Day 2 Main Conference Roundup

After a highly successful first day at the Fifth King’s John Price Paediatric Respiratory Conference - and enjoying a fifth birthday dinner at the Waldorf - delegates returned to Bush House on the morning of April 4th for the second main conference day. Following on from yesterday’s packed programme of keynote plenaries, concurrent sessions tailored to delegates interests and personal and professional sessions, Day 2 of the conference also offered delegates the opportunity to interact with the many fantastic posters of new research submitted by paediatric respiratory researchers worldwide.

Parallel Personal Practice Sessions

This morning’s personal practice sessions allowed delegates to choose one of three very different sessions. For those with an appetite for early morning statistics, a masterclass on lung function reports and consolidation of knowledge through case based discussions was a popular choice, while a professional development session sharing reflections on a career in medical education and service delivery alongside clinical work offered delegates the opportunity to explore career options with an experienced portfolio clinician. As part of the conference’s health and wellbeing strand, begun on day 1 with concurrent sessions on coaching and positive thinking for healthcare professionals, a final parallel practice session addressed the tricky topic of junior doctor burnout - presenting reasons and approaches to combating burnout through understanding the roots of the problem and practical advice.

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Keynote Plenary

Professor Stan Szefler joined us to expand upon conversations from day 1 on the use of technology in asthma care. He focused on using technology to close the communication gap between asthma practitioners, schools and parents of asthmatic children; highlighting his success with the use of an online school record communication system for improving outcomes by connecting the dots of all the environments in which an asthmatic child moves. He also discussed the importance of a yearly plan in school age children that robustly prepares them for the summer holidays, which is a risky time for asthma exacerbations. The vast amount of data produced and the need to develop machine learning and other artificial intelligence to extract meaningful data sets and conclusions from this ‘big data’ was also touched upon.

Following Prof Szefler, we heard from Professor Francine Ducharme on the risks and benefits of daily versus intermittent inhaled corticosteroids (ICS) in controlling preschool episodic wheeze. She first discussed the limitations of assessing the respiratory function of children between episodes of wheeze - asking if our detection level is low enough in preschool children, as clinicians rely on third party reporting to assess the ‘normality’ of a child’s breathing between episodes. Take home message: if there are exacerbations of wheeze but no symptoms between, treat with low dose ICS daily rather than a ‘rescue’ therapy of moderate or high dose ICS at onset of symptoms.

Concurrent Session: Asthma

With asthma mortality and morbidity in the UK lagging behind other developed countries, this indepth session took delegates through the ‘timeline’ of asthma, from the evidence for risk factors that can be modified in early life, to ensuring that the diagnosis of asthma is correct every time, to a comprehensive update on the latest developments in treatment strategies for asthmatic children. The three talks in the session all emphasised the need for a holistic approach at all stages as children move through asthma presentation, diagnosis and management; ensuring that clinical history and examination is used in conjunction with investigations, including exercise provocation, methylcholine challenges and oscillometry, in diagnosing children with asthma.

The longer talks were interspersed with poster presentations, including projects on an innovative school network for managing asthma at school; preventing admission to PICU in severe asthmatics; work from Hong Kong on the effectiveness of a smoking cessation programme in parents of children with chronic lung disease; and adrenal suppression in asthmatic children.

Concurrent Session: Cystic Fibrosis

Creative thinking in diagnosing and treating infections in patients with cystic fibrosis, as well as an update on emerging therapies, were discussed in this session aimed at clinicians with frequent contact with children with cystic fibrosis. The benefits of early diagnosis of cystic fibrosis through neonatal testing were outlined - not only on lung function, but in other, holistic areas, such as an early diagnosis increasing parental confidence in medical professionals; crucial in patients who will have multiple interactions with healthcare professionals in the course of their chronic disease. The role of air pollution in cystic fibrosis was explored, interestingly concluding that there is not a clear picture of the interaction between air pollution and poorer lung function and frequency of exacerbations in patients with cystic fibrosis.

