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Tuberculosis (TB) is the leading cause of death from a single infectious agent globally. Mortality is related to the delay in diagnosis and starting treatment. According to new guidelines it is very important to classify pulmonary tuberculosis (PTB) as severe or not severe disease due to the difference in treatment duration. Bronchoscopy is the gold standard for assessing the degree of airway compression and obstruction in paediatric PTB. Paediatric bronchoscopy has evolved from a primarily diagnostic procedure to include interventional bronchoscopy for diagnostic purposes. Endobronchial ultrasound (EBUS) has increased the potential of sampling mediastinal lymph nodes both for histological diagnosis and microbiological confirmation.

Echinococcosis is a worldwide public health problem causing considerable paediatric morbidity and mortality in endemic areas. The presentation of cystic echinococcosis (CE) varies by age. Unlike adults, where hepatic involvement is common, pulmonary CE is the dominant site in the paediatric population. Pulmonary cysts are typically first seen on chest X-ray, either as an incidental finding or following respiratory symptoms after cyst rupture or secondary infection of the cyst. In children, pulmonary cysts have a broad differential diagnosis, and a definitive diagnosis relies on the combination of imaging, serology, and histology. In countries with high infectious burdens from diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), the diagnosis is additionally challenging, as atypical infections are more common than in developed countries. Pulmonary CE is treated with a combination of surgery and chemotherapy.

Cystic fibrosis (CF) - although primarily a lung disease - also causes a variety of gastrointestinal manifestations which are important for diagnosis, prognosis and quality of life. All parts of the gastrointestinal tract can be affected by CF. Besides the well-known pancreatic insufficiency, gastroesophageal reflux disease, liver disease and diseases of the large intestine are important pathologies that impact on prognosis and also impair quality of life. Diagnosis and management of gastrointestinal manifestations will be discussed in this review. Since optimisation of CF therapy is associated with a significantly longer life-span of CF patients nowadays, also gastrointestinal malignancies, which are more common in CF than in the non-CF population need to be considered. Furthermore, novel evidence on the role of the gut microbiome in CF is emerging. The introduction of cystic fibrosis transmembrane conductance regulator (CFTR) protein modulators gives hope for symptom alleviation and even cure of gastrointestinal manifestations of CF.

Introduction In primary ciliary dyskinesia (PCD) impaired mucociliary clearance leads to recurrent airway infections and progressive lung destruction, and concern over chronic airway infection and patient-to-patient transmission is considerable. So far, there has been no defined consensus on how to control infection across centres caring for patients with PCD. Within the BEAT-PCD network, COST Action and ERS CRC together with the ERN-Lung PCD core a first initiative has now been taken towards creating such a consensus statement. Methods A multidisciplinary international PCD expert panel was set up to create a consensus statement for infection prevention and control (IP&C) for PCD, covering diagnostic microbiology, infection prevention for specific pathogens considered indicated for treatment and segregation aspects. Using a modified Delphi process, consensus to a statement demanded at least 80% agreement within the PCD expert panel group. Patient organisation representatives were involved throughout the process. Results We present a consensus statement on 20 IP&C statements for PCD including suggested actions for microbiological identification, indications for treatment of Pseudomonas aeruginosa, Burkholderia cepacia and nontuberculous mycobacteria and suggested segregation aspects aimed to minimise patient-to-patient transmission of infections whether in-hospital, in PCD clinics or wards, or out of hospital at meetings between people with PCD. The statement also includes segregation aspects adapted to the current coronavirus disease 2019 (COVID-19) pandemic. Conclusion The first ever international consensus statement on IP&C intended specifically for PCD is presented and is targeted at clinicians managing paediatric and adult patients with PCD, microbiologists, patient organisations and not least the patients and their families., For the first time ever, an international consensus statement for infection prevention and control in PCD is presented. A total of 20 statements were developed in a collaboration of BEAT-PCD, COST Action, ERS CRC and ERN-LUNG PCD Core Network. https://bit.ly/3yuahKt

ZusammenfassungAsthma und COPD sind die häufigsten obstruktiven Atemwegserkrankungen. Die chronische Inflammation bedingt eine Induktion von proinflammatorischen Zytokinkaskaden. Neben der systemischen Inflammation tragen Hypoxämie, Hyperkapnie, eine katabole Stoffwechsellage, eine gonadale oder eine Schilddrüsendysfunktion, eine muskuloskelettale Dysfunktion und Inaktivität sowie Vitamin D‑Mangel zu einem erhöhten Knochenbruchrisiko bei. Iatrogene Ursachen der Osteoporose sind die zum Teil langjährigen Anwendungen von inhalativen oder systemischen Glukokortikoiden (GC). Die inhalative GC Applikation bei Asthma ist oft schon im Kindes- und Jugendalter indiziert, aber auch interstitielle Lungenerkrankungen wie die chronisch organisierende Pneumonie, die Sarkoidose oder rheumatische Erkrankungen mit Lungenbeteiligung werden mit inhalativen oder oralen GC behandelt. Bei PatientInnen mit zystischer Fibrose kommt es durch die Malabsorption im Rahmen der Pankreasinsuffizienz, durch Hypogonadismus und chronische Inflammation mit erhöhter Knochenresorption zu einer Abnahme der Knochenstruktur. Nach Lungentransplantation ist die Immunsuppression mit GC ein Risikofaktor.Die pneumologischen Grunderkrankungen führen zu einer Veränderung der trabekulären und kortikalen Mikroarchitektur des Knochens und zu einer Verminderung von osteologischen Formations- und Resorptionsmarkern. Hyperkapnie, Azidose und Vitamin D‑Mangel können diesen Prozess beschleunigen und somit das individuelle Risiko für osteoporotische Fragilitätsfrakturen erhöhen.Eine Knochendichtemessung mit einem T‑Score −2,5 auf. Eine niedrig-traumatische Fraktur in der Anamnese indiziert eine osteologische Therapie.Neben der Optimierung des Vitamin D‑Spiegels sind sämtliche in Österreich zur Behandlung der Osteoporose zugelassenen antiresorptiv oder anabol wirksamen Medikamente auch bei pneumologischen PatientInnen mit einem erhöhten Knochenbruchrisiko entsprechend der nationalen Erstattungskriterien indiziert.

Chronic inflammation induces proinflammatory cytokine cascades. In addition to systemic inflammation, hypoxemia, hypercapnia, a catabolic metabolism, gonadal or thyroid dysfunction, musculoskeletal dysfunction and inactivity as well as vitamin D deficiency contribute to an increased risk of fragility fractures. Iatrogenic causes of osteoporosis are long-term use of inhaled or systemic glucocorticoids (GC). Inhalative GC application in asthma is often indicated in childhood and adolescence, but interstitial lung diseases such as chronic organizing pneumonia, COPD, sarcoid or rheumatic diseases with lung involvement are also treated with inhalative or oral GC. In patients with cystic fibrosis, malabsorption in the context of pancreatic insufficiency, hypogonadism and chronic inflammation with increased bone resorption lead to a decrease in bone structure. After lung transplantation, immunosuppression with GC is a risk factor.The underlying pneumological diseases lead to a change in the trabecular and cortical bone microarchitecture and to a reduction in osteological formation and resorption markers. Hypercapnia, acidosis and vitamin D deficiency can accelerate this process and thus increase the individual risk of osteoporotic fragility fractures.A bone mineral density measurement with a T‑Score -2.5 is a threshold value for the diagnosis of osteoporosis; in contrast the vast majority of all osteoporotic fractures occur with a T‑Score -2.5. A history of low-trauma fracture indicates osteological therapy.All antiresorptive or anabolic drugs approved in Austria for the treatment of osteoporosis are also indicated for pneumological patients with an increased fragility fracture risk of bone fractures in accordance with the national reimbursement criteria.Asthma und COPD sind die häufigsten obstruktiven Atemwegserkrankungen. Die chronische Inflammation bedingt eine Induktion von proinflammatorischen Zytokinkaskaden. Neben der systemischen Inflammation tragen Hypoxämie, Hyperkapnie, eine katabole Stoffwechsellage, eine gonadale oder eine Schilddrüsendysfunktion, eine muskuloskelettale Dysfunktion und Inaktivität sowie Vitamin D‑Mangel zu einem erhöhten Knochenbruchrisiko bei. Iatrogene Ursachen der Osteoporose sind die zum Teil langjährigen Anwendungen von inhalativen oder systemischen Glukokortikoiden (GC). Die inhalative GC Applikation bei Asthma ist oft schon im Kindes- und Jugendalter indiziert, aber auch interstitielle Lungenerkrankungen wie die chronisch organisierende Pneumonie, die Sarkoidose oder rheumatische Erkrankungen mit Lungenbeteiligung werden mit inhalativen oder oralen GC behandelt. Bei PatientInnen mit zystischer Fibrose kommt es durch die Malabsorption im Rahmen der Pankreasinsuffizienz, durch Hypogonadismus und chronische Inflammation mit erhöhter Knochenresorption zu einer Abnahme der Knochenstruktur. Nach Lungentransplantation ist die Immunsuppression mit GC ein Risikofaktor.Die pneumologischen Grunderkrankungen führen zu einer Veränderung der trabekulären und kortikalen Mikroarchitektur des Knochens und zu einer Verminderung von osteologischen Formations- und Resorptionsmarkern. Hyperkapnie, Azidose und Vitamin D‑Mangel können diesen Prozess beschleunigen und somit das individuelle Risiko für osteoporotische Fragilitätsfrakturen erhöhen.Eine Knochendichtemessung mit einem T‑Score −2,5 ist ein Schwellenwert zur Diagnose der Osteoporose, die überwiegende Mehrzahl aller osteoporotischen Frakturen tritt bei einem T‑Score von −2,5 auf. Eine niedrig-traumatische Fraktur in der Anamnese indiziert eine osteologische Therapie.Neben der Optimierung des Vitamin D‑Spiegels sind sämtliche in Österreich zur Behandlung der Osteoporose zugelassenen antiresorptiv oder anabol wirksamen Medikamente auch bei pneumologischen PatientInnen mit einem erhöhten Knochenbruchrisiko entsprechend der nationalen Erstattungskriterien indiziert.

Montelukast, a leukotriene receptor antagonist (LTRA) has been approved for use in Europe since 1998. Indications for use (from the age of 6 months) include mild to moderate asthma, seasonal allergic rhinitis with asthma, and the prevention of exercise-induced asthma episodes. The psychiatric side effects of montelukast have been known for the last 10 years; in the case of such symptoms benefits and risks should be considered. Due to potential life-threatening psychiatric adverse events, particularly suicide, a black box warning was issued. In this statement the Austrian working group of pediatric pulmonology and allergology advises that treatment with montelukast should be started only after critical evaluation. Treatment should be stopped on the occurrence of any neuropsychiatric side effects.

On March 11, 2020, the World Health Organization (WHO) declared the pandemic because of a novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). In January 2020, the first transmission to healthcare workers (HCWs) was described. SARS‐CoV‐2 is transmitted between people because of contact, droplets, and airborne. Airborne transmission is caused by aerosols that remain infectious when suspended in air over long distances and time. In the clinical setting, airborne transmission may occur during aerosol generating procedures like flexible bronchoscopy. To date, although the role of children in the transmission of SARS‐CoV‐2 is not clear the execution of bronchoscopy is associated with a considerably increased risk of SARS‐CoV‐2 transmission to HCWs. The aim of this overview is to summarize available recommendations and to apply them to pediatric bronchoscopy. We performed systematic literature searches using the MEDLINE (accessed via PubMed) and Scopus databases. We reviewed major recommendations and position statements published at the moment by the American Association for Bronchology and Interventional Pulmonology, WHO, European Center for Disease Prevention and Control and expert groups on the management of patients with COVID‐19 to limit transmission among HCWs. To date there is a lack of recommendations for safe bronchoscopy during the pandemic period. The main indications concern adults and little has been said about children. We have summarized available recommendations and we have applied them to pediatric bronchoscopy.

