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Dysphagia is the most troublesome symptom of eosinophilic esophagitis (EoE). This study aimed to investigate oropharyngeal dysphagia in children with EoE and possible related factors. Children with a definite diagnosis of EoE were included in the study. Medical and feeding histories were recorded. A disease control level was determined for each child. An oral structure examination, the Turkish version of the Mastication and Observation Evaluation (T-MOE), the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-oz water swallow test were applied in screening for oropharyngeal dysphagia. Fifty-two children participated in the study. Oropharyngeal dysphagia took the form of abnormal swallowing (PEDI-EAT-10 score >= 4) and increased aspiration risk (PEDI- EAT-10 score >= 13) in 51.9% and 25.0% of the children, respectively. Seven children failed the 3-oz water swallow test. Abnormal swallowing and aspiration risk were significantly higher in children with prolonged mealtimes, impaired chewing function, and uncontrolled disease (p < 0.05). Chewing function was the most important risk factor for abnormal swallowing and increased aspiration (R-2 = 0.36, R-2 = 0.52, p < 0.001, respectively). Oropharyngeal dysphagia is common in children with EoE and associated with increased aspiration risk in a subpopulation. Uncontrolled disease, prolonged mealtimes, and impaired chewing function may provide clues for oropharyngeal dysphagia in EoE.

Hacer Ilbilge Ertoy Karagol, Arzu Bakirtas Department of Pediatric Allergy and Asthma, Gazi University School of Medicine, Ankara, TurkeyCorrespondence: Hacer Ilbilge Ertoy KaragolDepartment of Pediatric Allergy and Asthma, Gazi University School of Medicine, Besevler, Ankara, 06510, TurkeyTel +90 312 202 51 29Fax +90 312 212 90 16Email theilbilge@yahoo.com.auAbstract: Mild to moderate asthma makes up the greatest proportion of all asthma severities in childhood. Children who are treated with steps 1– 2 are defined as having mild asthma and step 3 as having moderate asthma, according to the guidelines. Although many studies focused on the management of severe asthma over the last decade, there have also been important changes and improvements in the management of mild to moderate asthma. In this article, new perspectives in the management of children with mild to moderate asthma will be reviewed and compared according to the two major guidelines.Keywords: asthma, mild, moderate, long-acting inhaled bronchodilators, treatment

Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident.

Mild to moderate asthma makes up the greatest proportion of all asthma severities in childhood. Children who are treated with steps 1–2 are defined as having mild asthma and step 3 as having moderate asthma, according to the guidelines. Although many studies focused on the management of severe asthma over the last decade, there have also been important changes and improvements in the management of mild to moderate asthma. In this article, new perspectives in the management of children with mild to moderate asthma will be reviewed and compared according to the two major guidelines.