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Concurrent Session: Other Respiratory Comments

This session covered a diverse selection of respiratory complaints that had not been fully covered elsewhere, including respiratory sequelae of obesity in children - with the revelation that if children with obstructive sleep apnoea (OSA) are non-compliant with nightly non-invasive ventilation, they should not be recommended for a provisional driving licence! Investigating and managing anatomical chest wall deformities, such as pectus excavatum and carinatum with a final talk covering the risks of air travel to children’s lungs - and if - and why - testing may be needed to avoid harm from air travel in certain demographics of paediatric patients, an extremely interesting perspective on the now-innocuous practice of travelling by plane.

Poster presentations in this session covered OSA as an independent risk factor for adult hypertension; the associations between nutrition and adverse respiratory outcomes in extremely premature infants; keeping wheezy children out of hospital where appropriate; and an exploration of subsequent respiratory exacerbations in children with post-infectious obliterative bronchiolitis.

Severe Asthma Symposium

Sponsored by GSK, one of the conference’s Gold level sponsors this year, this symposium of two speakers covered the evidence for emerging treatments in severe asthma, including use of biologics such as mepolizumab and omalizumab, with reflections on the evidence base and clinical experiences of successfully using these treatments in severe asthma.

Keynote Plenary: Respiratory Pearls

To round off a fantastic three days at the Fifth King’s John Price Paediatric Respiratory Conference four experienced paediatric respiratory clinicians were welcomed to the stage to share their experiences, insights and pearls of wisdom from their clinical lives. Professor Hans Bisgaard, lead of the extensive Copenhagen Studies on Asthma in Childhood in Denmark, opened with the provocative title of ‘From the Black Cobra Snake to the Salmon,’ a talk on the effect of the uterine and very early life environmental milieu on future risk of developing asthma and atopy, drawing on his experience with large longitudinal studies. By understanding these environmental risk factors, we can modify them - as Professor Bisgaard did in his work with supplementing pregnant mothers with fatty acids from fish oils.

Professor Steve Cunningham joined us from the University of Edinburgh to discuss RSV, including the efficacy of maternal vaccination for RSV and subsequent offspring RSV infection and severity of infection - vaccination reduces severity, but a recent large study failed to meet their primary outcome. Monoclonal antibodies have also been explored in treatment of RSV, with mixed results - difficulties include the natural history of the mutation of the RSV from season to season, and thus the pitfalls of targeting single epitopes on the RSV genome.

The pertinent topic of the effect of air pollution on paediatric respiratory disease, briefly covered earlier on in the day in one of the concurrent sessions was the focus of Professor Jonathan Grigg’s talk, who lamented the UK’s ability to measure - but not reduce - levels of air pollution. High levels of air pollution put children at risk of a reduction in lung function, development of asthma and worsening of underlying respiratory disease. Pollutants penetrate into the deepest realms of the lung, causing oxidative stress and being taken up by immune cells; even placental macrophages have been found with carbon particulates in situ.

Dr Mark Rosenthal had the considerable honor of closing the John Price Paediatric Respiratory Conference this year with his talk ‘30 Years in Paediatric Respiratory: Myths, Mistakes, Controversies and Dogma.’ Through his entertaining lecture he reflected upon the experiences he has had during his clinical practice and refuted many misconceptions in commonly held beliefs across the spectrum of paediatric respiratory disease.

Alongside the afternoon’s pearls of wisdom our winning poster abstracts were presented and discussed. Many of these abstracts were submitted by talented medical students and early career researchers, 25 of whom received bursaries to cover the cost of their attendance at the conference. All of the abstracts that were selected are available to read here: http://www.paediatricrespiratory.com/abstracts-2019

The conference closed with drinks with the fantastic view from the terrace of Bush House - still beautiful despite the inclement weather!

The conference organisers would like to thank their faculty, the team of student and junior doctor volunteers, and the catering staff who kept us fed and watered throughout the three days of the event. Most of all, they thank the delegates for giving up their valuable time for being with us and joining the conversation on how we can best serve our paediatric respiratory patients. Remember to fill in the feedback form on the conference app to receive your attendance certificate.

The conference organiser, Dr Atul Gupta, must be congratulated for organising and running such an ambitious programme with so many fantastic national and international speakers, and concurrent sessions to meet all interests. We look forward to seeing you again next year!

If you were unable to be with us this year, you can join the conversation on our Twitter feed @LondonPaedResp or by searching our conference hashtag ‘#paedresp2019.