For many decades, pediatric bronchoscopy has been an integral part of the diagnosis and treatment of acute and chronic pulmonary diseases in children. Rapid technical advances have continuously influenced the performance of the procedure. Over the years, the application of pediatric bronchoscopy has considerably expanded to a broad range of indications. In this comprehensive and up-to-date guideline, the Special Interest Group of the Society for Pediatric Pneumology reviewed the most recent literature on pediatric bronchoscopy and reached a consensus on a safe technical performance of the procedure.

ZusammenfassungMitglieder der Österreichischen Gesellschaft für Pneumologie (ÖGP) beschreiben die erwartete Entwicklung der respiratorischen Gesundheit und zeigen Wege einer patientenorientierten und kosteneffizienten Versorgung für Österreich auf.Methoden: Im November 2017 trifft sich eine Gruppe von respiratorisch tätigen Ärzten, Pflegekräften und Physiotherapeuten, gemeinsam mit Vertretern von Selbsthilfe-Gruppen und Experten für Gesundheitsentwicklung, um die Themen Rahmenbedingungen für Lungengesundheit, Asthma und Allergie, COPD, Mukoviszidose und andere Krankheitsbilder der pädiatrischen Pneumologie, Infektionen in der Pneumologie, Schlafbezogene Atemstörungen, Interventionelle Pneumologie, Thorakale Onkologie, und Orphan Diseases zu bearbeiten.Ergebnisse: Respiratorische Erkrankungen sind extrem häufig und werden sehr oft durch individuelles Fehlverhalten (Zigarettenrauchen, Überernährung, körperliche Inaktivität) verursacht. Zudem wird für respiratorische Erkrankungen eine Zunahme der Prävalenz, aber eine Abnahme der Hospitalisierungen erwartet. Folgende Maßnahmen sind erforderlich, um den Herausforderungen der Zukunft zu begegnen.1. Maßnahmen des Screenings und der Fallfindung sollen für Lungenkarzinom und COPD umgesetzt werden.2. E-Health (Telemedizin, personalisierte Apps) soll vermehrt eingesetzt werden mit dem Ziel das Patientenmanagement zu erleichtern.3. Regionale Unterschiede der medizinischen Versorgung können durch E‑Health und Harmonisierung der Angebote der Gesundheitskassen reduziert werden.4. Patientenschulung und Awareness für respiratorische Erkrankungen soll verbessert werden (essentiell für Schlafstörungen, aber auch für andere respiratorische Erkrankungen)5. Die angebotene Versorgung soll interprofessionell, und auf der Grundlage erkrankungsspezifischer Boards wie bei Tumorboards (z. B. für interstitielle Lungenerkrankungen, Schlaf und Allergie) erfolgen.6. Die ambulante Rehabilitation im niedergelassenen Bereich kann einen großen Beitrag zur respiratorischen Gesundheit leisten.7. Das vermehrte Verständnis der Molekularbiologie wird die personalisierte Medizin und zielgerichtete Therapien (z. B. für Asthma, Lungenkarzinom) ermöglichen, aber auch Gesundheitskosten verändern.

ZusammenfassungAkute Bronchiolitis und obstruktive Bronchitis sind im Säuglings- und Kleinkindalter sehr häufige Krankheitsbilder. Sie werden durch Viren, v. a. respiratorisches Synzytialvirus und Rhinoviren, verursacht. Risikofaktoren für schwere Verläufe sind u. a. Frühgeburtlichkeit, Tabakrauchexposition und Immundysfunktionen. Die Diagnose kann durch Anamnese und klinische Untersuchung gestellt werden; Thorax-Röntgen und Laboruntersuchungen sind in der Regel nicht notwendig. Für die akute Bronchiolitis wurden viele therapeutische Ansätze propagiert, generell empfohlen sind aber nur supportive Maßnahmen (minimales Handling, Sicherstellung ausreichender Oxygenierung und Hydratation). Routinemäßig nicht empfohlen werden u. a. Antibiotika, Bronchodilatatoren, Kortikosteroide und Leukotrienrezeptorantagonisten. Kurz wirksame β2-Agonisten sind Therapie der 1. Wahl bei akuter obstruktiver Bronchitis. Bei häufigen und/oder schweren obstruktiven Bronchitiden kann zur Symptomkontrolle eine Therapie mit inhalativen Kortikosteroiden versucht werden. Die Entstehung von Asthma bronchiale ist jedoch durch keine medikamentöse Therapie zu verhindern.

