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Feleszko W, Jartti T, Bacharier LB. Current strategies for phenotyping and managing asthma in preschool children. Curr Opin Allergy Clin Immunol 2022; 22:107-114. [PMID: 35197432 DOI: 10.1097/aci.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Half of all children will experience an episode of wheezing by 6 years. Recurrent preschool wheezing is associated with early lung function loss and has a lifelong impact on airway health, so deciding which children should be treated to prevent exacerbations while also avoiding irreversible health consequences is crucial. The purpose of this review is to provide a practical approach to the pediatric patient under 5 years of age with asthma, with particular attention to the recent enhanced identification of wheeze phenotypes. RECENT FINDINGS Here, we note the difficulty of defining 'asthma' for this age group and advocate that it be determined by the set of respiratory symptoms presented, without assumptions about the underlying mechanisms of the disease. In addition, we propose a forward-looking approach, what treatment to apply to particular phenotypes, which child should be treated, and, if so, which treatment strategy to choose. No clear recommendation exists for the management of nonallergic preschool wheezing, a substantial clinical and research gap. SUMMARY We recommend an empathetic approach to parent anxiety and considering objective markers: timing, severity, and frequency of symptoms, along with an assessment of other biomarkers, including viral etiology, aeroallergen sensitization, and blood eosinophils, that contribute to successful decision-making.
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Affiliation(s)
- Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku
- Department of Pediatrics, Oulu University Hospital and the University of Oulu
- Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
| | - Leonard B Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Precision medicine in pediatric severe asthma: Targeted blockade of type 2 inflammation. Cell Rep Med 2022; 3:100570. [PMID: 35492881 PMCID: PMC9040171 DOI: 10.1016/j.xcrm.2022.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A study by Bacharier et al. demonstrated that children with uncontrolled moderate-to-severe asthma with elevated type 2 biomarkers who received dupilumab had fewer exacerbations and better lung function.1 These results highlight precision medicine approaches in pediatric asthma.
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Paediatric asthma - all that wheezes is not necessarily asthma - current diagnostic and management strategies. Curr Opin Pulm Med 2022; 28:258-265. [PMID: 35256553 DOI: 10.1097/mcp.0000000000000874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Asthma is a frequently encountered chronic medical condition encountered in paediatrics, affecting 7% of children under the age of 18 in the United States. Although asthma is one of the more common conditions that is associated with wheezing, there is a broad differential diagnosis to consider. The purpose of this review is to describe other causes of wheezing outside of asthma in a paediatric population and discuss diagnostic and management strategies to consider when evaluating a child or adolescent with wheezing. RECENT FINDINGS The characteristics of the wheezing along with other associated signs and symptoms can be helpful in narrowing the differential diagnosis. The age and the past medical history of the patient are also important aspects to consider when determining next steps in the evaluation and management of paediatric wheezing. In addition to considering other causes of wheezing, it is often necessary to assess for the presence of underlying asthma, and recently updated asthma guidelines from the National Heart, Lung and Blood Institute provide a graded review of various recommendations for making the diagnosis and managing asthma in the clinical setting. SUMMARY It is important to maintain a broad differential diagnosis when evaluating a paediatric patient with wheezing.
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Kouis P, Michaelidou E, Kinni P, Michanikou A, Anagnostopoulou P, Dimitriou H, Karanicolas K, Matthaiou AM, Achilleos S, Papatheodorou SI, Koutrakis P, Middleton N, Galanakis E, Yiallouros PK. Pediatric asthma symptom control during lockdown for the COVID-19 pandemic in Spring 2020: A prospective community-based study in Cyprus and Greece. Pediatr Pulmonol 2022; 57:386-394. [PMID: 34818465 DOI: 10.1002/ppul.25765] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/07/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To prospectively quantify at the community level changes in asthma symptom control and other morbidity indices, among asthmatic schoolchildren in response to coronavirus disease 2019 (COVID-19) lockdown measures. METHODS In Spring 2019 and Spring 2020, we prospectively assessed monthly changes in pediatric asthma control test (c-ACT), asthma medication usage, infections and unscheduled visits for asthma among schoolchildren with active asthma in Cyprus and Greece. We compared asthma symptom control and other morbidity indices before and during lockdown measures, while participants' time spent at home was objectively assessed by wearable sensors. RESULTS A total of 119 asthmatic children participated in the study during Spring 2020. Compared to a mean baseline (pre-COVID-19 lockdown) c-ACT score of 22.70, adjusted mean increases of 2.58 (95% confidence interval [CI]: 1.91, 3.26, p < 0.001) and 3.57 (95% CI: 2.88, 4.27, p < 0.001) in the 2nd and 3rd monthly assessments were observed after implementation of lockdown measures. A mean increase in c-ACT score of 0.32 (95% CI: 0.17, 0.47, p < 0.001) was noted per 10% increase in the time spent at home. Improvement was more profound in children with severe asthma, while significant reductions in infections, asthma medication usage and unscheduled visits for asthma were also observed. During Spring 2019, 39 children participated in the study in the absence of lockdown measures and no changes in c-ACT or other indices of disease severity were observed. CONCLUSIONS Clinically meaningful improvements in asthma symptom control, among asthmatic schoolchildren were observed during the COVID-19 lockdown measures in Spring 2020. Improvements were independently associated with time spent at home and were more profound in the children with severe asthma.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Antonis Michanikou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Pinelopi Anagnostopoulou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus.,Institute of Anatomy, University of Bern, Bern, Switzerland
| | | | - Kostas Karanicolas
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Andreas M Matthaiou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Souzana Achilleos
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Stefania I Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Nicos Middleton
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
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Bush A, Fitzpatrick AM, Saglani S, Anderson WC, Szefler SJ. Difficult-to-Treat Asthma Management in School-Age Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:359-375. [PMID: 34838706 DOI: 10.1016/j.jaip.2021.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
The World Health Organization divides severe asthma into three categories: untreated severe asthma; difficult-to-treat severe asthma; and severe, therapy-resistant asthma. The apparent frequency of severe asthma in the general population of asthmatic children is probably around 5%. Upon referral of these children, it is important to evaluate the diagnosis of asthma carefully before modifying management and applying a long-term monitoring plan. Identification of pathophysiologic phenotypes using objective biomarkers is essential in our routine assessments of severe asthma. Although conventional pharmacologic approaches should be attempted first, there is growing recognition that children with difficult-to-treat asthma may have unique clinical phenotypes that may necessitate alternative treatment approaches including asthma biologics. These new medications, especially those with effects on multiple pathologic features of asthma, raise the hope that new treatment strategies could induce remission. Besides introducing new medications, the opportunity for closer monitoring is feasible with advances in digital health. Therefore, we have the opportunity to improve response to medications, individualize treatment, and monitor response along with potential steps to prevent severe asthma.
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Affiliation(s)
- Andy Bush
- Director, Imperial Centre for Paediatrics and Child Health, Professor of Paediatrics and Paediatric Respirology, National Heart and Lung Institute, Imperial College, Consultant Paediatric Chest Physician, Royal Brompton Hospital, London, United Kingdom
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Sejal Saglani
- National Heart & Lung Institute, Imperial College London and Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - William C Anderson
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Allergy and Immunology Section, Children's Hospital Colorado, Aurora, Colo
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Breathing Institute, Children's Hospital Colorado, Aurora, Colo; University of Colorado Anschutz Medical Campus, Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colo.
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Kryvopustova MV. PREDICTION OF ASTHMA CONTROL STATUS IN SCHOOL-AGE CHILDREN SENSITIZED TO CAT ALLERGENS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1481-1485. [PMID: 35907220 DOI: 10.36740/wlek202206110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To develop a model for predicting asthma control status in school-age children sensitized to cat allergens. PATIENTS AND METHODS Materials and methods: The study included 302 children aged 6-17 years who were sensitized to cat allergens. The ALEX² test (Macro Array Diagnostics GmbH, Austria) was used to analyze the sensitization profile in these children. After 12 months of treatment, control of clinical asthma symptoms was achieved in 185 (61.26%) children. Single-factor logistic regression models were constructed to analyze the probability of achieving asthma control in school-age children with sensitization to cat allergens. RESULTS Results: It was found that asthma control status depended on the FeNO dynamics after 3 months of treatment, the number of cat allergens to which sensitization was detected, and the duration of exposure to a domestic cat after sensitization tests, which were conducted to verify the allergic capacity to cat allergens. The investigation resulted in the creation of a mathematical model for predicting the probability of asthma control, sensitivity 94.6 (95% CI 90.3 - 97.4) %, specificity - 81.2 (95% CI 72.9 - 87.8) %, PPV = 88.8 (95% CI 84.5 - 92.1) %, NPV = 90.5 (95% CI 83.8 - 94.6) %. CONCLUSION Conclusions: A model for predicting the probability of asthma control was created. The formula is used to calculate the patient's P. P > 0.44 allows predicting the achievement of asthma control after 12 months of treatment.
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Park SY, Kang SY, Song WJ, Kim JH. Evolving Concept of Severe Asthma: Transition From Diagnosis to Treatable Traits. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:447-464. [PMID: 36174989 PMCID: PMC9523415 DOI: 10.4168/aair.2022.14.5.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
In recent decades, the concept of severe asthma has evolved from an umbrella term encompassing patients with high-intensity treatment needs to a clinical syndrome with heterogeneous, albeit distinct, pathophysiological processes. Biased and unbiased cluster approaches have been used to identify several clinical phenotypes. In parallel, cellular and molecular approaches allow for the development of biological therapies, especially targeting type 2 (T2) cytokine pathways. Although T2-biologics have significantly improved clinical outcomes for patients with severe asthma in real-world practice, questions on the proper use of biologics remain open. Furthermore, a subset of severe asthma patients remains poorly controlled. The unmet needs require a new approach. The “treatable traits” concept has been suggested to address a diversity of pathophysiological factors in severe asthma and overcome the limitations of existing treatment strategies. With a tailored therapy that targets the treatable traits in individual patients, better personalized medical care and outcomes should be achieved.
