Choosing Wisely: 5 Practices to Avoid in Pediatric Pulmonology and Sleep Medicine

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American Academy of Pediatrics has released a list of five practices in pediatric pulmonology and sleep medicine that clinicians should question, as part of the Choosing Wisely campaign:

• Clinicians should avoid adding new asthma therapies or stepping up to higher doses before first assessing patient adherence, appropriateness of the device, and technique with current medications.

• Long-acting beta agonist (LABA) and steroid combination therapy shouldn't be used as the initial treatment for patients with intermittent or mild persistent asthma. A LABA should be reserved for patients with moderate or severe persistent asthma.

• Nebulized medications shouldn't be administered by "blow by" — that is, placing the mask/tubing near the child's airway instead of attaching it properly. The group recommends using a t-piece with a mouthpiece or a face mask instead.

• Pediatric sleep studies shouldn't be interpreted using adult standards.

• Airway clearance therapy shouldn't be regularly used in pediatric patients with asthma, bronchiolitis, or pneumonia.