Interstitial Lung Disease in childhood (chILD) is rare and no longer solely a childhood issue. Many are surviving into adult life. Therefore, many affected with chILD need to transition from paediatric to adult healthcare services. Transition is a significant life event that has the potential to impact on physical and mental health outcomes and across Europe this is a haphazard process for chILD. This qualitative study explores how young people and parents in the United Kingdom experienced transition from paediatric to adult healthcare services for chILD. Participants (n = 7) were recruited from chILD patient organisations and online communities. We focused on the experience of transition and whether there were any information packs or support provided for the transition. The data was analysed by constructivist grounded theory. The study presents a lived experience of transition with themes of lack of transition preparation and planning, challenges of learning how to adapt to adult services and a changing healthcare scene. Due to the complexity of ChILD, parents discussed their need to remain, in part, as an advocate for the young person. Respondents provided recommendations for how transition could be improved along with tips for young people who are new to the transition process, which include educating oneself about the condition and learning medical terminology, being open if there are issues and reaching out for support.

Introduction: Non-adherence to inhaled corticosteroids (ICS) in children with asthma leads to significant morbidity and mortality. Few interventions to improve adherence have been effective and little is known about what contributes to intervention effectiveness. This systematic review summarises the efficacy of these interventions and the characteristics of effective interventions to inform future studies aiming to improve adherence to ICS in children with asthma. Methods: PubMed, Embase, PsychINFO, Medline, Web of Science, and International Pharmaceutical Abstracts were systematically searched on the 3rd of October 2020 for randomised control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the NICE guidelines for medicines adherence (The Perceptions and Practicalities Approach, PAPA) and Behaviour Change Techniques (BCT), to determine the effective aspects of the intervention. Results: Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the twenty-five studies were categorised as being highly reliable. Nine of the thirteen studies were effective at increasing adherence and six of those met the criteria for a PAPA intervention. Conclusion: Adherence interventions in children with asthma have mixed effectiveness. Effective studies tended to be of higher quality, were tailored to individuals perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design as outlined in this review

Background: Adherence to inhaled corticosteroids (ICS) is suboptimal in school-age children with asthma. Little is known about adherence to ICS in preschool children with troublesome wheeze. Children with aeroallergen sensitisation, or those with multiple trigger wheeze (MTW), should be differential ICS responders. We hypothesised that adherence to ICS and symptom control are only positively related in atopic children, or those with MTW. Methods: Patients aged 1-5 years with recurrent wheeze prescribed ICS were recruited from a tertiary respiratory clinic. Clinical phenotype and aeroallergen sensitisation were determined, and adherence assessed using an electronic monitoring device (Smartinhaler®). Symptom control (Test for Respiratory and Asthma Control in Kids (TRACK)), quality of life (PACQLQ), airway inflammation (offline exhaled nitric oxide (FeNO)) were assessed at baseline and follow-up. Results: Forty-eight children (mean age 3.7 years, SD 1.2) were monitored for a median of 112 (IQR 91-126) days. At baseline n=29 had episodic viral wheeze (EVW) and n= 19 had MTW. 24/48 (50%) wheezers had sub-optimal ICS adherence (<80%). Median adherence was 64% (IQR 38-84). There was a significant increase in TRACK in the group as a whole, unrelated to adherence. When split according to ICS responders, a significant increase in TRACK was only seen in atopic wheezers with adherence >60%. There was no relationship between clinical phenotype, adherence and symptom control. Conclusion: Adherence to ICS was sub-optimal and was positively related to symptom control in atopic wheezers only. Assessments of adherence are important in preschool children with an ICS responsive phenotype prior to therapy escalation.