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Affiliation(s)
- So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University Gwangmyeong Medical Center, Gwangmyeong, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
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Schatz M, Zeiger RS. Asthma Guidance: Options for Individualized Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:S39-S40. [PMID: 34949333 DOI: 10.1016/j.jaip.2021.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
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Liu L, Zhou P, Wang Z, Zhai S, Zhou W. Efficacy and Safety of Omalizumab for the Treatment of Severe or Poorly Controlled Allergic Diseases in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:851177. [PMID: 35372142 PMCID: PMC8965060 DOI: 10.3389/fped.2022.851177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of omalizumab in the treatment of severe or uncontrolled allergic diseases in children. METHODS We conducted a systematic search of the PubMed, Embase, CENTRAL, and clinicaltrials.gov databases up to 23rd July 2021, with no language limitations. Randomised controlled trials (RCTs) comparing omalizumab with other treatments or placebo in children with severe or inadequately controlled allergic diseases were considered. The primary outcomes of interest were asthma exacerbation rate, allergic symptom score, desensitisation achievement for food allergy (FA), and incidence of serious adverse events (SAEs). The study selection and data extraction were conducted independently by two researchers. Quality assessments were conducted using the Cochrane risk-of-bias tool, and data were pooled using a random-effects model if I 2 was 50% or greater in the Cochrane Review Manager. RESULTS Overall, 10 RCTs [six on severe asthma, one on atopic dermatitis (AD), one on seasonal allergic rhinitis [SAR], and one on FA] consisting of 2,376 participants met the inclusion criteria. For severe asthma, omalizumab may reduce exacerbations at 12 weeks [risk ratio (RR), 0.52; 95% confidence interval (CI), 0.31-0.89], 24 weeks (RR, 0.69; 95% CI, 0.55-0.85; GRADE: moderate-quality evidence), and 52 weeks (RR, 0.62; 95% CI, 0.40-0.94; GRADE: moderate-quality evidence) and reduce the dose of inhalation corticosteroid compared with placebo. For severe AD, the association between omalizumab and allergic symptom improvement [i.e., SCORing Atopic Dermatitis or Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ)] was not confirmed. For severe SAR, omalizumab showed greater improvement in symptom load scores and saved rescue medication days. For FA, omalizumab demonstrated superiority in desensitisation compared with placebo. To date, no clinically significant drug-related SAEs have been reported. CONCLUSION For severe or uncontrolled asthma, AD, SAR, and FA, omalizumab may be associated with improved allergic symptoms and safety in children. Future studies should focus on the benefits and pharmacoeconomic evaluation of omalizumab in multiple allergic diseases compared with other treatments. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42021271863].
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Affiliation(s)
- Ling Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Zhenhuan Wang
- Department of Pharmacy, First Hospital of Tsinghua University, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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Marchant JM, Cook AL, Roberts J, Yerkovich ST, Goyal V, Arnold D, O’Farrell HE, Chang AB. Burden of Care for Children with Bronchiectasis from Parents/Carers Perspective. J Clin Med 2021; 10:jcm10245856. [PMID: 34945152 PMCID: PMC8707334 DOI: 10.3390/jcm10245856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchiectasis is a neglected chronic respiratory condition. In children optimal appropriate management can halt the disease process, and in some cases reverse the radiological abnormality. This requires many facets, including parental/carer bronchiectasis-specific knowledge, for which there is currently no such published data. Further, the importance of patient voices in guiding clinical research is becoming increasingly appreciated. To address these issues, we aimed to describe the voices of parents of children with bronchiectasis relating to (a) burden of illness and quality of life (QoL), (b) their major worries/concerns and (c) understanding/management of exacerbations. The parents of 152 children with bronchiectasis (median age = 5.8 years, range 3.5-8.4) recruited from the Queensland Children's Hospital (Australia) completed questionnaires, including a parent-proxy cough-specific QoL. We found that parents of children with bronchiectasis had impaired QoL (median 4.38, range 3.13-5.63) and a high disease burden with median 7.0 (range 4.0-10.0) doctor visits in 12-months. Parental knowledge varied with only 41% understanding appropriate management of an exacerbation. The highest worry/concern expressed were long-term effects (n = 42, 29.8%) and perceived declining health (n = 36, 25.5%). Our study has highlighted the need for improved education, high parental burden and areas of concern/worry which may inform development of a bronchiectasis-specific paediatric QoL tool.
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Affiliation(s)
- Julie M. Marchant
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Correspondence:
| | - Anne L. Cook
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Jack Roberts
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Daniel Arnold
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Hannah E. O’Farrell
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Anne B. Chang
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
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