on behalf of the American Thoracic Society/ European Respiratory Society Working Group on Infant and Young Children Pulmonary Function Testing This official statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) was approved by the ATS Board of Directors, September 2006, and the ERS Executive Committee, December 2006 6. Further multidisciplinary work is required to investigate the best combination of tests (e.g., structure, function, inflammation, atopy) and challenges (e.g., pharmaceutical vs. physical) to investigate specific clinical entities during early childhood.

There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

BACKGROUND-A single family has been described in which obesity results from a mutation in the leptin-receptor gene (LEPR), but the prevalence of such mutations in severe, early-onset obesity has not been systematically examined.

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Background-Reported wheeze is the cornerstone of asthma diagnosis. Aims-To determine what parents understand by wheeze. Methods-Two studies were undertaken: (1) Parents of clinic attendees with reported wheeze (n=160) were asked by questionnaire what they understood by "wheeze" and how they knew their child was wheezy. Responses were compared to definitions of wheeze in 12 epidemiology studies and their response options. (2) The extent of agreement of parents' reports (n=139) of acute wheezing in their children and clinicians' findings of "wheeze" and "asthma" was examined. Results-(1) "Sound" and "diYculty in breathing" were perceived central to "wheeze". "What you hear" was not selected by 23% (95% confidence interval (CI) 16-30%). "Whistling" was mentioned by 11% (CI 6-15%) but featured in 11 of 12 epidemiology questionnaires. (2) There was les than 50% agreement between parents' and clinicians' reports of wheeze and asthma. Conclusions-Conceptual understandings of "wheeze" for parents of children with reported wheeze are diVerent from epidemiology definitions. Parents' reports of acute wheeze and clinicians' findings also diVer. (Arch Dis Child 2000;82:327-332)

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This study suggests that CPAP compared with ST improves ventilation in children with bronchiolitis and hypercapnoea.

Measurement of airway resistance using the interrupter technique in preschool children in the ambulatory setting. P.D. Bridge, S. Ranganathan, S.A. McKenzie. #ERS Journals Ltd 1999. ABSTRACT: This study describes the feasibility, repeatability, and interrater reliability of the measurement of airway resistance by the interrupter technique (Rint) in children 2±5 yrs of age, and examines whether reversibility to bronchodilator can be demonstrated in wheezy children.The mean of six Rint values was taken as a measurement. If subjects could complete one measurement and then a second 15 min after bronchodilator, baseline testing and reversibility testing were considered feasible. To measure repeatability, two measurements 30 s apart and measurements before and 15 min after placebo bronchodilator were compared. Measurements by two testers were compared for interrater reliability. Change in Rint in wheezy children was measured after bronchodilator.Fifty-six per cent of 2±3-yr-olds (n=79), 81% of 3±4-yr-olds (n=104) and 95% of 4± 5-yr-olds (n=88) completed baseline testing, and 53%, 71% and 91% completed reversibility testing. Baseline measurements were 0.47±2.56 kPa . Asthma is considered to reflect reversible airways disease. A precise definition his yet to be agreed. It is one of the few organic diseases where diagnosis and treatment are often made only on the parental reporting of symptoms [1], one of which is wheeze. Although there is an assumption that parents know what wheeze is, the history is sometimes vague and often there are no physical signs. In schoolchildren, reversibility of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) to bronchodilator treatment can be measured [2] so that, in cases where the history is not clear, objective measurements can be made. Changes in expiratory flow in infants in response to bronchodilator can be measured [3]. There are no readily available lung function tests suitable for children aged between 18 months and 5 yrs.The measurement of respiratory resistance in young and uncooperative subjects using the forced oscillation technique (FOT) and the interrupter technique (Rint) has been evaluated by several laboratories since the 1980s [4±7]. The simplicity of use for the patient and smaller size of the Rint device make it attractive for use in children aged 2±5 yrs in the ambulatory setting. Respiratory resistance is measured during quiet tidal breathing and requires minimal cooperation on the part of the subject.The theoretical background has been well described [5,6] along with the technical aspects in older children [7]. Although the technique has been tried in a small group of selected preschool children [6], very little has been published on the practicalities of using Rint in an ambulatory setting. In contrast to spirometry, only minimal comprehension and co-ordination are needed for Rint. This means that even acutely ill or tired children, of all ages, should be able to undertake the test successfully. There is no evidence that either bronchoco...