Recent advances in pediatric pulmonology: Articles of interest to fellows. Azithromycin for preschool wheezing, combined maternal RSV immunization and infant nirsevimab, and oscillometric assessment of small-airway dysfunction.

Recent advances in pediatric respiratory medicine continue to refine preventive strategies, therapeutic decision-making, and physiological assessment. This review highlights three recent publications of particular interest to pediatric pulmonology fellows. First, we discuss a multicenter randomized trial demonstrating that azithromycin does not improve outcomes in preschool children presenting to the emergency department with moderate-to-severe wheezing, despite effectively eradicating respiratory bacterial colonization. Second, we review an interim randomized trial showing that combined maternal respiratory syncytial virus (RSV) vaccination and infant nirsevimab appear safe and elicit robust antibody responses, with no evidence of immune interference. Finally, we summarize evidence that impulse oscillometry can detect subclinical small-airway dysfunction in children with well-controlled asthma despite normal spirometry. Together, these studies highlight the growing importance of evidence-based prevention, antimicrobial stewardship, and precision respiratory assessment in pediatric practice.