Measles is an important vaccine-preventable disease that has re-emerged in recent years. Since the COVID-19 pandemic, interruptions to routine immunisation programs and declining vaccine coverage have altered the incidence and patterns of respiratory virus infections. Global outbreaks have intensified, and vaccine hesitancy is recognised as major health threat. Revisiting the clinical presentation of measles is crucial for early diagnosis and to reduce transmission of this highly contagious infection. As serious respiratory and neurological complications can follow natural infection and no specific antiviral therapy is available, vaccination remains the most effective strategy for prevention and control.

Consolidated nighttime sleep is a critical milestone in infant development, underpinning physical, cognitive, and socioemotional growth. Despite being a normative maturational process, fragmented sleep and difficulties initiating/maintaining sleep are common parental concerns. This review synthesizes developmental and behavioral science to elucidate mechanisms and evidence-based strategies that foster healthy sleep consolidation in infants and toddlers. First, we describe the evolution of sleep architecture and the interaction between circadian and homeostatic processes that regulate sleep-wake cycles. Then, we highlight how environmental and caregiving factors support these biological systems. Lastly, we describe behavioral strategies and the influence of environmental elements on circadian entrainment and independent sleep initiation. Across approaches, we emphasize the importance of family-centered implementation, where caregivers can both promote and benefit from optimal infant sleep. This review provides clinicians, researchers, and caregivers with a comprehensive framework to promote sleep consolidation and well-being during early childhood.

In the era of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, we have seen impressive improvements to quality of life and life expectancy in people with cystic fibrosis (pwCF). However, there have been emerging adverse events related to elexacaftor/tezacaftor/ivacaftor (ETI). We present 8 paediatric pwCF who developed chalazion/hordeolum on standard dosing of ETI, of which one third needed interruption of ETI therapy to achieve resolution. This report highlights a 5.5-fold increased incidence of chalazion/hordeolum in pwCF and raises concerns of a clinical association between ETI and chalazion/hordeolum.

Non-invasive ventilation (NIV) has become an essential component of pediatric respiratory support, offering effective alternatives to invasive mechanical ventilation in both acute and chronic conditions. Advances in technology and a growing understanding of pediatric respiratory physiology have expanded the application of NIV across a range of clinical scenarios, from acute respiratory failure in the intensive care unit to long-term management of neuromuscular and sleep-related breathing disorders in outpatient settings. As part of a review series, in this part 1 we provide an overview of conventional NIV modes in children, highlighting the history of mechanical ventilation, indications, interfaces, conventional modes of NIV and considerations unique to the pediatric population in both acute and chronic care contexts.

Non-invasive ventilation (NIV) has become an essential component of pediatric respiratory support, offering effective alternatives to invasive mechanical ventilation in both acute and chronic conditions. Advances in technology and a growing understanding of pediatric respiratory physiology have expanded the application of NIV across a range of clinical scenarios, from acute respiratory failure in the intensive care unit to long-term management of neuromuscular and sleep-related breathing disorders in outpatient settings. As part of a review series, in this part 2 we provide an overview of new and emerging modes of NIV, their recommended clinical applications and we will briefly discuss the available evidence in pediatrics.

Pressurised metered-dose inhalers (pMDIs) are widely used in the treatment of paediatric respiratory diseases. Despite their widespread use, knowledge about effective inhaler technique amongst patients and clinicians is poor. Even amongst well-trained specialists, knowledge about how these devices function is limited. This short review outlines what it is critical to understand about how pMDIs work. This allows advanced troubleshooting of problems for patients and can decrease non-intentional non-adherence from a variety of causes.

Preterm birth, affecting approximately 10 % of live births worldwide, is the most common cause of altered lung development and can have lasting respiratory consequences, including the occurrence of bronchopulmonary dysplasia (BPD). This review summarizes prenatal and postnatal strategies to promote pulmonary growth and reduce morbidity in preterm infants. Prenatal interventions such as optimizing maternal health and antenatal corticosteroids improve foetal lung maturity. Postnatally, non-invasive respiratory support-particularly continuous positive airway pressure (CPAP)-both prevents injury and promotes alveolar and vascular growth. Lung-protective ventilation strategies, adequate nutrition, and pharmacologic agents like caffeine enhance outcomes. Experimental therapies, including mesenchymal stem cells, insulin-like growth factor-1 (IGF-1), and artificial placenta technology, show promise in restoring pulmonary growth and function. Despite advances, many preterm survivors exhibit persistent lung deficits into adulthood, underscoring the need for longitudinal monitoring and continued innovation to support lung growth and lifelong respiratory health.

Despite a high burden of respiratory disease among infants globally, limited options exist for lung function testing in this age group. Tidal breathing techniques such as oscillometry allow for understanding the pathophysiology of diseases that originate early in life, thus providing the opportunity to develop timely prevention and treatment strategies. This review summarises the principles of infant oscillometry, the primary oscillometry measures, physiological differences compared to older age groups, commonly used testing platforms, laboratory benchmarking, and future directions for research. Expanding the use of infant oscillometry will require further standardisation of equipment, calibration, protocols, and technical standards, followed by well-designed studies to outline clinical utility. While infant oscillometry is currently limited to the research setting, this technique has the potential for clinical applications in the future, ultimately providing opportunities for improving respiratory outcomes in infants globally.

Large language models (LLMs) such as ChatGPT, Claude, and Gemini have become widely accessible since 2022. As childhood asthma remains the most common chronic paediatric condition with persistent gaps in optimal management, these tools present both opportunities and challenges for families and healthcare professionals. This narrative review examines the role of commercially available LLMs in childhood asthma care, exploring their fundamental principles, current evidence, and potential applications. Studies show that LLMs can generate medically accurate and comprehensible responses to asthma-related queries. Healthcare professionals may also benefit from rapid summarisation and tailored educational content. However, risks include hallucinations, bias, and data privacy concerns. Further research is required to evaluate the safety, clinical utility, and real-world acceptability of LLMs - particularly in acute asthma management by families and in supporting clinical decisions by healthcare professionals - and to guide the development of reliable, inclusive tools tailored to paediatric respiratory care.

Proponents of artificial intelligence (AI) believe that it will revolutionise the modern world, affecting how healthcare is delivered and improve both the clinical care we provide and the ease with which we perform our work. In this paper we explain what is meant by 'artificial intelligence' and explore how this technology has been implemented, or might be implemented, with respect to paediatric respiratory medicine. We review the current literature on how AI has been used to improve diagnostics - including examples in radiology, primary ciliary dyskinesia (PCD) diagnostics, sleep medicine, and pulmonary function tests. We also review how AI has been applied to therapeutics and drug discovery, how it will impact evidence-based medicine and literature review, and how clinician support tools will assist us in our work.

Parents commonly report in sleep questionnaires and in person to clinicians that their child is restless in sleep. There is little agreement on what constitutes restless sleep and so the significance of this observation is uncertain and its relationship to parental concerns about daytime tiredness, learning difficulties or problematic behaviours is unclear. Restless sleep may be secondary to other sleep problems such as obstructive sleep apnoea or periodic limb movement disorder. However, there may be some evidence to support the concept of restless sleep as a primary sleep problem. Certainly, more evaluation of restless sleep with validated tools and agreed definitions should be the starting point in clarifying the significance of restless sleep in childhood.

Smart inhaler systems represent a major opportunity to transform paediatric asthma care by potentially addressing three fundamental problems affecting paediatric asthma outcomes: medication adherence, inhalation technique and reliever overuse. The data generated across these domains opens up multiple applications - from supporting patient self-management to enabling early detection of asthma deterioration. In this review, we outline the main categories of smart inhalers - including digital dose counters, smart spacers, and smart nebulisers - and summarise the current evidence surrounding their use in children. We discuss key obstacles to implementation, including technical limitations, behavioural factors, and health system-level challenges. Establishing clear smart inhaler systems quality standards, defining appropriate indications resulting in better asthma outcomes, achieving better integration of smart inhaler data into electronic health care records, and generating robust cost-effectiveness data will be essential to support the widespread clinical adoption of these technologies.

Asthma is an umbrella term for several phenotypes and endotypes. It most frequently begins before the age of 6, with significant morbidity and decline in lung function occurring among all pediatric age groups. A delay in the diagnosis of asthma in preschoolers is associated with more severe exacerbations. One problem clinicians face is how to diagnose asthma early in its course; epidemiological phenotypes (i.e., transient, persistent, late-onset, and mid-childhood remitting wheeze) can only be ascertained retrospectively, and clinical phenotypes (e.g., episodic viral and multi-trigger wheeze) suffer from high variability and no relation with underlying pathological airway markers. International guidelines recommend that lung function tests and biomarkers be performed before diagnosing asthma in children under 5 years old. However, spirometry and airway resistance measures are typically normal in most preschoolers with asthma, and blood eosinophil counts, the most reliable biomarker for inhaled corticosteroid therapy, vary widely over time. Clinical predictive indices can help in predicting and diagnosing asthma in preschoolers. At least eight clinical predictive indices have been published, and four have been validated (API, PIAMA, APT, and PARS). Here, we will review the challenges of diagnosing asthma in the preschool age, the utility of several clinical indices, and the usefulness of incorporating biomarkers such as volatile organic components, exhaled breath condensate, and gene expression. Finally, we will discuss existing gaps and future directions for research in the field.

Obstructive sleep apnoea (OSA) and obesity may co-exist in children and adolescents. Childhood obesity tends to persist into adulthood. Sustained weight loss is recommended for obesity and OSA but may be very difficult to achieve and maintain in the real world. The need to provide effective and integrated solutions for the constellation of associated pro-inflammatory and mechanical complications of obesity including obstructive sleep apnoea, metabolic syndrome, and type 2 diabetes mellitus is obvious. Sleep laboratories cannot meet the demand for diagnostic polysomnograms and under resourced paediatric obesity clinics limit themselves to treating those with severe obesity. Importantly, readily accessible resources, such as community-based dietitians and other allied health professionals, are both scarce and overwhelmed by demands for their services. The result is that many families who need assistance, especially those with socio-economic disadvantage and those with neurodiverse children, are unable to access treatments in a timely and equitable manner. In adults, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been demonstrated to reduce body weight by up to 15 % in a 12-month period, improve glycaemic control, improve blood pressure and cardiovascular risk factors and significantly decrease the severity of obstructive sleep apnoea. As part of an integrated, multi-disciplinary approach, GLP-1 RA treatment in the medium to long term may be useful in those adolescents with severe obesity and OSA who are unable, unwilling or unsuitable for treatment with adenotonsillectomy or continuous positive airway pressure [CPAP]. Treatment benefits using GLP-1 RAs as adjunct therapy for OSA have been demonstrated in adults. The time has come to consider prioritising funded availability for adolescents with severe OSA and obesity in combination with support for behaviour change.

Respiratory symptoms are among the most common presentations of inborn errors of immunity (IEI) and acquired immunodeficiencies in children. Pediatric pulmonologists are often the first to evaluate these patients, yet immunologic evaluations remain underutilized due to diagnostic complexity and limited familiarity with immune testing. Not all patients will have access to a timely consultation with an immunologist. This review provides a practical framework to aid pediatric pulmonologists in identifying, evaluating, and managing immune dysfunction in children with respiratory disease. It outlines clinical indicators, such as recurrent infections, bronchiectasis, failure to thrive, and syndromic features, and describes the utility and limitations of key immunologic tests. Stepwise diagnostic strategies are presented, from initial laboratory screening to functional assays and genetic testing. Common IEI with respiratory manifestations, including antibody deficiencies, combined immunodeficiencies, phagocytic disorders, and immune dysregulation syndromes, are reviewed. The article also addresses acquired immunodeficiencies, diagnostic mimics, and principles of pulmonary co-management, including prophylaxis and long-term follow-up. Early recognition and collaborative care can improve outcomes and prevent irreversible pulmonary damage in this vulnerable population.

Omalizumab, a monoclonal antibody targeting IgE, was the first biologic therapy approved in 2003 for treating severe, allergen-driven, therapy-resistant asthma. Since then, many new biologics have been approved for use in children, targeting specific pathways, including anti-interleukin (IL)-5 (mepolizumab), IL-5 receptor (benralizumab), IL-4/IL-13 receptor (dupilumab), and thymic stromal lymphopoietin (TSLP) (tezepelumab). As the portfolio of biologics with diverse targets continues to expand, it has brought additional challenges to clinical practice. These include accurately identifying the endotype/phenotype of asthmatic inflammation and determining response criteria. Here, we summarise findings from phase 3 trials, discuss practical considerations for individual patients, and propose an algorithm for initiating biologics in children and adolescents with severe asthma.

As survival rates for premature infants improve, understanding the link between prematurity and obstructive sleep apnea (OSA) has become critical for enhancing outcomes in this high-risk population. Children born severely prematurely face a threefold increased risk of developing OSA due to anatomical and physiological factors, such as an abnormal upper airway, unstable ventilatory control, bronchopulmonary dysplasia, and increased susceptibility to respiratory infections. The multisystemic impact of prematurity also increases the likelihood of adverse OSA outcomes, such as neurodevelopmental deficits and pulmonary hypertension, generating a "Perfect Storm" for children affected by both conditions. Here, we summarize new insights into the shared pathophysiological mechanisms linking prematurity and OSA, highlighting the need to identify and characterize OSA in all premature infants. Polysomnographic assessments of sleep-disordered breathing and ventilatory responses to hypoxia/hyperoxia may enable tailored oxygen saturation targets for supplementation and weaning, based on each infant's unique physiology rather than relying on generalized protocols.

Although severe asthma in low- and middle-income countries (LMICs) is relatively uncommon in children and adolescents (2.1 % and 4.3 %, respectively), it results in significant morbidity, occasional fatality, and great challenges of management, compared to high-income countries. Additionally, nearly 6 % of infants in LMICs experience nighttime symptoms on a weekly basis. Socioeconomic inequities and exposure to environmental risk factors contributed to variability in prevalence, with children from disadvantaged backgrounds being at a higher risk of developing the condition. Numerous preventable risk factors have been identified in these regions, including tobacco smoke, indoor and outdoor pollution (e.g., the use of biomass fuels), allergens, diet, and urbanization, among other lifestyle factors. Almost half of the patients with severe asthma received inadequate treatment. For example, only 55 % use inhaled corticosteroids (ICS), and while most physicians prefer pressurized metered-dose inhalers, only a third recommend using spacers. In some countries, oral short-acting beta agonists and theophylline are still used as treatment options. Compared to fixed-dose ICS/long-acting beta-agonists (LABA), maintenance and reliever therapy (MART), adding tiotropium, and triple therapy (ICS + LABA + LAMA) are cost-effective options in LMICs. Biologic drugs are expensive and have limited access, and studies have shown that omalizumab and dupilumab are not cost-effective treatments in LMICs. Barriers to adequate follow-up include poorly organized health services, limited spirometry, and patients' non-compliance. Public health efforts should prioritize improving access to affordable asthma medications, enhancing diagnostic capacity in underserved areas, and addressing environmental risk factors that contribute to asthma.