COVID-19 pandemic has reshaped our understanding of respiratory infections in children, with increasing attention to viral induced airway inflammation. The risk of croup among children with COVID-19 is higher, particularly during the Omicron wave, as shown in a retrospective study by Hu et al. presented in this journal.[9] This study provides valuable insights to guide pediatric healthcare strategies. Future research should aim to elucidate the long-term impact of SARS-CoV-2 on pediatric airway diseases and explore potential intervention to mitigate its burden on young children. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.