Optimizing Fluticasone Propionate and Ciclesonide pMDI Delivery: The Protective Role of Valved Holding Chambers Against Inhalation Timing Errors.

Introduction: Discoordination between inhalation and pressurized metered-dose inhaler (pMDI) actuation when delivering inhaled corticosteroids (ICS) is a common technique error that can lead to worsened treatment outcomes. Valved holding chambers (VHCs) are thought to improve the delivered dose if inhalation is delayed, but this effect has not been sufficiently quantified.

Methods: The aerodynamic particle size distribution of fluticasone propionate (FP) and ciclesonide (CIC) was studied under three conditions: inhalation initiated before actuation without a VHC, inhalation started at actuation without a VHC, and inhalation started at actuation with a VHC.

Inhaled salbutamol delivery in small children with disposable and reusable spacers: an in vitro study.

Background: Research on spacers for paediatric breathing patterns is limited, especially for disposable types, which may be a practical alternative to reusable valved holding chambers (VHC) in certain clinical settings.

Methods: In vitro, the fine particle dose (FPD) of salbutamol from a pressurised metered-dose inhaler (pMDI) was tested using two paperboard spacers-DispozABLE (Diz) and LiteAire (LA)-and three reusable VHCs: AeroChamber Plus Flow-Vu (AC), EasyChamber (EC) and OptiChamber Diamond (OC). The pMDI+VHC setup was connected to a child throat model without a facemask.

The effect of inhalation delay on the aerodynamic particle size distribution of fluticasone propionate and ciclesonide using pMDI and valved holding chambers.

Delayed inhalation when using pressurised metered-dose inhalers (pMDIs) for inhaled corticosteroids (ICS) is a common technique error. Valved holding chambers (VHCs) can mitigate its impact, but the effect of delays on drug delivery from suspension versus solution formulations remains poorly understood. We compared the doses of fluticasone propionate (FP) and ciclesonide (CIC) delivered to an anatomical adult throat model and a Next Generation Impactor as particles 1-5 μm and under 1 μm in diameter, using AeroChamber (AC), EasyChamber (EC), and OptiChamber Diamond (OD) VHCs with inhalation delays of 0, 1, 3, and 5 s.

Cough medicine prescriptions for children by physician specialty and healthcare sector: a Finnish population-based nationwide register study.

Unlabelled: Despite clear clinical guidelines advising against the use of cough and cold medicines (CCMs) in children, these products continue to be prescribed. We aimed at describing recent trends and identifying deviations from guidelines to inform future targeted interventions. We retrospectively retrieved data on all CCM prescriptions for children under 16 years of age in Finland between 2017 and 2023 from the centralised nationwide prescription registry.

Epicutaneous immunotherapy for food allergy: A systematic review and meta-analysis.

Background: Food allergies pose a global healthcare challenge, underscoring the need for effective interventions. This study evaluated the efficacy and safety of epicutaneous immunotherapy (EPIT) for food allergen desensitisation.

Methods: We conducted a systematic review of randomised controlled trials by searching Ovid EMBASE, PubMed and Scopus in April 2024.

Consensus outcomes between health professionals and parents for oral corticosteroids in treating preschool wheeze: a multi-national survey and nominal group technique study.

Objective: To obtain priority consensus for outcome measures of oral corticosteroid treatment of preschool wheeze that represent stakeholder groups.

Design: (1) A systematic review to identify a set of outcome measures; (2) an international survey for healthcare professionals (HCPs) and a nominal group meeting with parents; (3) a final consensus nominal group meeting with key HCPs (trial investigators and paediatric emergency medicine clinicians) and the same parent group.

Main Outcome Measures: Consensus priority of treatment outcome measures, outcome minimal clinically important differences (MCIDs) and level of concerns about adverse effects.

Inhaled corticosteroid delivery is markedly affected by breathing pattern and valved holding chamber model.

Background: There is a scarcity of high-quality research on the efficient delivery of inhaled corticosteroids using valved holding chambers (VHCs) in children.

Methods: The delivered dose (DD) of fluticasone from a metered dose inhaler (pMDI) was tested using four VHCs: AeroChamber plus Flow-Vu (AC), Babyhaler (BH), EasyChamber (EC), and Optichamber Diamond (OD). The in vitro setup included an anatomical child throat model, Next Generation Impactor, and a breathing simulator to generate tidal breathing of a four and a 6-year-old child, and adult type single inhalation.

SQ sublingual immunotherapy tablets for children with allergic rhinitis: A review of phase three trials.

Aim: To provide paediatricians with a summary of efficacy and safety of SQ sublingual immunotherapy (SLIT) tablets from phase three, randomised, double-blind, placebo-controlled trials in children and adolescents with allergic rhinitis or rhinoconjunctivitis, with and without asthma.

