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This study examined the emergence and implementation of community touchpoints established in the UK during the COVID-19 pandemic for victims/survivors of domestic abuse (DA). Community touchpoints are designated places, both online and in accessible settings such as pharmacies and banks, where victims/survivors can seek confidential advice and be directed to expert DA services. The research adopted a case study approach and explored a range of perspectives through expert interviews, document analysis, consultation with survivors and stakeholders and a survey of DA co-ordinators. Four national community touchpoint schemes were identified and, of these, three were implemented rapidly and were available in 2020-2021 when the UK experienced lockdowns. Partnerships between Government/voluntary organisations and commercial businesses-assisted design and implementation. Some stakeholders considered that the schemes lacked responsivity to the local context and noted challenges in providing a confidential service in rural areas. Whilst pharmacies, banks and online spaces were identified as non-stigmatised and trusted places to seek advice, community touchpoints were judged less accessible for some groups including those experiencing digital poverty and victims whose movements were heavily scrutinised. Most of the touchpoint schemes targeted adults only. There were also concerns about whether frontline staff in commercial businesses received sufficient training. Whilst robust evidence of outcomes was limited, there were indications that the schemes had achieved good reach with some early evidence of take-up. Testimonials indicated that victims/survivors were using the touchpoints in flexible ways which met their needs. Moreover, the wide reach and visibility of these initiatives delivered in non-stigmatised settings may have served to raise public awareness of DA, reducing the silence that has traditionally surrounded it. Further research into the use and impact of these initiatives is required and there may be future potential to extend community touchpoints to include children and young people experiencing DA.

Summary Background In adults with mild asthma, a combination of an inhaled corticosteroid with a fast-onset long-acting β-agonist (LABA) used as reliever monotherapy reduces severe exacerbations compared with short-acting β-agonist (SABA) reliever therapy. We investigated the efficacy of combination budesonide–formoterol reliever therapy compared with maintenance budesonide plus as-needed terbutaline. Methods We did a 52-week, open-label, parallel-group, multicentre, superiority, randomised controlled trial at 15 primary care or hospital-based clinical trials units and primary care practices in New Zealand. Participants were adults aged 18–75 years with a self-reported doctor's diagnosis of asthma who were using SABA for symptom relief with or without maintenance low to moderate doses of inhaled corticosteroids in the previous 12 weeks. We randomly assigned participants (1:1) to either reliever therapy with budesonide 200 μg–formoterol 6 μg Turbuhaler (one inhalation as needed for relief of symptoms) or maintenance budesonide 200 μg Turbuhaler (one inhalation twice daily) plus terbutaline 250 μg Turbuhaler (two inhalations as needed). Participants and investigators were not masked to group assignment; the statistician was masked for analysis of the primary outcome. Six study visits were scheduled: randomisation, and weeks 4, 16, 28, 40, and 52. The primary outcome was the number of severe exacerbations per patient per year analysed by intention to treat (severe exacerbations defined as use of systemic corticosteroids for at least 3 days because of asthma, or admission to hospital or an emergency department visit because of asthma requiring systemic corticosteroids). Safety analyses included all participants who had received at least one dose of study treatment. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12616000377437. Findings Between May 4, 2016, and Dec 22, 2017, we assigned 890 participants to treatment and included 885 eligible participants in the analysis: 437 assigned to budesonide–formoterol as needed and 448 to budesonide maintenance plus terbutaline as needed. Severe exacerbations per patient per year were lower with as-needed budesonide–formoterol than with maintenance budesonide plus terbutaline as needed (absolute rate per patient per year 0·119 vs 0·172; relative rate 0·69, 95% CI 0·48–1·00; p=0·049). Nasopharyngitis was the most common adverse event in both groups, occurring in 154 (35%) of 440 patients receiving as-needed budesonide–formoterol and 144 (32%) of 448 receiving maintenance budesonide plus terbutaline as needed. Interpretation In adults with mild to moderate asthma, budesonide–formoterol used as needed for symptom relief was more effective at preventing severe exacerbations than maintenance low-dose budesonide plus as-needed terbutaline. The findings support the 2019 Global Initiative for Asthma recommendation that inhaled corticosteroid–formoterol reliever therapy is an alternative regimen to daily low-dose inhaled corticosteroid for patients with mild asthma. Funding Health Research Council of New Zealand.

Traditional asthma maintenance therapy in adults and adolescents comprises inhaled corticosteroids (ICS), with a long-acting β2-agonist (LABA) added if ICS monotherapy provides insufficient control [1, 2]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Papi reports grants and personal fees from MRINZ, during the conduct of the study; grants, personal fees, non-financial support and other from GlaxoSmithKline, grants, personal fees and non-financial support from AstraZeneca, grants, personal fees, non-financial support and other from Boehringer Ingelheim, grants, personal fees, non-financial support and other from Chiesi Farmaceutici, grants, personal fees, non-financial support and other from TEVA, personal fees, non-financial support and other from Mundipharma, personal fees, non-financial support and other from Zambon, personal fees, non-financial support and other from Novartis, grants, personal fees and non-financial support from Menarini, personal fees, non-financial support and other from Sanofi/Regeneron, personal fees from Roche, grants from Fondazione Maugeri, grants from Fondazione Chiesi, personal fees from Edmondpharma, outside the submitted work. Conflict of interest: Dr. Braithwaite reports grants from Astra Zeneca, grants from Health Research Council of New Zealand, during the conduct of the study. Conflict of interest: Dr. Ebmeier reports grants from MRINZ, during the conduct of the study. Conflict of interest: Dr. Hancox reports personal fees from Menarini, personal fees and other from Astra Zeaneca, other from Boehringer Ingelheim, during the conduct of the study. Conflict of interest: Dr. Harrison reports grants from MRINZ, during the conduct of the study; grants, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from GSK, personal fees from Vectura, personal fees from Synairgen, personal fees from Chiesi, outside the submitted work. Conflict of interest: Mr. Holliday reports grants from Health Research Council of New Zealand, grants from AstraZeneca, during the conduct of the study. Conflict of interest: Dr. Houghton reports grants from Health Research Council of New Zealand, grants and personal fees from AstraZeneca, during the conduct of the study. Conflict of interest: Dr. Morandi reports grants from MRINZ, during the conduct of the study. Conflict of interest: Dr. Oldfield reports grants to MRINZ from the Health Research Council of New Zealand, grants from AstraZeneca, during the conduct of the study; she has nothing personal to disclose. Conflict of interest: Dr. Pavord reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Aerocrine, personal fees from Almirall, personal fees from Novartis, personal fees from GlaxoSmithKline, personal fees from Genentech, personal fees from Regeneron, from Teva, from Chiesi, from Sanofi, from Circassia, from Knopp, grants from NIHR, outside the submitted work. Conflict of interest: Dr. Reddel reports grants from AstraZeneca, grants from Health Research Council of New Zealand, during the conduct of the study; grants and personal fees from AstraZeneca, grants and personal fees from GlaxoSmithKline, personal fees from Merck, personal fees from Novartis, personal fees from Teva, personal fees from Boehringer Ingelheim, personal fees from Sanofi Genzyme, outside the submitted work; and Dr Reddel is Chair of the GINA Science Committee. Conflict of interest: Mr. Williams reports grants from MRINZ, during the conduct of the study; personal fees from Genentech Respiratory Operational Review Board, outside the submitted work. Conflict of interest: Dr. Weatherall has nothing to disclose. Conflict of interest: Dr. Beasley reports grants from Health Research Council of New Zealand, grants and personal fees from AstraZeneca, during the conduct of the study; grants and personal fees from AstraZeneca, grants from GlaxoSmithKline, grants from Genentech, personal fees from Theravance Biopharma, outside the submitted work.

