ABSTRACT
OBJECTIVE: Severe paediatric obstructive sleep apnoea in typically developing children with adenotonsillar hypertrophy is primarily managed surgically. Non-emergency ENT surgery was paused early in the coronavirus disease 2019 pandemic and children were offered medical management for obstructive sleep apnoea. METHODS: A service evaluation was performed to assess the impact of continuous positive airway pressure alongside medical management for severe obstructive sleep apnoea. RESULTS: Over 5 months during 2020, in a tertiary care setting, two children (one boy and one girl), aged 2.7 years and 4.1 years, were offered continuous positive airway pressure and medical treatments for severe obstructive sleep apnoea whilst surgery was paused during the coronavirus disease 2019 pandemic. Both children failed to establish continuous positive airway pressure therapy because of ongoing disturbed sleep on ventilation, and they proceeded to adenotonsillectomy. Sleep-Related Breathing Disorder scale scores improved following surgical intervention. CONCLUSION: Continuous positive airway pressure therapy is poorly tolerated in children with severe obstructive sleep apnoea secondary to adenotonsillar hypertrophy. Surgery remains the most appropriate treatment.
ABSTRACT
Introduction and Objectives Asthma is a complex disease with multiple interacting factors determining individual phenotypes. We performed a service evaluation of children attending specialist paediatric respiratory clinics for their asthma at tertiary care hospital as part of routine follow up and whilst shielding according to NHS advice during the COVID 19 pandemic (March-July 2020). Method Patients and parents/guardians were asked to complete a pre-prepared series of questions about how their asthma had been affected by shielding as a part of telephone/video link follow-up consultations having shielded for between 2-5 months. Results 58 families (Male 33, Female 25) provided data. Mean age of respondents was 12 years (range 5-18 years). All families were shielding. Only one patient had been admitted for acute asthma whilst shielding. They were COVID-19 positive at the end of admission. One other asymptomatic patient was COVID-19 positive through screening. Only 11 (19%) reported being less likely to self-refer for symptoms with 6 (11%) more likely and 41 (70%) no difference. Twenty-three (40%) reported better asthma control, 10 (17%) worse asthma and 25 (43%) no different. Twenty-nine (50%) had an ACT-20 indicative of well controlled asthma. 47 (81%) were using the same or less relief medication, 40 (69%) were sleeping the same or better at night and 38 (66%) were the same or less anxious. Comparing asthma control to the same period in the previous year 28 (48%) reported better symptom control, 7 (12%) worse control and 23 (40%) no different. Reasons reported for improved asthma are shown in table 1. Reasons for the 7 with worse control included increased seasonal allergic rhinitis 3 (43%) and more indoor aeroallergen exposure 3 (43%). Thirty-one families (53%) preferred video link (attend anywhere) consultations and 11 (19%) expressed a preference for face to face appointments. Conclusion Overall severe asthmatics have experienced better symptom control during shielding. Reasons are multiple although decreased infections were identified as a cause by the majority of families. Ongoing care using video link consultations would be acceptable for the majority of families attending our service.
ABSTRACT
P120 Table 1Reasons for better asthma controlConclusionOverall severe asthmatics have experienced better symptom control during shielding. Reasons are multiple although decreased infections were identified as a cause by the majority of families. Ongoing care using video link consultations would be acceptable for the majority of families attending our service.