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An introduction is presented in which author discusses articles on topics including focuses on analysis of lung function development from childhood to early adulthood in two unselected birth cohorts which used a data driven Markovian dependent mixture model to identify five lung function states.

Aims: To synthesize the qualitative evidence of the views and experiences of people living with dementia, family carers, and practitioners on practice related to nutrition and hydration of people living with dementia who are nearing end of life. Design: Systematic review and narrative synthesis of qualitative studies. Data sources: MEDLINE, Embase, PsycINFO, CINAHL. Review methods: Databases were searched for qualitative studies from January 2000‐February 2020. Quantitative studies, or studies reporting on biological mechanisms, assessments, scales or diagnostic tools were excluded. Results were synthesized using a narrative synthesis approach with thematic analysis. Results: Twenty studies were included; 15 explored the views of practitioners working with people living with dementia in long‐term care settings or in hospitals. Four themes were developed: challenges of supporting nutrition and hydration; balancing the views of all parties involved with 'the right thing to do'; national context and sociocultural influences; and strategies to support nutrition and hydration near the end of life in dementia. Conclusion: The complexity of supporting nutrition and hydration near the end of life for someone living with dementia relates to national context, lack of knowledge, and limited planning while the person can communicate. Impact: This review summarizes practitioners and families' experiences and highlights the need to include people living with dementia in studies to help understand their views and preferences about nutrition and hydration near the end of life; and those of their families supporting them in the community. The review findings are relevant to multidisciplinary teams who can learn from strategies to help with nutrition and hydration decisions and support. [ABSTRACT FROM AUTHOR]

Introduction: The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever-based therapy to inhaled corticosteroid-formoterol dry powder inhaler (DPI) reliever therapy, as recommended by the Global Initiative for Asthma., Methods: This post hoc analysis included all 668 adult participants in the Novel START trial, who were randomised 1:1:1 to treatment with as-needed budesonide/formoterol DPI, as-needed salbutamol pMDI or maintenance budesonide DPI plus as-needed salbutamol pMDI. The primary outcome was carbon footprint of asthma management, expressed as kilograms of carbon dioxide equivalent emissions (kgCO 2 e) per person-year. Secondary outcomes explored the effect of baseline symptom control and adherence (maintenance budesonide DPI arm only) on carbon footprint., Results: As-needed budesonide/formoterol DPI was associated with 95.8% and 93.6% lower carbon footprint compared with as-needed salbutamol pMDI (least-squares mean 1.1 versus 26.2 kgCO 2 e; difference -25.0, 95% CI -29.7 to -20.4; p<0.001) and maintenance budesonide DPI plus as-needed salbutamol pMDI (least-squares mean 1.1 versus 17.3 kgCO 2 e; difference -16.2, 95% CI -20.9 to -11.6; p<0.001), respectively. There was no statistically significant evidence that treatment differences in carbon footprint depended on baseline symptom control or adherence in the maintenance budesonide DPI arm., Conclusions: The as-needed budesonide/formoterol DPI treatment option was associated with a markedly lower carbon footprint than as-needed salbutamol pMDI and maintenance budesonide DPI plus as-needed salbutamol pMDI., Competing Interests: Conflict of interest: I.D. Pavord reports grants from Chiesi and Merck, lecture honoraria from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, Teva, Chiesi, Sanofi/Regeneron, Menarini and GSK, payment for expert testimony from AstraZeneca and Teva, travel support from GSK, Boehringer Ingelheim, AstraZeneca, Teva and Chiesi, patents from Merck, Bayer and Insmed, and advisory board participation with Genentech, Sanofi/Regeneron, AstraZeneca, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Circassia, Chiesi and Knopp. H.K. Reddel reports grants from AstraZeneca, GlaxoSmithKline and Perpetual Philanthropy, consulting fees from Novartis, AstraZeneca and GlaxoSmithKline, lecture honoraria from AstraZeneca, GlaxoSmithKline, Teva, Boehringer Ingelheim, Sanofi, Getz, Chiesi and Alkem, advisory board participation for AstraZeneca, GlaxoSmithKline, Novartis, Chiesi and Sanofi, and is chair of the Science Committee and member of the Board of Directors of the Global Initiative for Asthma, and member of the Australian Asthma Guidelines Committee. R.J. Hancox reports funding for the present manuscript from AstraZeneca, and reports an unpaid leadership role with Asthma Foundation of New Zealand. A. Papi reports grants from Chiesi, AstraZeneca, GlaxoSmithKline and Sanofi, consulting fees from Chiesi, AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, Iqvia, Avillion, Elpen Pharmaceuticals and Moderna, lecture honoraria from Chiesi, AstraZeneca, GlaxoSmithKline, Menarini, Zambon, Mundipharma, Sanofi, Edmond Pharma, Iqvia, MSD and Avillion, and advisory board participation with Chiesi, AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, Iqvia, Avillion, Elpen Pharmaceuticals and Moderna, outside the submitted work. R. Beasley reports support for the present manuscript from AstraZeneca and Health Research Council (NZ). In addition, outside the submitted work, R. Beasley reports grants from AstraZeneca, Genentech, HRC (NZ) and Cure Kids NZ, lecture honoraria and travel support from AstraZeneca, Avillion, Cipla, Teva and CSL Seqirus, leadership roles as chair of NZ asthma guidelines and board member of GOLD, and receipt of equipment from AstraZeneca. The remaining authors have no potential conflicts of interest to disclose., (Copyright ©The authors 2024. For reproduction rights and permissions contact permissions@ersnet.org.)

Background: Asthma is the most common chronic childhood respiratory condition globally. Inhaled corticosteroid (ICS)-formoterol reliever-based regimens reduce the risk of asthma exacerbations compared with conventional short-acting β 2 -agonist (SABA) reliever-based regimens in adults and adolescents. The current limited evidence for anti-inflammatory reliever therapy in children means it is unknown whether these findings are also applicable to children. High-quality randomised controlled trials (RCTs) are needed., Objective: The study aim is to determine the efficacy and safety of budesonide-formoterol reliever alone or maintenance and reliever therapy (MART) compared with standard therapy: budesonide or budesonide-formoterol maintenance, both with terbutaline reliever, in children aged 5 to 11 years with mild, moderate and severe asthma., Methods: A 52-week, multicentre, open-label, parallel group, phase III, two-sided superiority RCT will recruit 400 children aged 5 to 11 years with asthma. Participants will be randomised 1:1 to either budesonide-formoterol 100/6 µg Turbuhaler reliever alone or MART; or budesonide or budesonide-formoterol Turbuhaler maintenance, with terbutaline Turbuhaler reliever. The primary outcome is moderate and severe asthma exacerbations as rate per participant per year. Secondary outcomes are asthma control, lung function, exhaled nitric oxide and treatment step change. Assessment of Turbuhaler technique and cost-effectiveness analysis are also planned., Conclusion: This will be the first RCT to compare the efficacy and safety of a step-wise budesonide-formoterol reliever alone or MART regimen with conventional inhaled ICS or ICS-long-acting β-agonist maintenance plus SABA reliever in children. The results will provide a much-needed evidence base for the treatment of asthma in children., Competing Interests: Conflict of interest: L. Fleming reports consulting fees from AstraZeneca, Sanofi Regeneron and GSK, outside the submitted work; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events for AstraZeneca, Novartis and Sanofi Regeneron, outside the submitted work. Conflict of interest: C.A. Byrnes reports grants or contracts from the National Health and Medical Research Council Australia, Fisher & Paykel, the Buddle Findlay & Paul Stevenson Memorial Fund and FluLab, outside the submitted work; participation on a Clinical Advisory Panel for Cystic Fibrosis New Zealand and as a Bronchiectasis Foundation Trustee, outside the submitted work; and is a group for Chair, Respiratory Network, Paediatric Society of New Zealand, and a member of the Royal Australasian College of Physicians Paediatric Research Committee, outside the submitted work. Conflict of interest: D. McNamara reports participation on a data safety monitoring board or advisory board for PRECARE study primary outcome arbitration committee, outside the submitted work; leadership or fiduciary role in other board, society, committee or advocacy group for Co-Chair NZ Paediatric Respiratory and Sleep Clinical Network Reference Group, and Member Scientific Advisory Board, Asthma and Respiratory Foundation of NZ, outside the submitted work. Conflict of interest: S.R. Dalziel reports grants or contracts from Cure Kids New Zealand, Health Research Council New Zealand and Starship Foundation, outside the submitted work. Conflict of interest: R. Beasley reports receiving support for the present manuscript from AstraZeneca; grants or contracts from AstraZeneca, Genentech, HRC (NZ) and Cure Kids NZ, outside the submitted work; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Avillion, Cipla, Teva and CSL Seqirus, outside the submitted work; support for attending meetings and/or travel from AstraZeneca, Avillion, Cipla, Teva and CSL Seqirus, outside the submitted work; NZ asthma guidelines chair, and GOLD board member, disclosures made outside the submitted work; and receipt of equipment, materials, drugs, medical writing, gifts or other services from AstraZeneca, outside the submitted work. Conflict of interest: The remaining authors have nothing to disclose., (Copyright ©The authors 2024.)

Background: The Global Initiative for Asthma recommends as-needed inhaled corticosteroid (ICS)-formoterol as an alternative to maintenance ICS plus short-acting β 2 -agonist (SABA) reliever at step 2 of its stepwise treatment algorithm. Our aim was to assess the efficacy and safety of these two treatment regimens, with a focus on prevention of severe exacerbation., Methods: We performed a systematic review and meta-analysis of all randomised controlled trials (RCTs) comparing as-needed ICS-formoterol with maintenance ICS plus SABA. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrials.gov were searched from database inception to 12 December 2019. The primary outcome was time to first severe exacerbation. RCTs were excluded if they used as-needed budesonide-formoterol as part of a maintenance and reliever regimen, or did not report on severe exacerbations. The review is registered with PROSPERO (identifier number CRD42020154680)., Results: Four RCTs (n=8065 participants) were included in the analysis. As-needed ICS-formoterol was associated with a prolonged time to first severe exacerbation (hazard ratio 0.85, 95% CI 0.73-1.00; p=0.048) and reduced daily ICS dose (mean difference -177.3 μg, 95% CI -182.2--172.4 μg). Asthma symptom control was worse in the as-needed group (Asthma Control Questionnaire-5 mean difference 0.12, 95% CI 0.09-0.14), although this did not meet the minimal clinically important difference of 0.50 units. There was no significant difference in serious adverse events (OR 1.07, 95% CI 0.84-1.36)., Conclusion: As-needed ICS-formoterol offers a therapeutic alternative to maintenance low-dose ICS plus SABA in asthma and may be the preferred option when prevention of severe exacerbation is the primary aim of treatment., Competing Interests: Conflict of interest: L. Hatter has nothing to disclose. Conflict of interest: P. Bruce has nothing to disclose. Conflict of interest: I. Braithwaite reports personal fees from Equillium outside the submitted work. Conflict of interest: M. Holliday reports grants from AstraZeneca and the Health Research Council of New Zealand outside the submitted work. Conflict of interest: J. Fingleton reports grants, personal fees and nonfinancial support from AstraZeneca; grants from Genentech; grants, personal fees and nonfinancial support from GlaxoSmithKline; and personal fees and nonfinancial support from Boehringer lngleheim, all outside the submitted work. Conflict of interest: M. Weatherall has nothing to disclose. Conflict of interest: R. Beasley reports grants and personal fees from AstraZeneca, grants from Genentech and GlaxoSmithKline, and personal fees from Theravance and Avillion, outside the submitted work., (Copyright ©ERS 2021.)