Pulmonary physiology is a core element of pediatric pulmonology care and research.

Introduction: Asthma is one of the most common chronic respiratory conditions worldwide and can be exacerbated by influenza. Findings from early trials demonstrated a higher risk of medically significant wheezing in otherwise healthy young children (aged 6−23 months) following administration of the Ann Arborbackbone live attenuated influenza vaccine (LAIV-AA). In more recent years, several additional studies have investigated the safety of LAIV-AA in older children (2−17 years of age) and adults with asthma or prior wheezing, but these findings have not yet been systematically evaluated. Areas covered:We conducted a systematic literature review to assess and synthesize the evidence from all available studies on the safety of LAIV-AA in people aged 2−49 years with a diagnosis of asthma or recurrent wheezing. Expert opinion:Fourteen studies over 20 years, involving a total of 1.2 million participants, provided evidence that LAIV-AA was well tolerated with no safety concerns in individuals aged 2−49 years with a diagnosis of asthma or recurrent wheezing. These data can help inform guidelines for use of LAIV-AA in children and adults with a history of asthma or recurrent wheezing.

Objective: The purpose of this manuscript is to provide an overview of evidence-based strategies designed to promote adherence to and self-management of positive airway pressure (PAP) for the treatment of pediatric obstructive sleep apnea syndrome (OSAS) with an emphasis on those who are disproportionately impacted by OSAS. Methods: Utilized four recently published review articles and a book chapter, as well as a search of the literature since the most recent scoping review was published, to identify factors impacting pediatric adherence to PAP. Proposed conceptual models for self-management and adherence were also evaluated and strategies addressing factors within the context of these models were reviewed for application. Results: Evidence-based cognitive-behavioral strategies within a bio-socioecological framework and interdisciplinary team-based model are presented. A case study highlights the application of these interventions using an interdisciplinary coordinated care model, including clinical outcome data (e.g., objective adherence measures from the PAP device). Conclusions: Existing evidence supports a family-centered interdisciplinary approach to initiating PAP and supporting long-term PAP adherence for the treatment of pediatric OSAS. A bio-socioecological framework provides structure for assessment and flexibility in which interventions, such as education, cognitive-behavioral strategies, and social support, can be tailored to the unique needs of each child and family. Implications for Impact StatementStarting and regularly using positive airway pressure (PAP) for the treatment of obstructive sleep apnea syndrome (OSAS) in children is challenging due to an interplay of medical, developmental, behavioral, social, interpersonal, and technical factors. Assessment of these factors and identification of specific challenges for an individual child and their family can provide a framework in which evidence-based strategies can be applied to improve the initiation and long-term use of PAP. Education, cognitivebehavioral strategies, and social support provided by an interdisciplinary team can be tailored to the unique needs of each child and family to facilitate acceptance and longterm use of this efficacious treatment. Melissa S. Xanthopoulos https://orcid.org/0000-0003-4093-0539 Melissa S. Xanthopoulos reports grant support from the

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