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Children with complex neurodisability have increased risk of respiratory tract infections. Pseudomonas aeruginosa (PA) is an organism that commonly infects and colonises the airway. Treatment choices are complicated by adverse effects and development of antibiotic resistant organisms. There are no established guidelines and the treatment approach of clinicians varies. A retrospective case notes review was undertaken to look at the prevalence of PA in respiratory samples of children with neurodisability, treatment practices and outcomes. Of 226 children with a neuromuscular condition or cerebral palsy (GMFCS score 4-5), 25 had at least one PA positive sample during a 12-month period. Those using a tracheostomy were twice as likely to isolate PA; 21 (80%) had recurrent isolates, suggesting colonisation of the airway. 62 individual clinical episodes were identified. Patients most likely to deteriorate clinically were those treated with broad-spectrum antibiotics (41%) compared with PA-specific (27%) or no antibiotics (11%). All 10 patients in whom antibiotics were changed as directed by microbial results, improved clinically thereafter. No adverse effects were documented as a direct result of antibiotics. Antibiotic resistance was documented in 8/21 colonised patients with these more likely to require escalation to intensive care treatment. A guideline for management and more sophisticated methods to direct treatment choices are needed. Techniques such as the ability to identify virulent strains of PA using point-of-care testing may improve patient outcomes and prevent the development of antibiotic resistance in the future.

Dysfunctional breathing is a significant cause of morbidity, adversely affecting an individual's quality of life. There is currently no data from paediatric centres on the impact of breathing retraining for dysfunctional breathing. Symptoms and quality of life were measured in 34 subjects referred sequentially for breathing retraining to the first dedicated paediatric dysfunctional breathing clinic in the UK. Data were obtained prior to the first intervention (time point 1), at discharge (time point 2) and by post 6 months later (time point 3). The mean (interquartile range) age of participants was 13.3 (9.1–16.3) years, with 52% female. Data were obtained at time points 2 and 3 in 23 and 13 subjects, respectively. Statistically significant improvements were observed in symptom scores, child quality of life and parental proxy quality of life between time points 1 and 2 (p, Breathing retraining improves the quality of life and symptoms of children with dysfunctional breathing http://ow.ly/qg1c302sYAF

Background: Respiratory rate (RR) is an important vital sign used in the initial and ongoing assessment of acutely ill children. It is also used as a predictor of serious deterioration in a patient9s clinical condition. Convenient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although devices which measure RR exist, none has entered everyday clinical practice. Aims: We have developed a contactless portable respiratory rate monitor (CPRM) and aimed to evaluate the agreement in RR measurements between existing methods and our new device. Method: RR data were collected from 30 children undergoing polysomnography sleep studies at a tertiary children9s hospital. The RR of each participant was measured simultaneously by 3 different methods. Respiratory impedance plethysmography (RIP) the established contact method and gold standard. Visual counting of chest movements, and method used most in clinical settings. The contactless portable respiratory monitor (CPRM), which is the new method. Two data sets were collected from each child. Results: Data showed substantial agreement between measurements from the CPRM and the gold standard RIP, with intra-class correlation coefficient: 0.762, mean difference -0.212 and 95% limits of agreement of -6.842 to 6.419. Conclusion: A contactless device for accurately and quickly measuring RR will be an important tool in the assessment of unwell children. More testing is needed to explore the reasons for outlying measurements and to evaluate in different clinical settings. Further development and modification of the device and software are ongoing.

Background Persistent bacterial bronchitis (PBB) is recognised as an important cause of chronic cough. Aims and Objectives This study aimed to characterise the respiratory bacterial microbiota of children with PBB compared with healthy controls. Methods DNA was extracted from bronchial brushes from 24 PBB children and 18 healthy controls. A 16S rRNA gene qPCR was used to quantify bacterial burden prior to sequencing. Analysis was carried out using QIIME and R. Results Bacterial diversity measures were significantly lower in PBB than healthy controls ( p 2 = 0.08, p = 0.004). Indicator species analysis showed that Haemophilus was significantly associated with PBB Discussion The bacterial community in the lungs of children with PBB is significantly different to that of healthy individuals, showing lower diversity both in terms of richness and evenness. More information about the bacterial community associated with this condition could lead to rapid diagnosis and treatment, reducing the burden of this condition.

