The lack of available treatments in pediatric non-cystic fibrosis (non-CF) bronchiectasis is a major concern, especially in the context of the increasing disease burden due to better detection rates with advanced imaging techniques. Recurrent infections in these patients are the main cause of deterioration, leading to impaired lung function and increasing the risk of morbidity and mortality. Since pediatric non-CF bronchiectasis with early recognition and appropriate treatment can be reversible, optimal management is an issue of growing significance. The use of inhaled antibiotics as a treatment option, although a standard of care for CF patients, has been poorly studied in patients with non-CF bronchiectasis, especially in children. In this review, we present the current data on the potential use of inhaled antibiotics in the treatment of non-CF bronchiectasis and assess their safety and efficacy profile, focusing mainly on children. We conclude that inhaled antibiotics as an adjuvant maintenance treatment option could be tried in a subgroup of patients with frequent exacerbations and recent or chronic Pseudomonas aeruginosa infection as they appear to have beneficial effects on exacerbation rate and bacterial load with minimal safety concerns. However, the level of evidence in children is extremely low; therefore, further research is needed on the validity of this recommendation.

Background: Protracted bacterial bronchitis (PBB) and bronchiectasis share common clinical and microbiological features, but direct comparative data in children are limited. Objectives: To compare bronchoalveolar lavage (BAL) microbiology between pediatric PBB and bronchiectasis and identify predictors of lower airway and polymicrobial infections. Methods: We retrospectively reviewed children diagnosed with PBB or bronchiectasis at a tertiary center (January 2019–June 2025) who underwent both high-resolution computed tomography of the chest and bronchoscopy with BAL within a 6-month period. Multivariable logistic regression was used to identify predictors of lower airway and polymicrobial infections, adjusting for age, gender, tracheomalacia/bronchomalacia, asthma, and Bhalla score. Results: Among 135 children (85 with PBB, 50 with bronchiectasis), those with bronchiectasis were older (median 7.8 vs. 4.2 years, p < 0.001), while comorbidities showed statistically non-significant differences. The prevalence of lower airway infection was high (PBB 81.2%, bronchiectasis 74.0%; p = 0.330). Pathogen distribution demonstrated statistically non-significant differences between groups after adjustment, with Haemophilus influenzae being the most common pathogen in both groups. Moraxella catarrhalis was more frequent in PBB in unadjusted analysis (21.2% vs. 8.0%; p = 0.045), but this difference did not persist after adjustment. Polymicrobial infection occurred in 25.9% of PBB and 16.0% of bronchiectasis cases (p = 0.180). In regression analyses, younger age independently predicted polymicrobial infection (adjusted OR 0.81, 95% CI 0.69–0.95). Conclusions: BAL microbiology showed statistically non-significant differences between PBB and bronchiectasis, supporting the concept of a disease continuum. Younger children were more prone to polymicrobial infection. These findings support early targeted antibiotic therapy and close clinical surveillance to prevent progression to irreversible airway damage.

Background: Preschool wheezing is common, but distinguishing transient wheezing from early persistent asthma remains difficult. Oscillometric techniques, including impulse oscillometry (IOS), may provide objective prognostic information. Objective: To systematically review longitudinal studies assessing whether oscillometric measurements obtained at preschool age are associated with later asthma-related outcomes or lung function impairment. Methods: PubMed, Scopus, and MEDLINE (via EBSCOhost) were searched from inception to 28 February 2026. Eligible studies included preschool-aged children or closely related early-childhood populations assessed with IOS or forced oscillation technique (FOT), longitudinal follow-up, and later asthma-related or spirometric outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias with QUIPS. Owing to substantial heterogeneity, findings were synthesized qualitatively. Results: Seven longitudinal cohort studies, encompassing 1077 children, met the eligibility criteria; baseline oscillometry was performed between ages 2 and 7 years, and follow-up ranged from 1 to 10 years. Short-term classification and longer-term prognostic studies were interpreted separately. Resistance-based indices, particularly R5, showed the most consistent associations with later asthma-related outcomes and lower subsequent spirometric indices, including FEV₁ and FEV_1/FVC. Most studies were at moderate risk of bias, and some reports came from related cohorts. Conclusions: Preschool oscillometry may provide complementary physiological information to assess asthma risk in symptomatic or high-risk preschool-aged children, particularly through resistance-based measures. However, evidence remains limited, heterogeneous, and insufficient to support a single validated cutoff, routine screening of apparently healthy children, or routine stand-alone prognostic use.

