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New Clinical Advances in Pediatric Asthma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: 15 June 2026 | Viewed by 3005

Special Issue Editor


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Guest Editor
1. Medical Faculty, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
2. Prima Nova, Zagreb, Croatia
Interests: allergy; pulmonology; lung function; clinical trials; occupational health; sports medicine
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Special Issue Information

Dear Colleagues,

Pediatric asthma still represents a major clinical challenge in the modern medical landscape despite major research discoveries. Although inhaled steroids have been shown to be the cornerstone in clinical management, being both efficacious and safe, there is still a lot of controversy about their use in both parents and physicians. Still significant problems exist regarding diagnosis, proper choice of therapy regarding different phenotypes, the place of specific allergen immunotherapy, pulmonary rehabilitation, and biologics as the new classes of treatment in moderate to severe pediatric asthma. Low level of control, impaired lung function, and low level of physical activity all present in a significant proportion of patients with pediatric asthma can have a long-lasting impact on health in adulthood and be precursors of COPD. The most common therapeutic strategies are based on inhaled steroids, β2-agonists, muscarinic antagonists, and oral anti-leukotrienes. For the last few years, they have also been based on innovative and highly effective biological therapies with monoclonal antibodies (i.e., anti-IgE, anti-IL4Rα/IL13Rα1, Anti-IL5/IL5Rα). However, many issues are still open, and there is a need for improvement in clinical management in pediatric asthma.

The present special edition aims to describe the most up-to-date clinical advances in pediatric asthma and to outline the most promising and challenging research perspectives for the future.

Prof. Dr. Davor Plavec
Guest Editor

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Keywords

  • pediatric asthma
  • clinical management
  • treatment advances
  • diagnostic advances
  • biologic therapy
  • inhaled steroids
  • control of asthma
  • exacerbation prevention
  • quality of life

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Published Papers (3 papers)

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Review

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21 pages, 351 KB  
Review
Beyond the Usual Suspects: Unmasking Low-T2 Asthma in Children
by Iva Mrkić Kobal, Marta Navratil, Helena Munivrana Škvorc, Andrija Miculinić and Davor Plavec
J. Clin. Med. 2026, 15(2), 907; https://doi.org/10.3390/jcm15020907 - 22 Jan 2026
Viewed by 1059
Abstract
Background: T2 low asthma in children is an emerging yet underexplored endotype that challenges traditional views of type 2 inflammation. Recent data suggest that it is more prevalent than previously thought and is defined by low type 2 biomarkers, non-allergic clinical profiles, and [...] Read more.
Background: T2 low asthma in children is an emerging yet underexplored endotype that challenges traditional views of type 2 inflammation. Recent data suggest that it is more prevalent than previously thought and is defined by low type 2 biomarkers, non-allergic clinical profiles, and strong associations with modifiable comorbidities such as obesity, passive smoke exposure, and recurrent respiratory infections. This phenotype often shows a poor response to standard inhaled corticosteroid therapy and T2-targeted biologics, underscoring the urgent need for improved diagnostic and therapeutic approaches. Methods: This narrative review conducted a literature search from PubMed and WoS databases (2020–2025), focusing on T2-low asthma defined by low blood eosinophils (<150–300/µL), FeNO (<20–25 ppb), and absent atopy in children under 18. Results: This review highlights the heterogeneity of T2-low asthma, including subtypes from neutrophilic/Th 17-high to paucigranulocytic airway remodeling and metabolic driven forms, as well as diagnostic challenges from biomarker supresssion by high-dose therapies. Pragmatic phenotyping algorithms using routine tests enable identification, directing comorbidity management over ineffective biologics. Conclusions: Systematic T2-low phenotyping in pediatric practice, alongside prospective studies and non-T2 therapy trials, promises precision medicine to enhance outcomes for these children, moving beyond eosinophil-centric care. Full article
(This article belongs to the Special Issue New Clinical Advances in Pediatric Asthma)
13 pages, 540 KB  
Review
The Role of IOS in Identification of Specific Treatable Traits in Pediatric Asthma: Current Limitations and Future Perspectives—Narrative Review
by Joanna Połomska, Hanna Sikorska-Szaflik and Barbara Sozańska
J. Clin. Med. 2025, 14(20), 7368; https://doi.org/10.3390/jcm14207368 - 18 Oct 2025
Viewed by 949
Abstract
Asthma management in children aims to prevent ongoing symptoms, preserve lung function and support normal daily activities. Impulse oscillometry (IOS) represents a modern approach to evaluating lung function that is also suitable for performing in the pediatric asthma population. Further research is warranted [...] Read more.
Asthma management in children aims to prevent ongoing symptoms, preserve lung function and support normal daily activities. Impulse oscillometry (IOS) represents a modern approach to evaluating lung function that is also suitable for performing in the pediatric asthma population. Further research is warranted to clarify the role of IOS in the early identification of small airway disease (SAD) as a potential treatable asthma trait and to understand its implications for personalized treatment strategies. Before the integration of IOS into routine clinical protocols, it is necessary to establish population-specific reference values. Further studies in the pediatric population are needed to evaluate the added value of IOS in combination with conventional spirometry and fractional exhaled nitric oxide (FeNO). Future pediatric asthma management guidelines may consider incorporating the assessment of SAD with IOS as a possible tool for its evaluation. Full article
(This article belongs to the Special Issue New Clinical Advances in Pediatric Asthma)
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Other

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11 pages, 845 KB  
Systematic Review
Two-Level Meta-Analysis of Genetic and Epigenetic Markers of Asthma in Preschool Children
by Snezana Rsovac, Nadja Cukanovic, Luka Zekovic, Vesna Selakovic and Katarina Milosevic
J. Clin. Med. 2026, 15(3), 1229; https://doi.org/10.3390/jcm15031229 - 4 Feb 2026
Viewed by 535
Abstract
Background: Genetic variants within the 17q21 locus and epigenetic modifications regulating immune function have been associated with childhood asthma, yet reported effect sizes vary across studies due to methodological heterogeneity and differences in study design. Objectives: To systematically synthesize evidence on [...] Read more.
Background: Genetic variants within the 17q21 locus and epigenetic modifications regulating immune function have been associated with childhood asthma, yet reported effect sizes vary across studies due to methodological heterogeneity and differences in study design. Objectives: To systematically synthesize evidence on genetic and epigenetic markers associated with childhood asthma using a two-level random-effects meta-analysis integrating published meta-analyses and independent cohort studies. Methods: PubMed/MEDLINE and Embase were searched for studies published in English between 2011 and 2024. Eligible studies included pediatric populations with asthma or wheeze phenotypes assessing predefined genetic (ORMDL3, GSDMB) or epigenetic (AHRR, FOXP3, CpG loci) markers and reporting odds ratios (ORs) or sufficient data for their derivation. Risk of bias was assessed using established quality criteria for observational studies. Quantitative synthesis was performed using a two-level random-effects model with restricted maximum likelihood estimation. Results: Six studies comprising 51,235 children met the inclusion criteria. The overall pooled estimate demonstrated a significant association between molecular markers and childhood asthma (pooled OR = 1.45; 95% confidence interval (CI) 1.30–1.61). Subgroup analyses showed comparable effects for meta-analytic data (OR = 1.39; 95% CI 1.24–1.56) and cohort studies (OR = 1.47; 95% CI 1.31–1.64). Genetic markers yielded a pooled OR of 1.38 (95% CI 1.21–1.56), while epigenetic markers showed a pooled OR of 1.48 (95% CI 1.27–1.73). Heterogeneity in asthma definitions, methylation platforms, and limited representation of non-European populations may affect generalizability. Conclusions: This systematic review and two-level meta-analysis provides robust evidence that both genetic and epigenetic variations contribute to childhood asthma susceptibility and supports integrative multi-omic approaches for early-life risk stratification. Full article
(This article belongs to the Special Issue New Clinical Advances in Pediatric Asthma)
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