RATIONALE:The 2012 Global Lung Function Initiative (GLI) spirometry reference equations rely on race to predict pulmonary function, which may disproportionately affect diagnosis and management of respiratory conditions in certain groups. However, the impacts of newly endorsed race-neutral GLI Global equations have been understudied in pediatric populations. OBJECTIVES:To evaluate differences in percentage and severity of pediatric lung function impairments identified using the race-specific 2012 GLI equations compared to the race-neutral GLI Global equations. METHODS:Retrospective spirometry data for British Columbia Children's Hospital patients aged 5-18 years from August 2022 to June 2024 was interpreted using the race-specific and race-neutral GLI equations. Impairment severity was assessed with forced expiratory volume in 1 second (FEV1) z-scores. FEV1, forced vital capacity (FVC), and FEV1/FVC lower limits of normal were used to classify tests as normal, obstructive, suspected restrictive, or suspected mixed. RESULTS:Spirometry results from 1759 Caucasian, 44 Black, 31 North East Asian, 421 South East Asian, and 691 Other/Mixed individuals were analyzed. Compared to the race-specific, the race-neutral equations identified a mean decrease in FEV1 z-score of 0.77 (95% CI, 0.67-0.86) in the Black population, corresponding to increased impairment severity in 22.7% (95% CI, 11.5%-37.8%) of this group. In contrast, the Caucasian population showed a mean increase in FEV1 z-score of 0.36 (95% CI, 0.35-0.37), with decreased severity observed in 13.5% (95% CI, 11.9%-15.2%). Percentage of suspected restriction increased in Black individuals from 20.5% (95% CI, 9.8%-35.3%) to 43.2% (95% CI, 28.3%-59.0%) and decreased in Caucasian from 14.4% (95% CI, 12.8%-16.2%) to 9.0% (95% CI, 7.7%-10.5%). The South East Asian group experienced the largest increase in mean FEV1/FVC z-score using the race neutral equations, rising by 0.45 (95% CI, 0.44-0.46), which corresponded to a reduction in obstructive impairments from 17.1% (95% CI, 13.6%-21.0%) to 7.8% (95% CI, 5.5%-10.8%). CONCLUSIONS:The race-neutral GLI equations produced the greatest decrease in obstruction in the South East Asian population, while the largest increases in severity and suspected restriction were found in the Black population. The diagnostic and management implications of these changes will require consideration as the race-neutral equations are implemented clinically for pediatric patients.

BACKGROUND:Duchenne muscular dystrophy (DMD) is associated with impaired airway clearance and chest wall restriction, treated with lung volume recruitment (LVR) therapy. This study evaluated adherence patterns to LVR over 2 years in a cohort of boys with DMD. METHODS:Participants were included from the intervention arm of STEADFAST, a multi-centre randomized controlled trial of twice-daily LVR over 2 years in boys with DMD, 6-16 years with baseline forced vital capacity percent predicted (FVC%) ≥ 30% (Clinicaltrials. gov # NCT01999075). Adherence data were downloaded from a data logger on the LVR equipment and defined as LVR use at least daily on >50% of days. Logistic regression models evaluated associations between adherence and change in FVC%, rate of symptoms and change in quality of life (QOL) over 24 months. RESULTS:Fourteen of 33 boys (42.4%) were adherent to LVR. Among those non-adherent in the first 3 months, only one became adherent to LVR. Adherent participants tended to have lower baseline FVC % predicted than non-adherent individuals (median 77.2 (IQR (17.8) vs 89.7 (18.8) %; p = 0.08). The odds ratio for adherence was 1.02 (95% CI 0.97-1.08, p = 0.4) per unit increase in FVC%, and 0.08 (95% CI 0.001-11.7, p = 0.307) for each additional symptom/month over 24 months, adjusting for baseline age and ambulatory status. Adherence was not associated with QOL. CONCLUSIONS:Long-term LVR adherence was associated with early LVR usage pattern, but not change in lung function, symptoms or QOL. These findings underscore the importance of early support and education to promote long-term LVR adherence.