ZusammenfassungDie COVID-19-Pandemie stellt derzeit weltweit eine Herausforderung dar. In Österreich konnte eine Krise innerhalb des medizinischen Versorgungssystems bisher verhindert werden. Die Behandlung von Patienten mit ambulant erworbener Pneumonie („community acquired pneumonia“, CAP), inklusive durch SARS-CoV-2-Infektionen, sollte sich auch während der Pandemie weiterhin an evidenzbasierten CAP-Leitlinien orientieren. COVID-19-spezifische Anpassungen sind jedoch sinnvoll. Die Behandlung von Patienten mit chronischen Lungenerkrankungen muss während der Pandemie angepasst werden, ist aber weiterhin zu gewährleisten.

SummaryThe Austrian Society of Pneumology (ASP) launched a first statement on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, at a time when in Austria 285 people had died from this disease and vaccinations were not available. Lockdown and social distancing were the only available measures to prevent more infections and the breakdown of the health system. Meanwhile, in Austria over 13,000 patients have died in association with a SARS-CoV‑2 infection and coronavirus disease 2019 (COVID-19) was among the most common causes of death; however, SARS-CoV‑2 has been mutating all the time and currently, most patients have been affected by the delta variant where the vaccination is very effective but the omicron variant is rapidly rising and becoming predominant. Particularly in children and young adults, where the vaccination rate is low, the omicron variant is expected to spread very fast. This poses a particular threat to unvaccinated people who are at elevated risk of severe COVID-19 disease but also to people with an active vaccination. There are few publications that comprehensively addressed the special issues with SARS-CoV‑2 infection in patients with chronic lung diseases. These were the reasons for this updated statement. Pulmonologists care for many patients with an elevated risk of death in case of COVID-19 but also for patients that might be at an elevated risk of vaccination reactions or vaccination failure. In addition, lung function tests, bronchoscopy, respiratory physiotherapy and training therapy may put both patients and health professionals at an increased risk of infection. The working circles of the ASP have provided statements concerning these risks and how to avoid risks for the patients.

Rationale: The long-term effects of vigorous physical activity (PA) on lung function in cystic fibrosis are unclear. Objectives: To evaluate effects of a 12-month partially supervised PA intervention using motivational feedback. Methods: In a parallel arm multicenter randomized controlled trial (ACTIVATE-CF), relatively inactive patients aged ≥12 years were randomly assigned (1:1 ratio) to an intervention group or control group. The intervention group consented to add 3 hours of vigorous PA per week, while the control group was asked not to change their PA behavior. Primary endpoint was change in percent predicted forced expiratory volume in 1s (ΔFEV1) at 6 months. Secondary endpoints included PA, exercise capacity, exercise motives, time to first exacerbation and exacerbation rates, quality of life, anxiety, depression, and stress, and blood glucose control. Data were analyzed using mixed linear models. Measurements and Main Results: 117 patients (40% of target sample size) were randomized to an intervention (n=60) or control group (n=57). After 6 months, ΔFEV1 was significantly higher in the control group compared to the intervention group (2.70% predicted, 95% CI 0.13 to 5.26; p=0.04). The intervention group reported increased vigorous PA compared with the control group at each study visit, had higher exercise capacity at 6 and 12 months, and higher PA at 12 months. No effects were seen in other secondary outcomes. Conclusions: ACTIVATE-CF increased vigorous PA and exercise capacity, with effects carried over for the subsequent 6 months, but resulted in better FEV1 in the control group. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT01744561.

Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Actinomycosis develops when there is disruption of the mucosal barrier, and invasion and systemic spread of the organism, which can lead to endogenous infection affecting numerous organs. It is known to spread in tissue through fascial planes and most often involves the cervicofacial (55%), abdominopelvic (20%) and thoracic (15%) soft tissue. Pulmonary actinomycosis is rare in patients under the age of five years, with the median reported age in the fifth decade. Clinical findings include chest wall mass (49%), cough (40%), pain (back, chest, shoulders) (36%), weight loss (19%), fever (19%), Draining sinuses (15%) and hemoptysis (9%). Chest X-ray findings in pulmonary actinomycosis are mostly nonspecific and can overlap with pulmonary tuberculosis, foreign body aspiration and malignancy. Endobronchial tissue aggregates may show sulphur granules, with yellow to white conglomerate areas of gram positive Actinomyces. Removal or biopsy of these large endobronchial masses must be done with care, because of the risk of bleeding and large airway obstruction. The cytology on bronchoalveolar lavage fluid may show Periodic acid–Schiff (PAS) positive stain, ZN negative and Gram-positive filamentous bacilli which is morphologically suggestive of Actinomycosis. Actinomyces spp is highly susceptible to beta lactam antibiotics, penicillin G, and amoxicillin. A minimum of 3–6 months is needed but up to 20 months of treatment may be needed. Early diagnosis and correct treatment can lead to a good prognosis with a low mortality.

Summary Background Tezacaftor–ivacaftor is an approved cystic fibrosis transmembrane conductance regulator (CFTR) modulator shown to be efficacious and generally safe and well tolerated over 8–24 weeks in phase 3 clinical studies in participants aged 12 years or older with cystic fibrosis homozygous for the Phe508del CFTR mutation (F/F; study 661-106 [EVOLVE]) or heterozygous for the Phe508del CFTR mutation and a residual function mutation (F/RF; study 661-108 [EXPAND]). Longer-term (>24 weeks) safety and efficacy of tezacaftor–ivacaftor has not been assessed in clinical studies. Here, we present results of study 661-110 (EXTEND), a 96-week open-label extension study that assessed long-term safety, tolerability, and efficacy of tezacaftor–ivacaftor in participants aged 12 years or older with cystic fibrosis who were homozygous or heterozygous for the Phe508del CFTR mutation. Methods Study 661-110 was a 96-week, phase 3, multicentre, open-label study at 170 clinical research sites in Australia, Europe, Israel, and North America. Participants were aged 12 years or older, had cystic fibrosis, were homozygous or heterozygous for Phe508del CFTR, and completed one of six parent studies of tezacaftor–ivacaftor: studies 661-103, 661-106, 661-107, 661-108, 661-109, and 661-111. Participants received oral tezacaftor 100 mg once daily and oral ivacaftor 150 mg once every 12 h for up to 96 weeks. The primary endpoint was safety and tolerability. Secondary endpoints were changes in lung function, nutritional parameters, and respiratory symptom scores; pulmonary exacerbations; and pharmacokinetic parameters. A post-hoc analysis assessed the rate of lung function decline in F/F participants who received up to 120 weeks of tezacaftor–ivacaftor in studies 661-106 (F/F) and/or 661-110 compared with a matched cohort of CFTR modulator-untreated historical F/F controls from the Cystic Fibrosis Foundation Patient Registry. Primary safety analyses were done in all participants from all six parent studies who received at least one dose of study drug during this study. This study was registered at ClinicalTrials.gov ( NCT02565914 ). Findings Between Aug 31, 2015, to May 31, 2019, 1044 participants were enrolled in study 661-110 from the six parent studies of whom 1042 participants received at least one dose of study drug and were included in the safety set. 995 (95%) participants had at least one TEAE; 22 (2%) had TEAEs leading to discontinuation; and 351 (34%) had serious TEAEs. No deaths occurred during the treatment-emergent period; after the treatment-emergent period, two deaths occurred, which were both deemed unrelated to study drug. F/F (106/110; n=459) and F/RF (108/110; n=226) participants beginning tezacaftor–ivacaftor in study 661-110 had improvements in efficacy endpoints consistent with parent studies; improvements in lung function and nutritional parameters and reductions in pulmonary exacerbations observed in the tezacaftor–ivacaftor groups in the parent studies were generally maintained in study 661-110 for an additional 96 weeks. Pharmacokinetic parameters were also similar to those in the parent studies. The annualised rate of lung function decline was 61·5% (95% CI 35·8 to 86·1) lower in tezacaftor–ivacaftor-treated F/F participants versus untreated matched historical controls. Interpretation Tezacaftor–ivacaftor was generally safe, well tolerated, and efficacious for up to 120 weeks, and the safety profile of tezacaftor–ivacaftor in study 661-110 was consistent with cystic fibrosis manifestations and with the safety profiles of the parent studies. The rate of lung function decline was significantly reduced in F/F participants, consistent with cystic fibrosis disease modification. Our results support the clinical benefit of long-term tezacaftor–ivacaftor treatment for people aged 12 years or older with cystic fibrosis with F/F or F/RF genotypes. Funding Vertex Pharmaceuticals Incorporated.

