The variability in symptom control is a challenging feature of asthma that necessitates careful monitoring and the need to step-up and step-down individualized therapeutic regimens over time. This stepwise concept in asthma therapy can be considered in at least three contexts. For lack of control that is persistent over long periods of time, an increase in the overall medication or a “step-up long-term (SLT)” is indicated. A second approach, “step-up short-term (SST)”, may be utilized during a temporary loss of acceptable control, such as at the onset of a viral respiratory tract illness. In these cases, a step-up in therapy is usually terminated in 3–10 days once asthma control has been satisfactorily achieved. Finally, for treating symptoms related to the variability of asthma on a day to day basis, ICS used concomitantly with a beta agonist has been evaluated, though not currently approved in the United States. We will term this particular intervention as “step-up intermittent (SUI).” Here we summarize the existing data regarding these three approaches to step-up care, step-down management, as well as identify areas where more comparative studies are necessary to provide further guidance to clinicians regarding proper step-up and step-down strategies in the care of asthma.

Summary The association of early onset wheezing with common viral and bacterial infections has raised significant interest in the role of infections in childhood asthma inception. This article serves to review these relationships among infections, host factors, and asthma inception in childhood.

Background: Non-invasive positive airway pressure (PAP) therapy is used to treat children with sleep-disordered breathing. Effective management requires good adherence. In response to the problem of reduced adherence over time, a pilot study using ventilators equipped with technology to remotely monitor home adherence was undertaken.Methods: From July 2019, children requiring PAP therapy consented for remote monitoring. Data collected included ventilator usage, apnea-hypopnea index (AHI), and mask leak. Parents were contacted on Days 14, 42, and 90 post-establishment. A proforma was used to assess parental understanding and ways to improve therapy adherence. A parental feedback questionnaire was completed on Day 90 of the study.Results: Median nightly PAP usage over 90-day post-establishment was 6.58 h (interquartile range: 2.47-8.62); 60% of patients met criteria for good adherence (>4 h for >70% of nights). There was a decrease in median nightly usage in Week 1 (6.92 h) versus Week 12 (6.15 h), p = 0.04. Mask leak was higher in Week 1 (17.7 L/min) versus Week 12 (14.7 L/min), p = 0.053. There was no significant difference in AHI between Week 1 (2.7/h) versus Week 12 (2.3/h), p = 0.75. 45% of questionnaire respondents felt active remote monitoring positively influenced PAP usage, whilst 84% reported overall satisfaction with PAP therapy. Conclusions:Remote monitoring technology has the potential to guide adjustments in PAP therapy, monitor and improve adherence in children, and reduce the burden of hospital-based review. Preliminary work shows high approval from parents.

Previous reports associating raised LH concentrations with reduced fertilization and pregnancy rates in women undergoing in-vitro fertilization (IVF) have assumed a Gaussian distribution of LH values with IVF treatment. We have determined the serum LH range during ovarian stimulation for I V F with a single regimen of clomiphene citratei hMG from 102 consecutive IVF conception cycles. T h e results show a non-Gaussian distribution of LH values. Application of this LI1 range to a consecutive series of 596 women undergoing IVF treated with this single regimen showed no difference in pregnancy rates, fertilization rates, median number of oocytcs fertilized or retrieved whcn analysed with respect to serum LH concentrations above the 75th o r 95th centile for 3 3 days of an IVF treatment cycle. We conclude that follicularphasc LH concentrations do not predict IVF fertilization rates or clinical outcome and are not clinically useful in individual patient management It has bccn reported that follicular-phase concentrations of serum or urinary luteinizing hormone (LH) can predict fertilization and pregnancy rates in women undergoing ovarian stimulation fur in-vitro fertilization (TVF) (Stanger Rr Yovich 1985; Howles f t al. 15186). It was suggested that both the fertilization rate of mature oocytcs and the subsequent pregnancy rate were reduced in women whose LH con-

No abstract