Objectives To characterise the epidemiology of atopic eczema in adolescents from Kosovo, an area of very low prevalence of the condition and to know whether the same factors are associated to eczema with or without comorbid wheezing symptoms. Methods The cross-sectional survey Global Asthma Network validated questionnaire was self-completed by adolescents 13-14 years of age in the school setting from the main cities of Kosovo: Ferizaj, Gjakova, Gjilan, Peja, Prishtina and Prizren. Atopic eczema symptoms and diagnosis was put in relation with the environmental questionnaire which included questions on smoking; pet ownership; paracetamol use, truck traffic; siblings; time spent using screens or watching television; and exercise. Additionally, height and weight were measured at school. Results The prevalence of eczema symptoms ranged from 2.2% in Ferizaj to 5.5% in Gjakova. Severe symptoms were <1% in all cities. Eczema ever ranged from 3.0% in Ferizaj to 6.4% in Prizren. Factors significantly associated to the prevalence of current eczema symptoms in the metanalysis were male sex (pooled aOR 0.50; 95%CI 0.37-0.66); exercise (pooled aOR 2.79; 95%CI 1.89-4.10); and paracetamol intake (pooled 1.86; 95%CI 1.32-2.64). The corresponding figures for eczema ever were: 0.68 95%CI 0.44-1.06; 2.07 95%CI 1.48-2.90; and 1.19 95%CI 0.88-1.60. The associations tended to be higher in the subpopulation with eczema and wheeze comorbidity. Conclusions The prevalence of atopic eczema is very low in Kosovo and is associated to female sex, exercise, and paracetamol intake. Those associations are higher when eczema and wheezing are comorbid conditions.

Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization and natural history review. Numerous factors that may affect disease activity and patient wellbeing need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even ‘real-time’, monitoring between visits. Following an approach that included needs assessment, evidence appraisal and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.

Objectives: The aim of the present study was to summarize the principal findings of all available studies that have evaluated the use of ICS on an intermittent or as-needed basis as an add-on therapy to short-acting β2-agonists (SABAs) or fast-acting β2-agonists (FABAs), given alone or in addition to daily controller therapy, in pediatric asthmatic patients. Methods: Studies published by February 2021 that evaluate the use of ICS on an intermittent or as-needed basis as an add-on therapy to SABAs or FABAs given alone or in addition to daily controller therapy in pediatric asthma were identified. The quality of the studies was assessed using the Cochrane Risk of Bias and the AMSTAR 2 tools. Results: Of 294 references identified, 14 studies were included. The use of ICS on an intermittent or as-needed basis (as an add-on therapy to SABAs) has been shown to be more effective than treatment with SABA alone and to be similarly or less effective compared to regular daily ICS administration. Furthermore, strategies involving increasing the dose of ICS only when needed (as an add-on therapy to FABAs such as formoterol) and keeping it low during stable stages of the disease have been shown to be similarly or more effective than comparators. Conclusion: The use of ICS on an intermittent or as-needed basis as an add-on therapy to SABAs or FABAs, given alone or in addition to daily controller therapy in pediatric asthmatic patients, is an effective and well-tolerated treatment strategy.

Background: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 on childhood asthma outcomes. Methods: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4-18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks and hospitalizations due to asthma, in comparison to the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.