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OBJECTIVES In epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma. METHODS LuftiBus in the school is a cross-sectional survey of respiratory health among Swiss schoolchildren aged 6-17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parent-child answers with Cohen's kappa (k), and associations of answers from children and parents with fractional exhaled nitric oxide (FeNO) and forced expiratory volume in 1 s over forced vital capacity (FEV1 /FVC), using quantile regression. RESULTS We received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (k = 0.37) and exertional wheeze (k = 0.36). Median FeNO varied when wheeze was reported by children (19 ppb, interquartile range [IQR]: 9-44), parents (22 ppb, IQR: 12-46), both (31 ppb, IQR: 16-55), or neither (11 ppb, IQR: 7-19). Median absolute FEV1 /FVC was the same when wheeze was reported by children (84%, IQR: 78-89) and by parents (84%, IQR: 78-89), lower when reported by both (82%, IQR: 78-87), and higher when reported by neither (87%, IQR: 82-91). For exertional wheeze findings were similar. Results did not differ by age or sex. CONCLUSION Our findings suggest that surveying both parents and children and combining their responses can help us to better identify children with measurable asthma traits.

The early detection of inflammation and infection is important to prevent irreversible lung damage in cystic fibrosis. Novel and non-invasive monitoring tools would be of high benefit for the quality of life of patients. Our group previously detected over 100 exhaled mass-to-charge (m/z) features, using on-line secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS), which distinguish children with cystic fibrosis from healthy controls. The aim of this study was to annotate as many m/z features as possible with putative chemical structures. Compound identification was performed by applying a rigorous workflow, which included the analysis of on-line MS2 spectra and a literature comparison. A total of 49 discriminatory exhaled compounds were putatively identified. A group of compounds including glycolic acid, glyceric acid and xanthine were elevated in the cystic fibrosis group. A large group of acylcarnitines and aldehydes were found to be decreased in cystic fibrosis. The proposed compound identification workflow was used to identify signatures of volatile organic compounds that discriminate children with cystic fibrosis from healthy controls, which is the first step for future non-invasive and personalized applications.

OBJECTIVE Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. DESIGN Observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC). PATIENTS We included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS. RESULTS The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. CONCLUSIONS Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonised procedures for children seen for EIS. This article is protected by copyright. All rights reserved.

Background It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children. We evaluated predictors for these two outcomes in a clinical cohort study. Methods The Swiss Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks. Results At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline, wheeze triggered by allergens, colds and exercise, a more intense treatment at baseline, history of preschool and persistent wheeze, and exposure to tobacco smoke. Incident asthma attacks were associated with previous episodes of severe wheeze and asthma attacks, younger age and non-Swiss origin. Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks. Conclusion Predictors of suboptimal control differ from those of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes.

Rationale The lung clearance index (LCI) is increasingly being used in the clinical surveillance of patients with cystic fibrosis (CF). However, there are limited data on long-term variability and clinically relevant changes in LCI during routine clinical surveillance. Objectives To evaluate long-term variability of LCI and propose a threshold for a clinically relevant change. Methods Children with CF aged 4-18 years performed LCI measurements every three months as part of routine clinical surveillance during 2011-2020 in two centers. The variability of LCI during periods of clinical stability was assessed using mixed-effects models and was used to identify thresholds for clinically relevant changes. Results Repeated LCI measurements of acceptable quality (N= 858) were available in 100 patients with CF. Variability of repeated LCI measurements over time expressed as coefficient of variation (CV%) was 7.4%. The upper limit of normal (ULN) for relative changes in LCI between visits was 19%. Conclusion We report the variability of LCI in children and adolescents with CF during routine clinical surveillance. According to our data, a change in LCI beyond 19% may be considered clinically relevant. These findings will help guide clinical decisions according to LCI changes.

BACKGROUND Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways and there is no consensus for standardized reporting. OBJECTIVE We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. METHODS We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort (SPAC) from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (e.g., asthma) and features (e.g., triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. RESULTS Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. CONCLUSION We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.

