Background and objective: Severe asthma in preschool children is difficult to manage. Inhaled corticosteroids (ICS) are first-line therapy, but many remain uncontrolled, and evidence for additional treatments is scarce. We evaluated the real-world effectiveness and safety of adding long-acting beta agonists (LABA) to inhaled corticosteroids (ICS) in preschool children with severe uncontrolled asthma. Methods: We conducted a retrospective observational study (2021–2024) of children aged 6–72 months with severe asthma uncontrolled on medium- to high-dose ICS, treated with LABA add-on. We collected demographics and clinical data. Primary outcomes were rates of severe exacerbations defined as systemic corticosteroid [SCS] use and hospitalizations and uncontrolled symptoms; secondary outcomes included rate of pediatric intensive care unit (PICU) admissions and reported adverse events. Outcomes six months before and after LABA initiation, were compared. Results: Fifty-three children were included (mean age 39 ± 17.6 months, 43% male, atopy in 50.9%). Six-months following LABA initiation, hospitalizations declined from 39.6% to 1.9% (p<0.001), SCS use from 84.9% to 50.9% (p<0.001), and daily symptoms from 88.7% to 39.6% (p<0.001) compared to 6-months before. PICU admissions fell from 9.4% to 0%. No adverse effects were reported. Subgroup analyses confirmed consistent benefits across age, sex, atopic status, and smoke exposure. Conclusion: In this real-world cohort of preschool children with severe, difficult-to-control asthma, LABA add-on therapy to ICS was associated with marked clinical improvement and no safety concerns. These findings support the cautious use of LABA in this population and highlight the need for further prospective studies to guide practice.

Objective: To elucidate the impact of lack of Palivizumab administration during off-season RSV periods on the RSV-related hospitalization among 29-34 weeks of gestational age (wGA) preterm infants. We utilized the summer of 2021 off-season RSV surge during the COVID19 pandemic. Methods: This multi-center retrospective observational study was conducted in 11 medical centers across Israel. We included infants > 1 year-old hospitalized with RSV infection between November 2017-August 2021. Patients were categorized into an in-season admissions group (November-March) and off-season admissions group (April-October). The primary outcome was the proportion of RSV hospitalizations among 29-34wGA infants in relation to total RSV admissions during the same season. Secondary outcomes included clinical severity parameters. Results A total of 3,296 infants were admitted during the RSV season, and 1,044 during the off-season. The proportion of 29-34wGA preemies was significantly higher in the off-season group compared to the in-season group (7% vs 2.1%, p<0.001). In the off-season group, we observed a significantly higher proportion of Jewish individuals (80.1% vs. 59.2%, p=0.001) and higher socioeconomic status (55.1% vs. 45.1%, p<0.001) compared to the in-season group. In the multivariable logistic-regression model, off-season hospitalization odds for 29-34 wGA preemies were significantly higher (2.6-fold, 95% CI:1.8-3.9, p<0.001) compared to in-season, irrespective of demographic covariates. Similar clinical severity parameters was observed between the groups. Conclusions Our results revealed a significantly higher proportion of infants born at 29-34 wGA among those hospitalized during off-season periods compared to in-season periods. These findings highlight the importance of including 29-34 wGA infants into future RSV immunoprophylaxis recommendations.

Objective: This retrospective observational cohort study aimed to assess the real-life application of bronchial challenge test (BCT) in the management of preschool children presenting with atypical recurrent respiratory symptoms (ARRS). Methods: We included children, aged 0.5-6 years referred to a pediatric-pulmonology clinic, who underwent BCT using methacholine or adenosine between 2012-2018 due to ARRS including uncertain severity of airway hyperactivity. BCT was considered positive based on spirometry results and/or wheezing, desaturation, and tachypnea reactions. We collected data on demographics, BCT results, pre-BCT treatment, post-BCT treatment change and post-BCT symptoms control. The primary outcome measure was the change in treatment post-BCT (step-up or step-down). Secondary outcome included clinical improvement observed 3-6 months after BCT. Results: A total of 228 children (55% males) with a mean age of 4.2±0.6 years underwent BCT (52% adenosine-BCT, 48% methacholine-BCT). Children referred for methacholine were significantly younger compared to adenosine (3.6±1.2 vs. 4.2±1.2 years, P<0.01). Methacholine and adenosine BCTs were positive in 95% and 61%, respectively. Overall, changes in management were observed in 122(53.5%) children following BCT, with 83(36.4%) being stepped up and 37(17%) being stepped down. Significantly more children in the methacholine group were stepped up compared to the adenosine (46% vs 28%, p=0.004). During the follow-up assessment, we observed a clinical improvement in 119/162 (73.4%) of the children. Conclusion: This study demonstrates the importance of BCT in the management of preschool children presenting to pediatric pulmonary-units with ARRS. The change in treatment and subsequent clinical improvement observed, highlight the added-value of BCT in this populations.

Background: Since the outbreak of the Coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19, in comparison to the prior years. Methods: In this retrospective multicenter study, we compared the number of children that presented with FBA during the COVID-19 year (March 1st, 2020 to February 28, 2021), to the annual average of the years 2016-2019. We also compared the lockdown periods to the post-lockdown periods and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. Results: 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior four years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in post-lockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (Average of 15.4% vs 30.4%, p=0.001) Conclusion: There was no difference in the prevalence of FBA during the COVID-19 year. However, there were fewer cases during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision.