Matti Korppi

Background: Childhood risk factors, such as bronchiolitis, have been associated with airway obstruction later in life. However, assessing childhood risk factors for airway obstruction in adulthood requires long follow‐ups with carefully gathered data. Our long‐term follow‐up represents lung function in early adulthood after infant bronchiolitis with evaluation of asthma and tobacco smoke exposure as childhood risk factors. Methods: We prospectively followed 166 term children hospitalized for bronchiolitis under 6 months of age. Lung function was measured at the mean age of 18.3 years by spirometry on 72 former bronchiolitis patients and 28 controls. We compared z‐scores of FEV1 (forced expiratory volume in first second), FVC (forced vital capacity), and FEV1/FVC before and after bronchodilation. Reversibility was tested as FEV1 change in the bronchodilation test. The roles of asthma and smoke exposure were controlled in the analysis. Results: FEV1/FVC was lower in cases versus controls at baseline (mean z ‐score −0.90, SD 1.40 vs 0.10 SD 1.17; p = 0.001) and after bronchodilatation (0.54, SD 1.06 vs. −0.05, SD 1.22; p = 0.028). FEV1 increase in the bronchodilation test was greater in cases versus controls (6.3%, SD 5.3 vs. 2.3%, SD 3.7; p = 0.001). After excluding subjects with current asthma, the differences remained significant in baseline and post‐bronchodilator FEV1/FVC and in FEV1 change in bronchodilation test, and after adjusting for previous asthma and household smoking, the differences remained significant in baseline and post‐bronchodilator FEV1/FVC. Conclusion: Lower FEV1/FVC after bronchodilation in cases suggests a risk of irreversible obstructive lung function in young adults after infant bronchiolitis.

Background: Wheezing illnesses, especially those triggered by rhinovirus infection, cause a major disease burden, and they often precede asthma. Environmental exposures are known to affect recurrence of wheezing. We investigated the relations of population density, greenness (forested areas), and socioeconomic factors of the living surroundings to the burden of asthma in children with prior bronchiolitis. Methods: Three hundred and ninety‐four children, aged 0–24 months, with doctor‐diagnosed bronchiolitis were enrolled in the MARC‐30 Finland study. We assessed the children's early‐life exposures to greenness and socioeconomic factors using time‐series of Corine Land Cover data and Statistics Finland's grid data. We compared the living surroundings data to the prescription drug purchases and special asthma reimbursement benefits until the age 8 years; asthma data were from the Social Insurance Institution of Finland. Results: Children living in sparsely populated areas had lighter asthma disease burden than children living in densely populated ones, with burden measured in median bronchodilator (50DDD [defined daily dose] vs. 104DDD, p = 0.02) and inhaled corticosteroid (0DDD vs. 123DDD, p = 0.04) purchases. In the subgroup of children with rhinovirus‐induced bronchiolitis, children living in more forested areas developed asthma 10 months later than those with less forested areas ( p = 0.04). Neighborhood socioeconomic characteristics were not associated with differences in asthma burden. Conclusions: Sparsely populated areas and forested environments seem to have a beneficial association with children's respiratory health. These findings warrant further studies on the protective health effects of greenness and the type of biodiversity around homes.

Aim: We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014–2020. Data were compared before and after updated guidelines in 2018.Methods: The study comprised data on 45 296 children aged 2–17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics. We measured compliance with the updated 2018 Finnish guidelines, which recommended amoxicillin or amoxicillin‐clavulanic acid for children under 12 years old, with doxycycline as an alternative for 12 years plus.Results: There were 6621–7585 visits per year for acute sinusitis in 2014–2019 and 2954 in 2020. Antibiotics were prescribed for 37.9%–41.6% of patients during the study years. Amoxicillin, including penicillin, accounted for 35.9% of prescriptions, followed by amoxicillin‐clavulanic acid (26.9%). Macrolides accounted for 20.6% and, encouragingly, decreased by 38% from 2014–2019. Doxycycline accounted for 5.3%. Paediatricians, general practitioners (GPs) and ear, nose and throat specialists followed the guidelines in 75.1%, 73.8% and 66.7% of cases, respectively. GPs prescribed antibiotics more often than other physicians.Conclusion: Antibiotics were prescribed for about 40% of acute sinusitis visits by Finnish children from 2014–2019. Specialities differed with regard to prescribing rates and whether they followed the guidelines.

Aim: This study aimed to evaluate antibiotic prescriptions for children with otitis media (OM) in a large nationwide network of private clinics between 2014 and 2020. Special focus was paid to amoxicillin and amoxicillin-clavulanic acid prescriptions, which the national guidelines recommend for first-line drugs. We also focused on macrolides, which are commonly prescribed for respiratory tract infections in children but are not appropriate for OM cases. Methods: The data were obtained from the electronic health records of about 250,000 annual visits in <18 years old children. The collected variables were all diagnoses, age, visit year, doctor’s specialty, and prescribed antibiotics. Children with OM and upper respiratory tract infections were included, but those with lower respiratory tract infections were excluded. Results: The number of children with OM was 357,390 (55.2% boys). Antibiotics were prescribed in 44.8% of cases, with the lowest proportion (44.1%) being in <2 years old children. The overall prescription rate decreased from 48.3% in 2014 to 41.4% in 2020. The rates were 19.3% and 18.1% for amoxicillin and 12.6% and 13.2% for amoxicillin-clavulanic acid, respectively. Macrolide prescriptions were reduced from 7.5% to 3.5%. Pediatricians prescribed antibiotics for 38.8%, general practitioners for 54.0% and ear, nose and throat physicians for 39.8% of children with OM. Conclusion: The selection of antibiotics for OM, when prescribed, was according to the recommendations (amoxicillin or amoxicillin-clavulanic acid) in 80.1% of pediatricians, 67.0% of general practitioners and 55.1% of ear, nose and throat physicians.