Identifying and differentiating bacteria based on their emitted volatile organic compounds (VOCs) opens vast opportunities for rapid diagnostics. Secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS) is an ideal technique for VOC-biomarker discovery because of its speed, sensitivity towards polar molecules and compound characterization possibilities. Here, an in vitro SESI-HRMS workflow to find biomarkers for cystic fibrosis (CF)-related pathogens P. aeruginosa, S. pneumoniae, S. aureus, H. influenzae, E. coli and S. maltophilia is described. From 180 headspace samples, the six pathogens are distinguishable in the first three principal components and predictive analysis with a support vector machine algorithm using leave-one-out cross-validation exhibited perfect accuracy scores for the differentiation between the groups. Additionally, 94 distinc-tive features were found by recursive feature elimination and further characterized by SESI-MS/MS, which yielded 33 putatively identified biomarkers. In conclusion, the six pathogens can be distin-guished in vitro based on their VOC profiles as well as the herein reported putative biomarkers. In the future, these putative biomarkers might be helpful for pathogen detection in vivo based on breath samples from patients with CF., Metabolites, 11 (11), ISSN:2218-1989

References from the Global Lung Function Initiative (GLI) are widely used to interpret children's spirometry results. We assessed fit for healthy schoolchildren.LuftiBus in the School was a population-based cross-sectional study undertaken in 2013-2016 in the canton of Zurich, Switzerland. Parents and their children aged 6-17 years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for forced expiratory volume in 1 s (FEVWe analysed data from 2036 children with valid FEVGLI-based FEV

Background Lung disease can develop within the first year of life in infants with cystic fibrosis (CF). However, the frequency and severity of respiratory symptoms in infancy are not known. Methods We assessed respiratory symptoms in 50 infants with CF and 50 healthy matched controls from two prospective birth cohort studies. Respiratory symptoms and respiratory rate were documented by standardized weekly interviews throughout the first year. Infants performed multiple breath washout in the first weeks of life. Results We analyzed 4552 data points (2217 in CF). Respiratory symptoms (either mild or severe) were not more frequent in infants with CF (OR:1.1;95% CI:[0.76, 1.59]; p=0.6). Higher lung clearance index and higher respiratory rate in infants with CF were not associated with respiratory symptoms. Conclusions We found no difference in respiratory symptoms between healthy and CF infants. These data indicate that early CF lung disease may not be captured by clinical presentation alone.

BackgroundReferences from the Global Lung Function Initiative (GLI) are widely used to interpret children’s spirometry results. We assessed fit for healthy schoolchildren.MethodsLuftiBus in the school (LUIS) is a population-based cross-sectional study done from 2013-2016 in the canton of Zurich, Switzerland. Parents and children aged 6-17 years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for FEV1, FVC, FEV1/FVC, and FEF25-75for healthy White participants. We defined appropriate fit to GLI references by mean values ±0.5 z-scores. We assessed if fit varied by age, body mass index, height, and sex using linear regression models.ResultsWe analysed data from 2036 children with valid FEV1measurements of which 1762 also had valid FVC measurements. The median age was 12.2 years. Fit was appropriate for children aged 6-11 years for all indices. In adolescents aged 12-17 years, fit was appropriate for FEV1/FVC (mean: -0.09; SD: 1.02) z-scores, but not for FEV1(mean: -0.62; SD: 0.98), FVC (mean: -0.60; SD: 0.98), and FEF25-75(mean: -0.54; SD: 1.02). FEV1, FVC, and FEF25-75z-scores fitted better in children considered overweight (means: -0.25, -0.13, -0.38) than normal weight (means: -0.55, -0.50, -0.55;p-trend: 1, FVC, and FEF25-75z-scores depended on both age and height (pinteraction: 0.034, 0.019, ConclusionGLI-based FEV1, FVC, and FEF25-75z-scores do not fit White Swiss adolescents well. This should be considered when using reference equations for clinical decision making, research and international comparison.Take home messageOur study suggests GLI-based FEV1, FVC, and FEF25-75z-scores over detect abnormal lung function in Swiss adolescents, and more so among slimmer adolescents, which has important implications for clinical care, research, and international comparisons.