The unprecedented era of the SARS-CoV2 pandemic ushered in virtual care models as tools to promote healthcare access. To support rural and remote providers, a 24/7 on-demand service for virtual paediatric consultation via video conference, called Child Health Advice in ReaL-Time Electronically (CHARLiE), was created. The subsequent surge in paediatric respiratory illnesses during the 2022-2023 viral season resulted in an increased number of paediatric admissions for severe acute respiratory illnesses (SARIs). The impact on paediatric hospitals was profound, but data from rural and remote areas, as well as the role of CHARLiE support in the healthcare journeys of these patients, is unknown. The objective of this research is to describe the CHARLiE support pathways, clinical presentations, etiologies and outcomes for children from a geographically large and remote healthcare region during hospital admission with severe acute respiratory illnesses (SARI) in the 2022-2023 viral season. The READAPT Kids Study (clinical chaRacteristics and outcomEs of hospitAlized chilDren with Acute resPiratory infecTions) is a multisite retrospective observational cohort of children (ages 0-18 years) hospitalized with SARIs from July 1, 2022, to June 30, 2023. This dataset is a subset of the wider READAPT Kids cohort and includes data from the largest tertiary Paediatric Intensive Care Unit (PICU) in the province, plus three regional hospitals within a single health authority, which spans a geographical area of over 600,000 square kilometers. Cases were identified using ICD-10-CA codes, then manually screened for inclusion criteria. Detailed clinical, demographic, and home postal code data was extracted. In a separate dataset, all contact with the CHARLiE service over the same time period was tracked and linked to the READAPT cohort through unique personal health numbers. There were 204 distinct admissions for SARI to 3 regional hospitals within this health authority. The median patient age was 2.12 years, 38% (78/204) were female, many had a chronic comorbid condition and 75% (153/204) had a virus (Table 1). The most common diagnoses were asthma (37%; 75/204) and bronchiolitis (35%; 72/204). The median hospital length of stay was 2 days (1- 4), and 27% (55/204) were admitted for more than 4 days. 10 patients required transfer to the tertiary paediatric hospital and one child died prior to transfer (Table 2). Of the 204 SARI admissions, 57% (116/204) were either admitted to, or lived within a rural or remote community, representing the cohort eligible for CHARLiE support. Of this group, 14% (16/116) had contact with CHARLiE at one point between 72 hours prior to admission and 72 hours after discharge. From the tertiary care hospital cohort, a total of 237 patients were admitted with a SARI directly to the PICU. 65% (155/237) of these direct PICU admissions were transferred from another hospital and 14% (22/155) resided within the corresponding rural and remote health authority described. 54.5% (12/22) of these patients were transferred from community hospitals or nursing stations not captured in the health authority dataset. 36% (8/22) of this rural residing cohort that were admitted to PICU also had contact with CHARLiE during this period. CHARLiE supported almost 40% of direct PICU admissions for SARI from within a single, geographically vast, rural and remote health authority region. This patient population has a significant disease burden and length of stay within the regional centres, which highlights the ongoing need for paediatric care services, close to where patients live. Providing virtual, real-time expert paediatric advice, the CHARLiE service is a crucial resource for the rural providers who care for these patients.

Sleep disorders are prevalent in children and are associated with behavioral and neurocognitive impacts when left untreated. A recently identified sleep-related movement disorder, restless sleep disorder (RSD), is characterized by frequent body movements during sleep resulting in daytime impairment. RSD is diagnosed based on clinical symptoms as well as objective evidence of restless sleep on an overnight polysomnogram and improves with iron supplementation. Despite the frequent comorbidity of sleep disruption among children with neurodevelopmental disorders, there is a paucity of data assessing the association between RSD and neurodevelopmental disorders. Thus, we sought to evaluate the association between RSD and neurodevelopmental disorders in children. This is an interim analysis of a retrospective study of children aged 6-18 years old who completed a baseline diagnostic polysomnogram at British Columbia Children’s Hospital between December 2023 – May 2024. Polysomnogram data was evaluated for large muscle movements according to the International Restless Legs Syndrome Study Group standards. Neurodevelopmental disorders were classified according to the DSM-5. There were 150 children (median age = 11 years, females = 57/154 (38.0%) and 57/150 (38.0%) had a neurodevelopmental disorder. In total, there were 23/150 (15.3%) children with RSD, 48/150 (32.0%) with moderate or severe obstructive sleep apnea, and 2/150 (1.3%) with restless legs syndrome. Of the children with neurodevelopmental disorders, 5/57 (8.8%) had RSD whereas 18/93 (19.4%) children without a neurodevelopmental disorder were found to have RSD (p = 0.081). Children with a neurodevelopmental disorder were more likely to receive iron supplementation (18% of children with neurodevelopmental disorders vs 3.9% of children without neurodevelopmental disorders; p=0.012), which may confound the results. In this interim analysis, we did not find an association between neurodevelopmental disorders and RSD. However, children with neurodevelopmental disorders were more likely to receive iron supplementation, which may confound our results. Data collection is ongoing to better elucidate this relationship. Ultimately, the results of this study will examine the association between neurodevelopmental disorders and RSD to inform the need for the routine assessment of RSD in children with neurodevelopmental disorders. We thank the BC Children’s Hospital Research Institute for providing funding.

