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Objectives: Respiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations., Design: Cross-sectional study., Setting: We analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England., Participants: Children 5-12 years., Interventions: None. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma., Primary and Secondary Outcome Measures: We describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children., Results: 83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5-11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children., Conclusion: We showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A 14-year-old girl had experienced gross peripheral oedema for nearly 2 years. She was under review by several paediatric specialists for a variety of problems. Her local paediatric team were unable to find the cause of her oedema, despite extensive investigations. Eventually, her mother discovered the cause was inhaled fluticasone, prescribed at normal dosage for asthma. As far as the authors are aware, this is the first reported case of peripheral oedema associated with the use of fluticasone. Peripheral oedema is a rare side-effect of fluticasone in the form of either seretide or flixotide. Physicians should be aware of this possibility in cases of resistant peripheral oedema with no other identified cause.