BACKGROUND Nasal nitric oxide (nNO) measurement is recommended as a first line screening test for primary ciliary dyskinesia (PCD). While reliable velum- and non-velum-closure techniques exist for preschool children and older individuals, no data are available for neonates. AIMS To determine feasibility of nNO screening and nNO concentration in healthy newborns in the first week of life. METHODS Nasal NO was analyzed in tidal breathing during natural sleep using a CLD-88 sp NO analyzer (chemoluminescence sensor) and a NIOX MINO (electrochemical sensor). Test success and nNO concentration were determined and compared between the two devices. RESULTS Nasal NO was measured in 62 healthy neonates within the first week of life. Feasibility of nNO measurement was 100% for at least one nostril and 85.5% for both nostrils using the chemoluminescence device, but significantly lower with the electrochemical device (85.5% and 53.2%; p

Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident., This study reveals enormous differences in therapy with biologicals for childhood severe asthma across Europe, and demonstrates the urgent need for harmonisation in medication choice, definition of therapy success and how/when to discontinue treatment https://bit.ly/3tnJMTY

Antibiotic eradication treatment is the standard-of-care for cystic fibrosis (CF) patients with early Pseudomonas aeruginosa (Pa)-infection; however, evidence from placebo-controlled trials is limited.This double-blind, placebo-controlled trial randomised CF patients7 years (N = 51) with early Pa-infection to tobramycin inhalation solution (TOBI 300 mg) or placebo (twice daily) for 28 days with an optional cross-over on Day 35. Primary endpoint was proportion of patients having throat swabs/sputum free of Pa on Day 29.On Day 29, 84.6% patients in the TOBI versus 24.0% in the placebo group were Pa-free (p 0.001). At the end of the cross-over period, 76.0% patients receiving TOBI in the initial 28 days were Pa-free compared to 47.8% receiving placebo initially. Adverse events were consistent with the TOBI safety profile with no differences between TOBI and placebo.TOBI was effective in eradicating early Pa-infection with a favourable safety profile in young CF patients.NCT01082367.

We assessed how prevalence estimates of cough in 6-17-year-olds vary depending on the question asked in the population-based Luftibus in the school (LUIS) study. 3427 parents answered three different questions on cough. The prevalence of parent-reported cough varied substantially depending on the question: 25% of parents reported cough without a cold, 11% dry night cough and 5% that their child coughs more than other children. There was only partial overlap with 3% answering yes to all questions. This suggests that the exact question used to assess cough strongly affects prevalence estimates and must be taken into account when comparing studies.

In epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma.LuftiBus in the schoolis a cross-sectional survey of respiratory health among Swiss schoolchildren aged 6-17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parent-child answers with Cohen’s kappa (k), and associations of answers from children and parents with physiological measurements (i.e. FeNO and FEV1/FVC), using quantile regression.We received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (k=0.37) and exertional wheeze (k=0.36). Median FeNO varied when wheeze was reported by children (19 ppb, IQR: 9-44), parents (22 ppb, IQR: 12-46), both (31 ppb, IQR: 16-55) or neither (11 ppb, IQR: 7-19). Median absolute FEV1/FVC was the same when wheeze was reported by children (84%, IQR: 78-89) and by parents (84%, IQR: 78-89), lower when reported by both (82%, IQR: 78-87) and higher when reported by neither (87%, IQR: 82-91). For exertional wheeze findings were similar. Results did not differ by age or sex.Our findings suggest that surveying both parents and children and combining their responses can help us to better identify children with measurable asthma traits.Take home messageThere is poor agreement between schoolchildren and their parents when reporting current wheeze. However, wheeze correlates best with lung function and FeNO when reported by both children and parents.

BackgroundExercise-induced breathing problems with similar clinical presentations can have different aetiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult.ObjectiveWe studied which parent-reported, exercise-induced symptoms (EIS) can help distinguish diagnoses of EIS in children seen in respiratory outpatient clinics.MethodsThis study was nested in the Swiss Paediatric Airway Cohort (SPAC), an observational study of children aged 0-17 years referred to paediatric respiratory outpatient clinics in Switzerland. We studied children aged 6-17 years and compared information on EIS from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyse whether parent-reported symptoms differed between diagnoses (asthma as base).ResultsAmong 1109 children, EIS were reported for 732 (66%) (mean age 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnoea best distinguished thoracic DB (relative risk ratio [RRR] 5.4, 95%CI 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR 2.4, 95%CI 1.3-6.2) and asthma plus DB (RRR 1.8, 95%CI 0.9-3.4) from asthma only. Late onset of EIS was less common for extrathoracic DB (RRR 0.1, 95%CI 0.03-0.5) and thoracic DB (RRR 0.4, 95%CI 0.1-1.2) compared with asthma. Localisation of dyspnoea (throat vs. chest) differed between extrathoracic DB (RRR 2.3, 95%CI 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses.ConclusionParent-reported symptoms help distinguish different diagnoses in children with EIS. This highlights the importance of physicians obtaining detailed patient histories.Highlights boxWhat is already known about this topic?Experts suggest that information about the symptoms and their onset and duration can assist accurate diagnosis of children with exercise-induced respiratory problems, but no original studies have tested this. (29/35 words)What does this article add to our knowledge?Exercise-induced symptoms reported by parents and further information about their onset, triggers, and effects of treatment help differentiate diagnoses in children with exercise-induced respiratory problems. (25/35 words)How does this study impact current management guidelines?Our results emphasize the importance of taking detailed symptom histories of children with exercise-induced problems, and suggest which questions are most helpful.

In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies., Highlights from the Paediatrics Assembly at the #ERSCongress 2020 https://bit.ly/3ptcnFr

BACKGROUND Multiple breath washout (MBW) is increasingly used in the clinical assessment of patients with cystic fibrosis (CF). Guidelines for MBW quality control (QC) were developed primarily for retrospective assessment and central overreading. We assessed whether real-time QC of MBW data during the measurement improves test acceptability in the clinical setting. METHODS We implemented standardized real-time QC and reporting of MBW data at the time of the measurement in the clinical pediatric lung function laboratory in Bern, Switzerland in children with CF aged 4-18 years. We assessed MBW test acceptability before (31 tests; 89 trials) and after (32 tests; 96 trials) implementation of real-time QC and compared agreement between reviewers. Further, we assessed the implementation of real-time QC at a secondary center in Zurich, Switzerland. RESULTS Before implementation of real-time QC in Bern, only 58% of clinical MBW tests were deemed acceptable following retrospective QC by an experienced reviewer. After implementation of real-time QC, MBW test acceptability improved to 75% in Bern. In Zurich, after implementation of real-time QC, test acceptability improved from 38% to 70%. Further, the agreement between MBW operators and an experienced reviewer for test acceptability was 84% in Bern and 93% in Zurich. CONCLUSION Real-time QC of MBW data at the time of measurement is feasible in the clinical setting and results in improved test acceptability. This article is protected by copyright. All rights reserved.