RATIONALE: The 2012 Global Lung Function Initiative (GLI) spirometry reference equations rely on race to predict pulmonary function. Updated 2023 American Thoracic Society/European Respiratory Society guidelines now recommend race-neutral GLI Global equations to mitigate issues with the lack of a standardized race definition, the clinical implications of disproportionate spirometry standards between racial groups, and the overrepresentation of Caucasian populations in the equation derivation. While Black adults show improved interpretations with the race-specific equations compared to race-neutral, the inverse is found in Caucasian populations. However, these impacts remain understudied in children and non-Black populations of color. Here, we evaluate the differences in percentage and severity of pediatric lung function impairments identified using the race-specific compared to race-neutral GLI equations. METHODS: Retrospective spirometry data and self-identified race for BC Children's Hospital patients aged 5-18 years from August 2022 to June 2024 were interpreted using the race-specific and race-neutral GLI equations. Impairment severity was assessed with forced expiratory volume in one second (FEV1) z-scores. FEV1, forced vital capacity (FVC), and FEV1/FVC lower limits of normal were used to classify tests as normal, obstructive, suspected restrictive, or suspected mixed. RESULTS: Spirometry results from 1759 Caucasian, 44 Black, 31 North East Asian, 421 South East Asian, and 691 Other/Mixed individuals were analyzed. Compared to the race-specific, the race-neutral equations identified increased impairment severity in 22.7% (95% CI, 11.5%-37.8%) of Black and 3.3% (95% CI, 1.8%-5.5%) of South East Asian individuals. Decreased severity was found in 13.5% (95% CI, 11.9%-15.2%) of Caucasian and 16.1% (95% CI, 5.5%-33.7%) of North East Asian individuals, with fewer changes in the Other/Mixed group. Percentage of suspected restriction increased in Black individuals from 20.5% (95% CI, 9.8%-35.3%) to 43.2% (95% CI, 28.3%-59.0%) and decreased in Caucasian individuals from 14.4% (95% CI, 12.8%-16.2%) to 9.0% (95% CI, 7.7%-10.5%) using the race-neutral equations. Among the South East Asian group, percentage of obstructive impairments decreased from 17.1% (95% CI, 13.6%-21.0%) to 7.8% (95% CI, 5.5%-10.8%), corresponding to a decreased proportion meeting asthma diagnostic criteria from 6.9% (95% CI, 4.2%-10.6%) to 3.6% (95% CI, 1.8%-6.6%). CONCLUSION: Compared to the race-specific, the race-neutral GLI equations produced the largest increase in severity and suspected restriction in the Black population, while the greatest decrease in obstruction was found in the South East Asian population. The diagnostic and management implications of these changes to spirometry interpretation will require consideration as the race-neutral equations are implemented clinically for pediatric patients.

Objectives To explore the implementation of a provincial virtual paediatric consulting service, Child Health Advice in Real-Time Electronically (CHARLiE), integrated into the paediatric on-call schedule in Northwestern British Columbia.Methods Healthcare providers in Northwestern British Columbia responded to a survey (n = 72) and participated in focus groups (n = 35) and key informant interviews (n = 4) to share their experiences engaging in a healthcare model that incorporated virtual paediatric consultants in lieu of in-person local paediatrician coverage over a 28-month period. Survey data was analyzed using descriptive statistics. Themes were generated from a qualitative descriptive approach to focus groups and key informant interview transcripts.Results 96.1% of survey respondents who had used CHARLiE rated it as 'good' or 'very good' in the provision of overall support, while 77.6% reported that CHARLiE improved access to paediatric care. Focus group and key informant interview participants valued CHARLiE's timely, dedicated virtual bedside assessments of patients; collegiality and professionalism; amelioration of local paediatrician burnout; prevention of unnecessary transfers; and offloading of indirect patient care tasks. Video support improved provider confidence and appeared to improve caregiver trust. Suggested improvements included addressing technological barriers, enhancing providers' knowledge of local resources, and enabling continuity of care. Participants identified that virtual care does not replace on-the-ground specialist care.Conclusions Participants valued CHARLiE's 24/7, timely, and collegial video support. While maintaining a full complement of on-the-ground paediatricians remains the goal for some rural communities, dedicated virtual support provides access to paediatric care in smaller communities, thereby improving health equity for children in British Columbia.

Iron deficiency (ID) and restlessness are associated with sleep/wake-disorders (e.g., restless legs syndrome (RLS)) and neurodevelopmental disorders (attention deficit/hyperactivity and autism spectrum disorders (ADHD; ASD)). However, a standardized approach to assessing ID and restlessness is missing. We reviewed iron status and family sleep/ID history data collected at a sleep/wake behavior clinic under a quality improvement/quality assurance project. Restlessness was explored through patient and parental narratives and a ‘suggested clinical immobilization test’. Of 199 patients, 94% had ID, with 43% having a family history of ID. ADHD (46%) and ASD (45%) were common conditions, along with chronic insomnia (61%), sleep-disordered breathing (50%), and parasomnias (22%). In unadjusted analysis, a family history of ID increased the odds (95% CI) of familial RLS (OR: 5.98, p = 0.0002, [2.35–15.2]), insomnia/DIMS (OR: 3.44, p = 0.0084, [1.37–8.64]), and RLS (OR: 7.00, p = 0.01, [1.49–32.93]) in patients with ADHD, and of insomnia/DIMS (OR: 4.77, p = 0.0014, [1.82–12.5]), RLS/PLMS (OR: 5.83, p = 0.009, [1.54–22.1]), RLS (OR: 4.05, p = 0.01, [1.33–12.3]), and familial RLS (OR: 2.82, p = 0.02, [1.17–6.81]) in patients with ASD. ID and restlessness were characteristics of ADHD and ASD, and a family history of ID increased the risk of sleep/wake-disorders. These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors.

To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation.

Introduction:Motivated by challenges faced in outpatient sleep services for mental health and neurodevelopmental disorders (MHNDD) during the COVID-19 clinical shutdown, a pan-Canadian/international working group of clinicians and social scientists developed a concept for capturing challenging sleep and wake behaviours already at the referral stage in the community setting.Methods:In a quality improvement/quality assurance (QIQA) project, a visual logic model was the framework for identifying the multiple causes and possible interventions for sleep disturbances. Intake forms informed clinicians about situational experiences, goals/concerns, in addition to the questions from the Sleep Disturbances Scale for Children (SDSC), the ADHD Rating Scale-IV and medication history. Descriptive statistics were used to describe the sample.Results:66% of the pilot study patients (n = 41) scored in the SDSC red domains (highest scoring) with highest sub-scores for insomnia (falling asleep 73%; staying asleep: 51%) and daytime somnolence (27%). A total of 90% of patients were taking at least one medication; 59% sleep initiation/sleep medications, 41% in combination with further non-stimulant medications, 9% with stimulants, 27% with antidepressants and 18% with antipsychotics. Polypharmacy was observed in 62% of all patients and in 73% of the ones medicated for sleep disturbances. Qualitative information supported individualisation of assessments.Conclusion:Our intake process enabled a comprehensive understanding of patients' sleep and wake profiles prior to assessment, at the referral stage. The high prevalence of insomnia in patients, combined with polypharmacy, requires special attention in the triaging process at the community level.

To examine the association between multiple measures of socioeconomic status (SES) and objectively measured obstructive sleep apnea (OSA) in a Canadian pediatric population. This was a cross-sectional study of 188 children (4–17 years, mean age 9.3 ± 3.5 years) prospectively recruited from two hospital sleep clinics in Canada, using multivariable-adjusted linear and logistic regression of five measures of SES including parental education, income, social class, geographic location, and perceived SES based on the MacArthur Scale of Subjective Social Status, assessed in relation to four polysomnographic OSA variables including apnea-hypopnea index, apnea index, mean oxygen saturation level, and oxygen desaturation index. Overall, low household-level SES appeared to be associated with both frequency (apnea index ≥ 1 events/h) and severity (apnea-hypopnea index ≥ 5 events/h) of OSA in children, with maternal education showing the most consistent and significant associations. Specifically, children with mothers reporting less than high school education had nearly three times the odds of having OSA after controlling factors including body mass index (odds ratio 2.96 [95

Background: For hospitalized children admitted outside of a critical care unit, the location, mode of death, "do-not-resuscitate" order (DNR) use, and involvement of palliative care teams have not been described across high-income countries. Objective: To describe location of death, patient and terminal care plan characteristics of pediatric inpatient deaths inside and outside the pediatric intensive care unit (PICU). Design: Secondary analysis of inpatient deaths in the Evaluating Processes of Care and Outcomes of Children in Hospital (EPOCH) randomized controlled trial. Setting/Subjects: Twenty-one centers from Canada, Belgium, the United Kingdom, Ireland, Italy, the Netherlands, and New Zealand. Measurement: Descriptive statistics were used to compare patient and terminal care plan characteristics. A multivariable generalized estimating equation examined if palliative care consult during hospital admission was associated with location of death. Results: A total of 365 of 144,539 patients enrolled in EPOCH died; 219 (60%) died in PICU and 143 (40%) died on another inpatient unit. Compared with other inpatient wards, patients who died in PICU were less likely to be expected to die, have a DNR or palliative care consult. Hospital palliative care consultation was more common in older children and independently associated with a lower adjusted odds (95% confidence interval) of dying in PICU [0.59 (0.52-0.68)]. Conclusion: Most pediatric inpatient deaths occur in PICU where patients were less likely to have a DNR or palliative care consult. Palliative care consultation could be better integrated into end-of-life care for younger children and those dying in PICU.

Background Impaired cough results in airway secretion retention, atelectasis and pneumonia in individuals with Duchenne muscular dystrophy (DMD). Lung volume recruitment (LVR) stacks breaths to inflate the lungs to greater volumes than spontaneous effort. LVR is recommended in DMD clinical care guidelines but is not well studied. We aimed to determine whether twice-daily LVR, compared with standard of care alone, attenuates the decline in FVC at 2 years in boys with DMD. Methods In this multicentre, assessor-blinded, randomised controlled trial, boys with DMD, aged 6-16 years with FVC >30% predicted, were randomised to receive conventional treatment or conventional treatment plus manual LVR twice daily for 2 years. The primary outcome was FVC % predicted at 2 years, adjusted for baseline FVC % predicted, age and ambulatory status. Secondary outcomes included change in chest wall distensibility (maximal insufflation capacity minus FVC) and peak cough flow. Results Sixty-six boys (36 in LVR group, 30 in control) were evaluated (median age (IQR): 11.5 years (9.5-13.5), median baseline FVC (IQR): 85% predicted (73-96)). Adjusted mean difference in FVC between groups at 2 years was 1.9% predicted (95% CI -6.9% to 10.7%; p=0.68) in the direction of treatment benefit. We found no differences in secondary outcomes. Conclusion There was no difference in decline in FVC % predicted with use of twice-daily LVR for boys with DMD and relatively normal lung function. The burden associated with routine LVR may outweigh the benefit. Benefits of LVR to maintain lung health in boys with worse baseline lung function still need to be clarified.

Introduction and Objectives South Asian individuals living with asthma in the UK are more likely to experience excess morbidity and increased hospitalisation rates than any other ethnic group. Prevention is an integral part of self- management (Pinnock, 2015). Failure to adhere to prescribed regimens is common amongst this population. This study investigated people's experiences with asthma, including medication adherence, the use of non-pharmacological treatment approaches, and the healthcare professional (HCP)-patient relationship in asthma healthcare. Methods Using a qualitative approach, fourteen adults (12 female, 2 male, aged between 18–50) who identified as South Asian with a diagnosis of asthma (at least step 2 of the BTS guidelines) took part in semi-structured interviews. Interpretative phenomenological analysis (IPA) was used, informed by a symbolic interactionist (SI) perspective; a micro level theoretical framework which suggests that society is shaped and upheld by social interaction and explores how people make sense of their social world (Carter & Fuller, 2015). Results Four themes were developed, focusing on how the asthmatic identity is negotiated, managing medications, seeking non-pharmacological treatments, and the HCP-patient relationship (see figure 1). Despite suffering acute exacerbations, participants questioned whether they identified as asthmatic, which impacted their decision to use preventative medication. Cultural identity was linked to traditional treatments and medication adherence. Characteristics of developing a therapeutic relationship with HCPs were described, including patient involvement and mutual respect. This involved having open discussions on the use non-pharmacological treatments which were linked to participants' cultural identity, illustrating the HCP's desire to be culturally responsive. Conclusions HCP's should consider an explorative approach to consultation, to develop a culturally aware, therapeutic relationship and consider negotiation in prescribing. This could enhance the patients' ability to self-manage, and reduce resistance to advice and guidance from HCPs. Cultural identity is an important aspect of treatment and should be discussed to develop mutual care objectives between HCP and patient, to establish a therapeutic relationship.

AbstractPurposeTo describe a series of children with extensive PNF or treatment refractory PLGG treated on a compassionate basis with trametinib.MethodsWe report on six patients with NF‐1 treated with trametinib on a compassionate basis at British Columbia Children's Hospital since 2017. Data were collected retrospectively from the patient record. RAPNO and volumetric criteria were used to evaluate the response of intracranial and extracranial lesions, respectively.ResultsSubjects were 21 months to 14 years old at the time of initiation of trametinib therapy and 3/6 subjects are male. Duration of therapy was 4–28 months at the time of this report. All patients had partial response or were stable on analysis. Two patients with life‐threatening PNF had a partial radiographic response in tandem with significant clinical improvement and developmental catch up. One subject discontinued therapy after 6 months due to paronychia and inadequate response. The most common adverse effect (AE) was grade 1–2 paronychia or dermatitis in 5/6 patients. There were no grade 3 or 4 AEs. At the time of this report, five patients remain on therapy.ConclusionTrametinib is an effective therapy for advanced PNF and refractory PLGG in patients with NF‐1 and is well tolerated in children. Further data and clinical trials are required to assess tolerance, efficacy and durability of response, and length of treatment required in such patients.

Severity of illness scores may introduce or perpetuate bias when used to ration or prioritize intensive care. Using an economic framework that accounts for both demand and supply{side pathways, we nd direct physiology to be the relevant driver of intensive care utilization. A deeper implication and key take{away is that (i) including treatments and diagnosis in severity scores provides a channel to perpetuate bias in the triage process and (ii) evidence of this bias is drawn from unobserved patient{level factors working from both demand and supply{side directions.

Abstract OBJECTIVE Refractory symptomatic plexiform neurofibromas (PNF) and inoperable refractory low grade gliomas (LGG) pose a clinical challenge that may be life threatening. Phase 1 and 2 clinical trials of MEK inhibition with selumetinib in inoperable PNF and LGG have demonstrated promising results in pediatrics, however access has been limited to enrollment on clinical trial. Phase 1 clinical trial for trametinib a MEK 1 and 2 inhibitor has been completed, publication is pending. Thus we have treated a series of children on a compassionate basis with extensive PN or LGG refractory disease with trametinib, as this is available in Canada. METHODS We have treated children with trametinib on a compassionate basis in our province since 2017. Review of the clinical data regarding this therapy has been IRB approved. RESULTS Two young patients were treated for indication of life threatening extensive PNF and have had tumor shrinkage and improvement of clinical status. Treatment has been complicated by paronychiae, eczema exacerbation, chondrodermatitis nodularis helicis, RSV and influenza B infection and CTCAE grade 2 pneumonia. In spite of the side effects these two patients remain on treatment due to clear benefit from therapy including: improved respiratory compromise, hearing and dysphagia. We will present the data of additional patients treated with trametinib. CONCLUSION Trametinib is an effective therapy for life threatening PNF by changing the natural history of tumor growth in young children. Further data is required in terms of tolerance, efficacy and durability of response in such patients in the setting of clinical trials.

Journal of Paediatrics and Child HealthVolume 56, Issue 1 p. 165-167 Instructive Case Bronchial casts Ajay Kevat, Corresponding Author Ajay Kevat ajay.kevat@cw.bc.ca orcid.org/0000-0001-9881-6478 Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, CanadaCorrespondence: Dr Ajay Kevat, Division of Respiratory Medicine, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 0B3, Canada. Fax: +1 604 875 3293; email: ajay.kevat@cw.bc.caSearch for more papers by this authorDavid Wensley, David Wensley Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada Division of Critical Care, British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorOanu Popescu, Oanu Popescu Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorMichael Seear, Michael Seear Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, CanadaSearch for more papers by this author Ajay Kevat, Corresponding Author Ajay Kevat ajay.kevat@cw.bc.ca orcid.org/0000-0001-9881-6478 Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, CanadaCorrespondence: Dr Ajay Kevat, Division of Respiratory Medicine, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 0B3, Canada. Fax: +1 604 875 3293; email: ajay.kevat@cw.bc.caSearch for more papers by this authorDavid Wensley, David Wensley Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada Division of Critical Care, British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorOanu Popescu, Oanu Popescu Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, CanadaSearch for more papers by this authorMichael Seear, Michael Seear Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, CanadaSearch for more papers by this author First published: 02 August 2019 https://doi.org/10.1111/jpc.14587Citations: 2 Conflict of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume56, Issue1January 2020Pages 165-167 RelatedInformation