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The diversity of pathology of severe paediatric asthma demonstrates that the one-size-fits-all approach characterising many guidelines is inappropriate. The term “asthma” is best used to describe a clinical syndrome of wheeze, chest tightness, breathlessness, and sometimes cough, making no assumptions about underlying pathology. Before personalising treatment, it is essential to make the diagnosis correctly and optimise basic management. Clinicians must determine exactly what type of asthma each child has. We are moving from describing symptom patterns in preschool wheeze to describing multiple underlying phenotypes with implications for targeting treatment. Many new treatment options are available for school age asthma, including biological medicines targeting type 2 inflammation, but a paucity of options are available for non-type 2 disease. The traditional reliever treatment, shortacting β2 agonists, is being replaced by combination inhalers containing inhaled corticosteroids a
Usual interstitial pneumonia (UIP) is characterised by a distinctive morphological
and radiological appearance that was considered the pathognomonic hallmark of idiopathic
pulmonary fibrosis (IPF). However, this peculiar lung remodelling pattern is also
seen in other fibrotic interstitial lung diseases, including hypersensitivity pneumonitis,
and connective tissue diseases. In this Personal View, we advocate the designation
of a UIP pattern as a single, discrete diagnostic entity, amalgamating its primary
form and secondary processes in disorders such as hypersensitivity pneumonitis (hypersensitivity
pneumonitis with UIP), rheumatoid arthritis (rheumatoid arthritis with UIP), and others.