Introduction: Asthma and Allergic Rhinitis (AR) are among the most prevalent diseases worldwide and they frequently persist throughout life. These have significant effect on physical, financial and mental wellbeing of patients and caregivers. There have been few attempts previously, assessing quality of life in affected families suffering from these diseases. However, data from developing countries are scarce. Quality of life (QOL) assessment in children and caregivers of patients suffering can help in symptomatic management and provide inputs for better utilization of resources to achieve optimal treatment. Methods: Patient and caregiver QOLs were ascertained using mPAQLQ and PACQLQ respectively in the study and correlated with disease severity and chronicity using parametric and non-parametric statistical tools. Results: There were 246 pairs of children diagnosed with Asthma and/or AR and their caregivers attending the Pediatric Allergy and Asthma clinic. Symptom score, emotional domain and activity limitation in children did not validate a statistically significant difference in QOL in various grades of AR/Asthma (p=0.632)(p=0.772), (p=0.496) (p=0.918) and (p=0.384), (p=0.561) respectively. Additionally there was no significant correlation between the severity of asthma and caregiver emotional disturbance (p=0.594) or caregiver activity limitation (p=0.446). Conclusions: Quality of life in children and caregivers where children are suffering from either AR or Asthma, or both has not shown any significant difference as per the disease severity or chronicity in various domains. There was no significant difference in quality of life noted as per change in age group, gender of patients or education status of caregivers.

Objective: It was hypothesized that heated humidified high flow nasal cannula (HFNC) is non-inferior to non- invasive ventilation (NIV) for preventing reintubation in high risk children. Design: Prospective randomized clinical non-inferiority trial Setting: Single centre study in a 12-bed multidisciplinary paediatric intensive care unit (PICU) in Delhi. Patients: All children (1month -18years) receiving invasive mechanical ventilation longer than 48 hours and ready for scheduled extubation. Intervention: Heated humidified high flow nasal cannula(HFNC) or Non-invasive ventilation (NIV) Measurements and Main Results: Of total 230 patients enrolled, 139 were analysed (3 left against medical advice), out of which 70 (50.4%) received NIV and 69 (49.6%) HFNC. Mean duration of intubation was 150.8 ±74.3 hours in NIV group vs 138.5 ±81.9 hours in HFNC group (p= 0.16). Out of 139 children, 15(10.8%) were re-intubated; 6 (8.6%) in the NIV group vs 9 (13%) in the HFNC group (absolute difference 4.4%; p= 0.42). Median time to re-intubation did not differ between the group; NIV group 4 hours (IQR 1.7-12.5hours) vs HFNC group 3.7 hours (IQR 2-4hours) (absolute difference, 0.3 hours; p= 0.50). Mean post extubation PICU length of stay was significantly lower in HFNC group (3.5 ±2.5 days) vs NIV group (4.1± 2.3days; p= 0.01). There were multiple reasons for failure of assigned intervention which were comparable in both groups. These included : stridor, impaired consciousness (fall in GCS>2), haemodynamic instability, inability to clear airway, increased work of breathing, hypoxemia, respiratory acidosis. There was no mortality in either group within 48 hours of extubation. Conclusion: Among high-risk children who had undergone extubation, HFNC therapy was found to be non-inferior to NIV with respect to the re-intubation rate.

Spirometry, a gold standard technique for measuring lung functions, has been restricted to a select cohort of patients in current COVID-19 pandemic due to the enhanced risk of disease dissemination. To monitor pulmonary functions in various obstructive (e.g., asthma) and restrictive diseases (e.g., COVID-19 pneumonia) on in- and out-patients serially, there is an urgent requirement of an alternate reliable test. Impulse Oscillometry (IOS) measures lung functions by working at tidal volumes and thus reduces the risk of potential aerosol generation. Feasibility of IOS in smaller children and its ability to detect parenchymal and peripheral airway involvement are other advantages over conventional spirometry. IOS could be a potential solution to periodically monitor lung functions in current pandemic situation to keep a check on diseases affecting lung functionality.