Xinying Chen

To the Editor The randomized clinical trial by Csonka et al1 evaluating valved holding chambers (VHCs) in children with acute wheezing provides important evidence addressing a common challenge in pediatric acute care, demonstrating that use of a VHC with higher in vitro drug-delivery efficiency was associated with clinically significant improvements in respiratory distress assessment instrument scores, hospitalization rates, and physiologic parameters.

Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Supporting Information Filename Description smll71991-sup-0001-SuppMat.docx3.7 MB Supporting file: smll71991-sup-0001-SuppMat.docx References 1, , , et al., “Antibiotics in Global Rivers,” National Science Open 1, no. 2 (2022): 20220029, https://doi.org/10.1360/nso/20220029.

Filename Description jcsm70164-sup-0001-Supplementary_Figures.docxWord 2007 document , 313.9 KB Figure S1: Incidence rate of cancer dependent on baseline FI. Figure S2: Association of baseline frailty status with risks of incident cancer diagnoses in stratified analyses. Figure S3: Association of changes in frailty status with risks of incident cancer diagnoses in stratified analyses.