Asthma is a chronic airways disease with both immediate and longterm health implications, including death and permanent disability.The burden of asthma, both clinical and financial, is considerable, with more than 100,000 annual hospital admissions in the United Kingdom and an overall cost of more than £1 billion per annum to the NHS. 1 A significant proportion of these costs can be attributed to children with asthma, in particular, those with severe asthma, who utilize up to 50% of healthcare resources for asthma. In addition, pediatric severe asthma has long-term health consequences into adulthood, with longitudinal studies suggesting it predisposes for adult chronic obstructive pulmonary disease. 2 If management of pediatric severe asthma can be optimized, then some of these health burdens may be mitigated.Problematic severe asthma (PSA) is an all-encompassing definition used for children aged 6-16 years with a confirmed diagnosis of asthma who have persistent symptoms despite maximal conventional therapy. 3 In order to optimize the management of children with PSA, a thorough assessment must be undertaken by the multidisciplinary team (MDT)

Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis—frank pus in the pleural space. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.