Methods: PubMed searches were conducted and unpublished data were included if necessary.

Results: Of the 93 publications, 12 were identified reporting 10 trials.

Efficacy of oral corticosteroids for acute preschool wheeze: a systematic review and individual participant data meta-analysis of randomised clinical trials.

Background: Oral corticosteroids are commonly used for acute preschool wheeze, although there is conflicting evidence of their benefit. We assessed the clinical efficacy of oral corticosteroids by means of a systematic review and individual participant data (IPD) meta-analysis.

Methods: In this systematic review with IPD meta-analysis, we systematically searched eight databases (PubMed, Ovid Embase, CINAHLplus, CENTRAL, ClinicalTrials.

Use of antibiotics contrary to guidelines for children's lower respiratory tract infections in different health care settings.

Unlabelled: This study aimed to evaluate antibiotic prescriptions for children with lower respiratory tract infection (LRTI) in public and private primary care clinics and in a hospital's pediatric emergency department (PED) in 2012-2013 (pre-guideline) and in 2014-2015 (post-guideline). Special attention was paid to guideline compliance, especially regarding macrolide prescriptions, which the guidelines discourage. Retrospective data of 1431 children with LRTI in November-December 2012-2015 were collected from electronic registers and checked manually.

Antibiotic prescriptions for child sinusitis varied between specialties after Finnish guidelines were updated in 2018.

Aim: We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014-2020. Data were compared before and after updated guidelines in 2018.

Methods: The study comprised data on 45 296 children aged 2-17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics.

Outpatient Antibiotic Prescribing for 357,390 Children With Otitis Media.

Aim: This study aimed to evaluate antibiotic prescriptions for children with otitis media (OM) in a large nationwide network of private clinics between 2014 and 2020. Special focus was paid to amoxicillin and amoxicillin-clavulanic acid prescriptions, which the national guidelines recommend for first-line drugs. We also focused on macrolides, which are commonly prescribed for respiratory tract infections in children but are not appropriate for OM cases.

Trends in ferritin measurements in children and adolescents: A Finnish 9-year observational study.

Aim: A lack of stored iron, indicated by low serum ferritin, has been associated with various clinical symptoms. There are no longitudinal data on the frequency of ferritin measurements in children and adolescents.

Methods: A total of 2834 children aged <18 years with serum ferritin and other anaemia-related blood parameters taken during an outpatient visit between 2012 and 2019 were investigated.

Antibiotic prescribing for children with upper respiratory tract infection: a Finnish nationwide 7-year observational study.

Unlabelled: Upper respiratory tract infection (URTI) is a self-limiting viral infection and should not be treated with antibiotics. The aim was to evaluate antibiotic prescriptions for children with uncomplicated URTI in a large nationwide private clinic network between 2014 and 2020. Special focus was given to macrolide prescriptions and costs.

Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue.

Aim: We evaluated main trends in antibiotic prescriptions for children with lower respiratory tract infection (LRTI) by Terveystalo, Finland's largest private healthcare company.

Methods: The study comprised of 89,359 children aged 0-17 years (57.2% boys) who visited Terveystalo primary care clinics from 2014 to 2020 with LRTI.

Cough and cold medicine prescription rates can be significantly reduced by active intervention.

Unlabelled: Our aim was to construct and test an intervention programme to eradicate cough and cold medicine (CCM) prescriptions for children treated in a nationwide healthcare service company. The study was carried out in the largest private healthcare service company in Finland with a centralised electronic health record system allowing for real-time, doctor-specific practice monitoring. The step-by-step intervention consisted of company-level dissemination of educational materials to doctors and families, educational staff meetings, continuous monitoring of prescriptions, and targeted feedback.

Three Dose Levels of a Maternal Respiratory Syncytial Virus Vaccine Candidate Are Well Tolerated and Immunogenic in a Randomized Trial in Nonpregnant Women.

Background: Respiratory syncytial virus (RSV) causes respiratory tract infections, which may require hospitalization especially in early infancy. Transplacental transfer of RSV antibodies could confer protection to infants in their first months of life.

Methods: In this first-in-human, placebo-controlled study, 502 healthy nonpregnant women were randomized 1:1:1:1 to receive a single dose of unadjuvanted vaccine containing 30/60/120 µg of RSV fusion (F) protein stabilized in the prefusion conformation (RSVPreF3) or placebo.

Heterogeneity of emergency treatment practices in wheezing preschool children.

Aim: Our aim was to survey treatment practices used for preschool children with wheezing in emergency rooms (ER) focussing on inhalation device choice and handling, face mask use, salbutamol dosing and written instructions. We sought to assess whether current protocols are in line with published evidence and guidelines.

Methods: This is a cross-sectional survey done in paediatric ER units located in Finnish municipalities with more than 10 000 inhabitants.

Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature.

Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines.