Paediatrics

Cystic fibrosis (CF) is an area with major research activity, especially with the introduction of new therapies bolstered with good randomised controlled trials. Aerosolised antibiotics have been the mainstay of therapy for chronic Pseudomonas aeruginosa infection since Margaret Hodson's trials in the 1980s, replicated in the USA more than a decade later (if it did not happen in the USA, it did not happen!). Once daily nebulised amikacin had a good profile in a phase II trial1—but should it be reserved for atypical Mycobacterial infection? Dry powder devices are increasingly being used instead of nebulisers to try to reduce treatment burden, so an important study showed that for colomycin the two methods of delivery were equivalent.2 An accompanying editorial3 discussed how a favourite Thorax set of whipping boys, the National Institute of Health and Care Excellence, have made a dog's breakfast of their recommendations. Finally, non-CF bronchiectasis is an orphan disease, so good to see nebulised ciprofloxacin being shown to be effective in a phase II trial in this group.4 Another theme is the increasing realisation of the importance of pulmonary exacerbations (also known as lung attacks) in CF. High frequency chest wall oscillation is an expensive adjunct to airway clearance, which is much hyped at meetings. A randomised controlled trial, the winner …