Introduction: Bronchiectasis, characterized by airway dilation, mucus hypersecretion, and recurrent exacerbations, is increasingly recognized in children and adolescents. Recent guidelines from the European Respiratory Society (ERS) and Thoracic Society of Australia and New Zealand (TSANZ) emphasize early diagnosis and optimized management. This review explores therapeutic strategies for pediatric bronchiectasis. Materials and methods: Our review involved a comprehensive search of English-language literature in the PubMed and EMBASE databases until December 2023, focusing on observational studies, interventions, reviews, and guidelines in pediatric bronchiectasis. Results: Management strategies encompass airway clearance techniques, mucoactive agents, pulmonary rehabilitation, bronchodilators and inhaled corticosteroids tailored to individual needs and age-appropriate techniques. Antibiotics play key roles in preventing exacerbations, eradicating pathogens, and managing acute exacerbations, which are guided by culture sensitivities and symptoms. Long-term antibiotic prophylaxis, particularly macrolides, aims to reduce exacerbations, although concerns about antibiotic resistance persist. Vaccinations, including pneumococcal and influenza vaccines, are crucial for preventing infections and complications. Surgery and lung transplantation are reserved to severe, refractory cases after failure of medical therapies. Conclusions: The optimal management of pediatric bronchiectasis requires a multidisciplinary approach, including physiotherapy, pharmacotherapy, and vaccinations, tailored to individual needs and guided by evidence-based guidelines. Further research is needed to refine diagnostic and therapeutic strategies and improve outcomes for affected children and adolescents.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Chronic respiratory diseases (CRDs) are widespread pathologies that cause non-reversible airflow limitations as well as a variety of extrapulmonary adverse effects. For these reasons, these pathologies are related to frequent hospitalizations and, consequently, high levels of anxiety, depression, and stress. In this respect, relaxation in Virtual Reality (VR) integrated with savoring, which is the ability to generate and amplify positive emotions, can be used to increase well-being and relaxation in CRDs patients. Objective: This pilot randomized controlled trial aimed to investigate the effectiveness of a two-week VR-based relaxation intervention integrated with savoring in CRDs patients in increasing emotional and psychological well-being, positive emotions, relaxation, oxygen saturation levels (SpO2) and decreasing negative emotions. Methods: This study involved 45 hospitalized CRDs patients from the Pulmonary Rehabilitation Unit of IRCCS INRCA Casatenovo. Alongside traditional pulmonary rehabilitation, the experimental group (N = 23) took part in the four-session VR-based intervention, while the active control group (N = 22) listened to relaxing music. In each session, the experimental group experienced a relaxing virtual scenario followed by a savoring exercise. Both groups filled out the self-reported questionnaires before the intervention (T0), after (T1), and in the one-month follow-up (T2), and before and after each session. The experimental group's VR acceptance and sense of presence were also measured. Results: Regarding the primary outcomes, taking T0 and T1 into account, repeated measures ANCOVAs revealed a significant increase for the experimental group in emotional and psychological well-being, positive emotions, relaxation, and a significant decrease in negative emotions compared to the control group. The psychological changes were maintained at T2. Concerning secondary outcomes, patients reported high VR acceptance and sense of presence. Conclusions: These results suggest that relaxation VR integrated with savoring can promote well-being and reduce clinical symptoms not only in the post-intervention, but also in the long term. Indeed, savoring can amplify the positive effects of relaxing VR and help patients to focus and amplify their positive experiences, thus counteracting the negative psychological consequences of CRDs. Clinical Trial: anzctr.org, ACTRN12624000435583; https://www.anzctr.org.au/ACTRN12624000435583.aspx (retrospectively registered). This study was approved by the Ethics Committee of the IRCCS INRCA Casatenovo but for administrative issues the trial registration was no completed prospectively. The registration was therefore completed retrospectively before data analysis and paper writing.

BACKGROUND Chronic respiratory diseases (CRDs) are widespread pathologies that cause non-reversible airflow limitations as well as a variety of extrapulmonary adverse effects. For these reasons, these pathologies are related to frequent hospitalizations and, consequently, high levels of anxiety, depression, and stress. In this respect, relaxation in Virtual Reality (VR) integrated with savoring, which is the ability to generate and amplify positive emotions, can be used to increase well-being and relaxation in CRDs patients. OBJECTIVE This pilot randomized controlled trial aimed to investigate the effectiveness of a two-week VR-based relaxation intervention integrated with savoring in CRDs patients in increasing emotional and psychological well-being, positive emotions, relaxation, oxygen saturation levels (SpO2) and decreasing negative emotions. METHODS This study involved 45 hospitalized CRDs patients from the Pulmonary Rehabilitation Unit of IRCCS INRCA Casatenovo. Alongside traditional pulmonary rehabilitation, the experimental group (N = 23) took part in the four-session VR-based intervention, while the active control group (N = 22) listened to relaxing music. In each session, the experimental group experienced a relaxing virtual scenario followed by a savoring exercise. Both groups filled out the self-reported questionnaires before the intervention (T0), after (T1), and in the one-month follow-up (T2), and before and after each session. The experimental group's VR acceptance and sense of presence were also measured. RESULTS Regarding the primary outcomes, taking T0 and T1 into account, repeated measures ANCOVAs revealed a significant increase for the experimental group in emotional and psychological well-being, positive emotions, relaxation, and a significant decrease in negative emotions compared to the control group. The psychological changes were maintained at T2. Concerning secondary outcomes, patients reported high VR acceptance and sense of presence. CONCLUSIONS These results suggest that relaxation VR integrated with savoring can promote well-being and reduce clinical symptoms not only in the post-intervention, but also in the long term. Indeed, savoring can amplify the positive effects of relaxing VR and help patients to focus and amplify their positive experiences, thus counteracting the negative psychological consequences of CRDs. CLINICALTRIAL anzctr.org, ACTRN12624000435583; https://www.anzctr.org.au/ACTRN12624000435583.aspx (retrospectively registered). This study was approved by the Ethics Committee of the IRCCS INRCA Casatenovo but for administrative issues the trial registration was no completed prospectively. The registration was therefore completed retrospectively before data analysis and paper writing.