Parental and children’s questionnaires are used to assess respiratory symptoms, but we know little about their validity against objective markers of asthma. We studied agreement between parent and child reported current wheeze in Swiss schoolchildren and its association with FeNO and FEV1. We analysed data from Luftibus in the school, a population-based survey of respiratory health in children done in the canton of Zurich. Parents completed a questionnaire at home, children at school. We analysed parent-child agreement on wheeze with Cohen’s kappa and the association of parent and child reported wheeze with FEV1% predicted (adjusting for age, sex) and FeNO (adjusting also for hay fever) with linear regressions. We received questionnaires from 3113 families (median age 12years, range 6-17). Prevalence of wheeze was similar when analysing children’s (9%) and parents’ (8%) questionnaires, but agreement was poor (kappa 0.37, 0.31-0.43). Wheeze was reported by the parent only in 128 families (4%), child only in 166 (6%) and both in 108 (4%). Children had higher median FeNO and lower mean FEV1% if both reported wheeze (FeNO 31.2; FEV1% 91.3) than parent only (FeNO 17.8; FEV1% 92.4), child only (FeNO 15.5; FEV1% 94.4) or none (FeNO 11.4; FEV1% 94.1). Wheeze was similarly associated with FeNO and FEV1% when using parents’ (FeNO 14.7, 95%CI 11.4-17.9; FEV1% -2.1, 95%CI -3.7 to -0.4) vs children’s answers (FeNO 12.5, 95%CI 9.6-15.4; FEV1% -0.7, 95%CI -2.2 to 0.9). Parent-child agreement on reported wheeze is poor, but both reports are similarly associated with objective markers of asthma. If parents and children both report wheeze, the probability that this reflects true asthma seems high. Method: Lunge Zurich

Introduction: Population-based studies on chronic cough in children are scarce. Little is known on how chronic cough varies by sex, age and presence or absence of wheeze, and its risk factors are unclear. Methods: In 2013-16, we conducted a field study on respiratory health among schoolchildren in the canton of Zurich, Switzerland (“Luftibus in the school”). Parents and children completed a questionnaire, and lung function tests were done in a mobile lab. In the questionnaire chronic cough was defined as cough lasting more than 3 weeks. We performed a multivariable logistic regression to identify factors associated with chronic cough. Results: We analysed data from 3395 children (age range 6-17 years, 50% girls), of which 319 (9%) reported chronic cough. The prevalence was 10% in girls, 8% in boys, 12% in 6-9 years old and 8% in older children. 73 (23%) of those with chronic cough reported also wheeze. Factors associated with chronic cough in the multivariable regression were: female sex (OR 1.5, 95%CI 1.1-2.0), younger age (OR:1.1, 95%CI 1.0-1.2), overweight (OR 1.5, 95%CI 1.1-2.1), active smoking (≥1/week) (OR 4.1, 95%CI 1.7-10.0), asthma (OR 2.6, 95%CI 1.8-3.9), rhinitis (OR 1.8, 95%CI 1.3-2.5) and otitis media (OR 1.9, 95%CI 1.3-2.7). We found no association with number of siblings, parental smoking, living on a farm, pets, hay fever and snoring. Conclusion: Chronic cough is frequent among schoolchildren in Switzerland, especially girls and younger children and associated with asthma and upper respiratory disease. Overweight and smoking are modifiable risk factors which could be addressed to reduce the burden of chronic cough. Funding: Lunge Zurich, SNF:32003B_162820

BackgroundSmoking is a major preventable cause of morbidity and mortality. We assessed smoking behaviour in 6-17-year-olds. In 13-17-year-olds, we studied risk factors for smoking and compared the frequency of respiratory problems between those who smoked and those who did not.MethodsWe used data from LuftiBus in the school, a school-based survey of the respiratory health of children carried out 2013-2016 in the canton of Zurich, Switzerland. Participants were asked about cigarette, shisha, and electronic smoking device (ESD) smoking, and respiratory symptoms and diseases. We studied the association between smoking and risk factors using logistic regression.ResultsWe included 3488 schoolchildren with data on active smoking. Five percent of the 6-12-year-olds (90 of 1905) had smoked occasionally (ConclusionSmoking of shishas and ESDs is popular among Swiss adolescents and often combined with smoking cigarettes. Structural smoking prevention strategies should include all forms of smoking including shishas and ESDs.