Background: In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; impulse oscillometry (IOS) may be an alternative to spirometry. However, there is still no consensus in standardization of BDR for IOS in young children. Objective: The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS. Methods: Young infants aged 3 to 6 years with suspected asthma were evaluated in a real life setting with both IOS and spirometry pre- and post-BDR. The BDR was defined as positive when the change of FEV1 was ≥12% and/or ≥200 mL. Results: Among 72 patients (age 4.98 ± 0.94 years; 64% boys), 36 (age 5.15 ± 0.99 years; 64% boys) were selected for the subsequent analysis according to ATS / ERS quality criteria of measurements. The spirometric BDR was found positive in seven subjects (19.4%). In IOS, the mean decrease in R5 and AX was 19.86% ± 10.04 and 44% ± 22.10, and the mean increase in X5 was 23.28% ± 17.82, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = 0.03) and an increase in X5 of 25.7% (AUC 0.75, p = 0.04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥12% and/or ≥200 mL. Conclusion: The IOS may present a valid alternative to spirometry to measure BDR in preschool children. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.

Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self-manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence-based guideline on effective transition for AYA with asthma and allergies was published by EAACI. We herein summarize practical resources to support this guideline’s implementation in clinical practice. For this purpose, multi-stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality, and were pragmatically rated for their evidence-basis and user friendliness. Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace, and wider community. Most resources were in English, web-based and had limited evidence-basis. This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient-centred tools to further assist evidence-based transition care.

Adolescent and young adult (AYA) patients need additional support while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multi-disciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include: (i) starting transition early (11-13 years), (ii) using a structured, multidisciplinary approach, (iii) ensuring AYA fully understand their condition and have resources they can access, (iv) active monitoring of adherence and (v) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (i) simplifying medication regimes and using reminders; (ii) focusing on areas where AYA are not confident and involving peers in training AYA patients; (iii) identifying and managing psychological and socioeconomic issues impacting disease control and quality of life; (iv) enrolling the family in assisting AYA to undertake self-management and (v) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.