Reports have shown peaks in asthma episodes in school-aged children associated with the return to school following the summer vacation (Julious SA et al. Public Health 2007;121(6):482-4). A drop in prescription collection in the month of August has been observed which was associated with an increase in the number of unscheduled contacts after the return to school in September. The aim of the study was to assess whether a primary care intervention reduced the number of unscheduled medical contacts after the school return. A letter was sent from the GP to parents/carers of children aged 5-16 years with asthma at the start of school summer holidays reminding them to take their preventer medication prior to the start of the new school year. The study was a cluster randomised trial with a control group that received usual care. The intervention did not reduce unscheduled care in September (odds-ratio 1.09; 95% CI 0.96 to 1.25) against the intervention. It did succeed in increasing the proportion of children collecting prescriptions in August (odds-ratio 1.43; 95% CI 1.24 to 1.64) as well as scheduled contacts in the same month. For the wider time intervals (Sep-Dec 2013 and Sep-Aug 2014) there was weak evidence of effect. The economic analysis estimated a high probability that the intervention was cost saving. A higher uptake of prescriptions and scheduled contacts in August may indicate that the letter triggered parents to arrange asthma reviews in children whose prescriptions had lapsed. GPs and commissioning groups may wish to implement this intervention in areas with high rates of asthma and low rates of scheduled asthma reviews.

Background: Monitoring respiratory rate (RR) is an important task for medical diagnosis that is neglected due to complexities in performing it. Current methods require the sensing device to be attached to the subjects' body thereby constraining or causing them discomfort and thus potentially affecting the breathing rate. We have developed a noncontact method for RR monitoring using a thermal camera. Method: Algorithms to capture images and detect the location of the face in each image were developed. The amount of emitted infrared radiation was then determined and signal processing techniques were then utilised to obtain the respiration rate in real time. A FLIR A40 thermal camera was used in this study. The evaluations were conducted against five existing contact based methods. Results: Tests were conducted on 51 adults (mean age 35.7) and 20 children (mean age 6.4 years). Mean RR (thermal imaging) 14.8 per minute; (chest and abdominal band) 14.8 per minute in adults. The correlation coefficient was 0.88 - 0.998 in adults and 0.578 – 0.999 in children depending on the method used. Figure 1 shows a respiration signal for a child obtained during the evaluation. Conclusion: A reliable non-contact method of measuring respiratory rate is needed to improve assessment of acutely unwell children and will potentially enable earlier detection of clinical deterioration. The thermal imaging method is accurate, however further evaluation in children is required.

Introduction: Adherence to inhaled steroids is often sub-optimal in childhood asthma, with multiple consequences including poor disease control and increased health care utilisation. Aims and Objectives: To investigate whether a complex intervention comprising electronic adherence monitoring with feedback and reminder alarms can improve clinical outcomes and adherence in childhood asthma. Methods: Children with asthma in the UK were recruited and followed up in standard clinics for 12 months. The intervention group had their adherence electronically monitored and regularly fed- back. The devices in this group also played medication reminder alarms. The control group had their adherence monitored, but received no feedback or alarms. Clinical outcomes were recorded 3 monthly. Interim Results: 90 participants were recruited, 25 have completed study, and 60% of follow-up visits have been completed to date. The study will be complete by August 2015. At 12 months, the mean adherence in the intervention arm is currently 83%, compared to 34% in the control arm. At 12 months, the mean forced expiratory volume in 1 second % predicted in the intervention arm is 100%, compared to 87% in the control arm. The mean number of oral steroid courses in the 12 months is 1.7 in the intervention group and 2.7 in the control group. Conclusion: Electronic adherence monitoring with feedback and reminder alarms can potentially improve adherence and lung function, reducing the amount of oral steroids required for children with asthma.

Background: Respiratory rate (RR) is a vital physiological measurement used in the immediate assessment of acutely ill patients. It is used as a predictor of serious deterioration in a patient's clinical condition. Convenient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although devices which measure RR exist, none has entered everyday clinical practice. We have developed a contactless portable respiratory rate monitor (CPRM). We aimed to measure agreement with existing methods of RR measurement. Method: RR data were collected from 33 adult volunteers using respiratory impedance plethysmography (RIP) bands (established contact method), visual counting of chest movements (established non-contact method) and the CPRM (new method), simultaneously. Two to three data sets were collected for each volunteer. Results: Data showed good agreement between measurements from the CPRM and the gold standard RIP with limits of agreement -4.6 – 7.8. Conclusion: A contactless device for accurately and quickly measuring RR will be an important tool in the assessment of unwell children. More testing is needed to explore reasons for outlying measurements and to evaluate in the paediatric population. Further development and modification of the device and software are planned.