Summary Background Whether blood eosinophil counts and exhaled nitric oxide (FeNO) are associated with important outcomes in mild asthma is unclear. In this prespecified subgroup analysis of a previously published open-label clinical trial, we aimed to assess associations between blood eosinophil counts and FeNO with outcomes and response to asthma treatment. Methods In the previously reported 52-week, open-label, randomised controlled trial, people with mild asthma receiving only β agonist reliever inhalers were enrolled at one of 16 clinical trials units in New Zealand, the UK, Italy, or Australia. Eligible participants were randomly assigned (1:1:1, stratified by country), to receive inhalers to take as-needed salbutamol (two inhalations of 100 μg in a pressurised metered dose inhaler), maintenance budesonide (200 μg twice per day by inhaler) plus as-needed salbutamol (two inhalations of 100 μg), or as-needed budesonide–formoterol (one inhalation of 200 μg budesonide and 6μg formoterol by inhaler). The primary outcome was the annual rates of asthma exacerbations per patient, and in this prespecified subgroup analysis, we assessed whether annual exacerbation rates in each treatment group were significantly different depending on levels of blood eosinophil count, FeNO, or a composite score of both. Analyses were done for patients with available biomarker measurements The study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12615000999538. Findings 675 participants were enrolled between March 17, 2016, and Aug 29, 2017, of whom 656 had results for blood eosinophil analysis and 668 had results for FeNO. Of the patients who received as-needed salbutamol, the proportion of patients having a severe exacerbation increased progressively with increasing blood eosinophil count (two [4%] of 49 participants with Interpretation In patients with mild asthma, the effects of as-needed budesonide–formoterol on exacerbations are independent of biomarker profile, whereas the benefits of maintenance inhaled budesonide are greater in patients with high blood eosinophil counts than in patients with low counts. Funding AstraZeneca, Health Research Council of New Zealand.

BACKGROUND In double-blind, placebo-controlled trials, budesonide–formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting β2-agonist (SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA. The availability of data from clinical trials designed to better reflect clinical practice would be beneficial. METHODS We conducted a 52-week, randomized, open-label, parallel-group, controlled trial involving adults with mild asthma. Patients were randomly assigned to one of three treatment groups: albuterol (100 μg, two inhalations from a pressurized metered-dose inhaler as needed for asthma symptoms) (albuterol group); budesonide (200 μg, one inhalation through a Turbuhaler twice daily) plus as-needed albuterol (budesonide maintenance group); or budesonide–formoterol (200 μg of budesonide and 6 μg of formoterol, one inhalation through a Turbuhaler as needed) (budesonide–formoterol group). Electronic monitoring of inhalers was used to measure medication use. The primary outcome was the annualized rate of asthma exacerbations. RESULTS The analysis included 668 of 675 patients who underwent randomization. The annualized exacerbation rate in the budesonide–formoterol group was lower than that in the albuterol group (absolute rate, 0.195 vs. 0.400; relative rate, 0.49; 95% confidence interval [CI], 0.33 to 0.72; P CONCLUSIONS In an open-label trial involving adults with mild asthma, budesonide–formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations. (Funded by AstraZeneca and the Health Research Council of New Zealand; Novel START Australian New Zealand Clinical Trials Registry number, ACTRN12615000999538.)

Children's perspectives literature repositions children and young people as active participants in surviving domestic abuse, protecting their family, opposing the violence and recovering from abuse. However, key tenets of safeguarding in relation to domestic abuse, both in practice and childhood research ethics, struggle to fully recognise children's agency and the need to empower children and young people as well as women. Children's right to participation now extends to national policy-making in many countries, yet has not been explored in relation to the interdependency of women and children's rights, safety and wellbeing where both have been subject to abuse. This paper challenges the current exclusion of young voices from the development of ethical praxis. It outlines a participatory ethical approach that promotes the inclusion and empowerment of young survivors in research and policy. Young expert advisors on Scottish domestic abuse policy (2009–11) co-develop the approach (participatory action research) which is informed by a wider study (2004–11) about children's help-seeking and solutions for practice. Mullender et al.'s accepted model of three Cs and Ds (consent, confidentiality, child protection: danger, distress, disclosure) are adapted to focus on children's agency. Three Es are added focusing on children's power and impact: enjoyment, empowerment and emancipation. Copyright © 2015 John Wiley & Sons, Ltd. ‘This paper challenges the current exclusion of young voices from the development of ethical praxis’ Key Practitioner Messages Children and young people have a distinct, essential voice in risk assessment and management. They are competent and central decision-makers, they can consent to participation. Participation can be a powerful therapeutic tool. Enjoyment, empowerment and emancipation are intrinsic to participation, alongside recognition of children's agency in safeguarding. Access to power, equal voice and impact on children's lives are preconditions of participation to young survivors – to be worth the inherent risk of speaking out. ‘Participation can be a powerful therapeutic tool’ ‘Access to power, equal voice and impact on children's lives are preconditions of participation to young survivors’