Zusammenfassung Im Rahmen eines industrieunabhängigen Expertenkreises wurden die Empfehlungen zur Respiratory-Syncytial-Virus(RSV)-Prophylaxe mit Palivizumab der Österreichischen Gesellschaft für Kinder- und Jugendheilkunde (ÖGKJ) von 2008 überarbeitet und im Delphi-Verfahren ein Update für das Jahr 2019 geschaffen. Frühgeborene (FG) ≤28 (+6 Tage) Schwangerschaftswochen (SSW) sollen Palivizumab über die 1. Saison, bei Entlassung am Ende einer Saison (Alter Palivizumab wird mit 15 mg/kg Körpergewicht intramuskulär dosiert und maximal 5‑mal von Mitte/Ende November bis März in Injektionsintervallen von 28 bis 30 Tagen gegeben. Banale Infekte stellen keine Kontraindikation für die Immunisierung dar. Palivizumab hemmt auch nicht die Immunantwort gegenüber aktiven Immunisationen.

Background Multiple early reports of patients admitted to hospital with COVID-19 showed that patients with chronic respiratory disease were significantly under-represented in these cohorts. We hypothesised that the widespread use of inhaled glucocorticoids among these patients was responsible for this finding, and tested if inhaled glucocorticoids would be an effective treatment for early COVID-19. Methods We performed an open-label, parallel-group, phase 2, randomised controlled trial (Steroids in COVID-19; STOIC) of inhaled budesonide, compared with usual care, in adults within 7 days of the onset of mild COVID-19 symptoms. The trial was done in the community in Oxfordshire, UK. Participants were randomly assigned to inhaled budsonide or usual care stratified for age (≤40 years or >40 years), sex (male or female), and number of comorbidities (≤1 and ≥2). Randomisation was done using random sequence generation in block randomisation in a 1:1 ratio. Budesonide dry powder was delivered using a turbohaler at a dose of 400 μg per actuation. Participants were asked to take two inhalations twice a day until symptom resolution. The primary endpoint was COVID-19-related urgent care visit, including emergency department assessment or hospitalisation, analysed for both the per-protocol and intention-to-treat (ITT) populations. The secondary outcomes were self-reported clinical recovery (symptom resolution), viral symptoms measured using the Common Cold Questionnare (CCQ) and the InFLUenza Patient Reported Outcome Questionnaire (FLUPro), body temperature, blood oxygen saturations, and SARS-CoV-2 viral load. The trial was stopped early after independent statistical review concluded that study outcome would not change with further participant enrolment. This trial is registered with ClinicalTrials.gov, NCT04416399. Findings From July 16 to Dec 9, 2020, 167 participants were recruited and assessed for eligibility. 21 did not meet eligibility criteria and were excluded. 146 participants were randomly assigned—73 to usual care and 73 to budesonide. For the per-protocol population (n=139), the primary outcome occurred in ten (14%) of 70 participants in the usual care group and one (1%) of 69 participants in the budesonide group (difference in proportions 0·131, 95% CI 0·043 to 0·218; p=0·004). For the ITT population, the primary outcome occurred in 11 (15%) participants in the usual care group and two (3%) participants in the budesonide group (difference in proportions 0·123, 95% CI 0·033 to 0·213; p=0·009). The number needed to treat with inhaled budesonide to reduce COVID-19 deterioration was eight. Clinical recovery was 1 day shorter in the budesonide group compared with the usual care group (median 7 days [95% CI 6 to 9] in the budesonide group vs 8 days [7 to 11] in the usual care group; log-rank test p=0·007). The mean proportion of days with a fever in the first 14 days was lower in the budesonide group (2%, SD 6) than the usual care group (8%, SD 18; Wilcoxon test p=0·051) and the proportion of participants with at least 1 day of fever was lower in the budesonide group when compared with the usual care group. As-needed antipyretic medication was required for fewer proportion of days in the budesonide group compared with the usual care group (27% [IQR 0–50] vs 50% [15–71]; p=0·025) Fewer participants randomly assigned to budesonide had persistent symptoms at days 14 and 28 compared with participants receiving usual care (difference in proportions 0·204, 95% CI 0·075 to 0·334; p=0·003). The mean total score change in the CCQ and FLUPro over 14 days was significantly better in the budesonide group compared with the usual care group (CCQ mean difference −0·12, 95% CI −0·21 to −0·02 [p=0·016]; FLUPro mean difference −0·10, 95% CI −0·21 to −0·00 [p=0·044]). Blood oxygen saturations and SARS-CoV-2 load, measured by cycle threshold, were not different between the groups. Budesonide was safe, with only five (7%) participants reporting self-limiting adverse events. Interpretation Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery after early COVID-19. Funding National Institute for Health Research Biomedical Research Centre and AstraZeneca.

Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and intervent...

As the airways of SARS-CoV-2 infected patients contain a high viral load, bronchoscopy is associated with increased risk of patient to health care worker transmission due to aerosolised viral particles and contamination of surfaces during bronchoscopy. Bronchoscopy is not appropriate for diagnosing SARS-CoV-2 infection and, as an aerosol generating procedure involving a significant risk of transmission, has a very limited role in the management of SARS-CoV-2 infected patients including children. During the SARS-CoV-2 pandemic rigid bronchoscopy should be avoided due to the increased risk of droplet spread. Flexible bronchoscopy should be performed first in SARS-CoV-2 positive individuals or in unknown cases, to determine if rigid bronchoscopy is indicated. When available single-use flexible bronchoscopes may be considered for use; devices are available with a range of diameters, and improved image quality and degrees of angulation. When rigid bronchoscopy is necessary, jet ventilation must be avoided and conventional ventilation be used to reduce the risk of aerosolisation. Adequate personal protection equipment is key, as is training of health care workers in correct donning and doffing. Modified full face masks are a practical and safe alternative to filtering facepieces for use in bronchoscopy. When anaesthetic and infection prevention control protocols are strictly adhered to, bronchoscopy can be performed in SARS-CoV-2 positive children.

The aim of this study was to analyze the exhaled volatile organic compounds (VOCs) profile, airway microbiome, lung function and exercise performance in congenital diaphragmatic hernia (CDH) patients compared to healthy age and sex-matched controls. A total of nine patients (median age 9 years, range 6&ndash, 13 years) treated for CDH were included. Exhaled VOCs were measured by GC&ndash, MS. Airway microbiome was determined from deep induced sputum by 16S rRNA gene sequencing. Patients underwent conventional spirometry and exhausting bicycle spiroergometry. The exhaled VOC profile showed significantly higher levels of cyclohexane and significantly lower levels of acetone and 2-methylbutane in CDH patients. Microbiome analysis revealed no significant differences for alpha-diversity, beta-diversity and LefSe analysis. CDH patients had significantly lower relative abundances of Pasteurellales and Pasteurellaceae. CDH patients exhibited a significantly reduced Tiffeneau Index. Spiroergometry showed no significant differences. This is the first study to report the VOCs profile and airway microbiome in patients with CDH. Elevations of cyclohexane observed in the CDH group have also been reported in cases of lung cancer and pneumonia. CDH patients had no signs of impaired physical performance capacity, fueling controversial reports in the literature.