Introduction: The position of Paediatric Respiratory medicine as a paediatric subspecialty differs among countries in Europe. Aim: To record the status of formal recognition of the subspecialty and the level of training and clinical performance in different European countries. Methods: Standard questionnaires were sent online from February to March 2020 via Survey Monkey application to all members of Paediatric Assembly of European Respiratory Society.The collected underwent statistical analysis. Results: From the 250 collected questionnaires the subspecialty seems to be formally recognized in 20 of the 34 European countries. 18 countries reported the existence of a professional body representing the subspecialty at a national level. The duration of training was strictly defined in 16 of the 34 countries ranging from 1.5 to 3 years. Regarding demonstration of continuing competence, 50% of the respondents reported the collection of Continuing Professional Development points while 25% that there was no such obligation. The annual ERS exam, as part of training accreditation, was not formally recognized in most of the countries. Surprisingly, 40% of the respondents did not perform a flexible bronchoscopy during the last 12 months, despite that half of them reported working in university hospitals. Concerning educational training, it seems that the vast majority of respondents participate in teaching, research and other educational activities. Conclusions: It is of crucial importance to strengthen the harmonization of training in the subspecialty and support the Paediatric HERMES project as an important initiative towards this direction

Hymenoptera stings in children are a recognized cause of severe and potentially fatal reactions, yet clinical attention has been predominantly focused on IgE-mediated anaphylaxis. This narrative review addresses the broader spectrum of non-IgE-mediated toxic and unusual reactions in the pediatric population, organized by affected organ system. Toxic envenomation—dose-dependent and independent of allergic sensitization—occurs when venom components directly disrupt cellular membranes, producing rhabdomyolysis, hemolysis, acute kidney injury, hepatotoxicity, ARDS, and multi-organ failure; a sting burden of ≥1 sting per kilogram body weight warrants urgent evaluation in children. Unusual non-IgE-mediated immunological reactions—including Guillain–Barré syndrome, ADEM, cavernous sinus thrombosis, Kounis syndrome, autoimmune thrombocytopenic purpura, and serum sickness—can be triggered by even a single sting and manifest days to weeks later. A clinically deceptive asymptomatic interval common to both categories frequently leads to premature discharge and delayed diagnosis. Awareness of this extended spectrum, weight-based hospitalization thresholds, and early organ-specific supportive care are essential to reduce preventable morbidity and mortality in this population.

Paediatric rhinosinusitis (RS), particularly chronic rhinosinusitis (CRS), is a common inflammatory condition with a significant impact on quality of life and a well-recognized association with asthma within the framework of united airway disease. This review aims to evaluate the impact of RS on asthma control in children and explore its role as a modifiable determinant. Mechanistically, RS and asthma share key pathophysiological features, including type 2 inflammation, epithelial barrier dysfunction, and airway microbiome dysbiosis, supporting the concept of a unified inflammatory process across the respiratory tract. Clinically, epidemiological data demonstrate a high prevalence of coexisting RS and asthma, with consistent associations with poorer asthma control, increased disease severity, and higher exacerbation burden, even in cases of subclinical sinonasal inflammation. Emerging evidence suggests that appropriate management of CRS, including medical therapy and, in selected cases, surgical intervention, may improve asthma outcomes such as symptom control and lung function. However, the current evidence base remains limited, with a predominance of small, heterogeneous, and observational studies. RS therefore represents a potentially treatable trait in paediatric asthma, warranting systematic evaluation in children with difficult-to-treat disease. Further prospective and interventional studies are needed to clarify causality and define its impact on long-term outcomes.