In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and

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... allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies. @ERSpublications Highlights from the Paediatrics Assembly at the #ERSCongress 2020 https://bit.ly/3ptcnFr Although neonatal care has evolved dramatically in the last 30 years, few data exist on respiratory function of preterm neonates in adult life. This was the focus of several studies in the oral presentations session of the paediatric respiratory physiology and sleep group. BÅRDSEN et al. [1] studied three population-based cohorts (1982-1985, 1991-1992 and 1999-2000) of young adults born extremely preterm (gestational age <28 weeks) and compared them with adults born term by performing spirometry at the age of 18 years. Subjects born extremely preterm had significantly lower forced expiratory volume in 1 s (FEV 1 ) z-scores at the age of 18 years; however, significant improvement of the respiratory function of the subjects born extremely preterm was noted over the three decades. MARSOL et al. [2] investigated lung function trajectories of 109 children born preterm with body plethysmography, bronchodilator test and spirometry at the ages of 4, 5 and 6 years and compared these with lung function of children born at term. Even though lung function in subjects born prematurely was lower at birth, no differences were noted during preschool years, suggesting a catch-up of lung function in this group of children born prematurely. MAHMOUD et al. [3] investigated whether mode of delivery can influence respiratory outcomes during the first year of life. In this study, 580 full-term infants born by caesarean section (140 babies) or vaginal delivery (440 babies) performed multiple breath washout (MBW) measurements, tidal breathing measurements and were monitored for respiratory rate and symptoms during the first year of life. Children born by caesarean section did not have higher rates of respiratory symptoms in the first year of life. There were no differences in MBW or overall lung function between the two groups either. During this same oral session, FOUZAS et al. [4] presented their findings on the pattern of FEV 1 variability in healthy children and adolescents. In total, 92 children aged 6-18 years performed spirometry twice per day for 3 months. They showed that as age increased, the detrended fluctuation analysis of lung function (DFA) α exponent, an index of a person's lung function variability, decreased, and sample entropy of FEV 1 was elevated. These findings point to an increased adaptability of the respiratory system especially through adolescence. KENTGENS et al. [5] investigated whether volumetric capnography (VCap) can reflect ventilation inhomogeneity. In their study, MBW and VCap measurements from 63 healthy children and 50 children with cystic fibrosis (mean age 9.9 years) were evaluated. They found that obtaining capnographic indices (CII) derived by VCap is feasible, and CII showed a significant correlation with lung clearance index (LCI) in children with cystic fibrosis (r 2 =0.42; p<0.001). Thus, VCap seems promising as an indicator of ventilation inhomogeneity but further studies are needed to reveal its minimal methodological requirements along with its true clinical value. Affiliations: