Pediatric Pulmonology 2024 Year in Review: Asthma

Children with asthma account for a large share of pediatric pulmonology patients, with global pediatric asthma prevalence estimated at 9.1%. In this Pediatric Pulmonology Year in Review, we aim to highlight and summarize publications on pediatric asthma that were published in the year 2024. Our aim was to focus on publications that may impact clinical practice, although we recognize that all publications may not apply to every practitioner. We also acknowledge that we as authors are unable to properly highlight every publication of clinical relevance on pediatric asthma. Any exclusions do not necessarily indicate a lack of relevance but rather a limitation of space. Articles on pediatric asthma were reviewed if they were published in 2024. After articles were collected, the authors reviewed the selections to determine if they had potential to impact the clinical care of pediatric patients with asthma. The final selection of publications was then grouped into themes to help orient the readers to areas of interest. In this review, we will highlight publications on Diagnosis and Monitoring, Treatment and Management, Environmental and Social Factors, Genetics and Biomarkers, and Innovative Programs and Health Policy. We hope this review will spark discussions on current clinical practices, as well as inspire future work on relevant topics. Pediatric Pulmonology 2024 Year in Review: Asthma Andre Espaillat, MD, MPH, Meera Jairath, DO, and Ceila E. Loughlin MD *The authors contributed equally to this work. The University of North Carolina School of Medicine, Department of Pediatrics, Chapel Hill, North Carolina, USA **Corresponding Author Andre Espaillat, MD MPH 450 MacNider Building 333 S. Columbia Street, CB #7217 Chapel Hill, NC 27599 USA (P): 904-521-6323 Email: [email protected] Purpose and Contribution: This 2024 Pediatric Pulmonology Year in Review highlights publications in the field of pediatric asthma across multiple medical journals. Our aim is to discuss publications that pediatric pulmonologists can reference in their daily clinical practice, as well as spark discourse for future research in the field. Word Count: 4225 Funding Information: Submission of this publication was supported by the National Institutes of Health/ National Heart, Lung, and Blood Institute under award number T32HL166141 (AE). Pediatric Pulmonology 2024 Year in Review: Asthma Andre Espaillat, MD, MPH, Meera Jairath, DO, and Ceila E. Loughlin MD The University of North Carolina School of Medicine, Department of Pediatrics, Chapel Hill, North Carolina, USA Children with asthma account for a large share of pediatric pulmonology patients, with global pediatric asthma prevalence estimated at 9.1% 1 . In this Pediatric Pulmonology Year in Review, we aim to highlight and summarize publications on pediatric asthma that were published in the year 2024. Our aim was to focus on publications that may impact clinical practice, although we recognize that all publications may not apply to every practitioner. We also acknowledge that we as authors are unable to properly highlight every publication of clinical relevance on pediatric asthma. Any exclusions do not necessarily indicate a lack of relevance but rather a limitation of space. Articles on pediatric asthma were reviewed if they were published in 2024. After articles were collected, the authors reviewed the selections to determine if they had potential to impact the clinical care of pediatric patients with asthma. The final selection of publications was then grouped into themes to help orient the readers to areas of interest. In this review, we will highlight publications on Diagnosis and Monitoring, Treatment and Management, Environmental and Social Factors, Genetics and Biomarkers, and Innovative Programs and Health Policy. We hope this review will spark discussions on current clinical practices, as well as inspire future work on relevant topics. Diagnosis and Monitoring Diagnosing and treating asthma early in young children remains a challenge and therefore an ever-growing field for pediatric pulmonologists. Multiple studies have explored new methods of diagnostic testing and disease monitoring to improve asthma management. Meoli and colleagues explored the use of impulse oscillometry (IOS) as a diagnostic tool for asthma in preschool-aged children given their inability to perform spirometry reliably 2 . The objective of their study was to use IOS to identify optimal thresholds for a positive bronchodilator response (BDR) test in preschoolers with suspected asthma. The authors conducted a retrospective analysis of 36 preschool-aged children (3–6 years old) with suspected asthma who met appropriate quality standards for both IOS and spirometry before and after bronchodilator administration. They assessed traditional IOS BDR thresholds, such as a ≥40% decrease in resistance at 5 Hz (R5) or ≥50% increase in reactance at 5 Hz (X5) but found these were not well-aligned with spirometry-defined BDR (FEV1 increase ≥12% or ≥200 mL). Using a receiver operator characteristic (ROC) curve analysis, the study identified optimal IOS thresholds of R5 decrease ≥ 26% and X5 increase ≥ 26%, with corresponding Areas Under the Receiver Operating Characteristic Curves (AUROCC) of 0.77 and 0.75, respectively. Based on these findings, the authors recommend implementing a 26% decrease in R5 and a 26% increase in X5 as an objective and clinically relevant IOS threshold for diagnosing bronchodilator responsiveness in preschool children. This study was limited by the use of a small sample size and a population with highly variable spirometry measurements to define appropriate IOS values. Larger prospective studies that could limit this measured variability would help validate the proposed IOS values. Cleves et al. aimed to determine whether FeNO levels correlate with adherence to inhaled controller therapy in children with asthma 3 .The authors conducted a cross-sectional study involving 82 patients with asthma (5–18 years old) at Hospital Militar Central in Bogota, Colombia. They assessed therapeutic adherence using the Pediatric Inhaler Adherence Questionnaire (PIAQ), defining adequate adherence as “perfect inhaled corticosteroid use over the past 15 days.” Asthma control was evaluated using the Asthma Control Test (ACT) or Childhood ACT (cACT). FeNO levels were measured, and a Poisson regression model was applied to identify factors associated with adherence. The study found that 68.3% of participants reported adequate adherence, which was associated with FeNO levels below 20 ppb (Relative Risk = 1.5, 95% Confidence Interval: 1.03–2.19, p = 0.04). This suggests that lower FeNO levels may indicate better adherence to inhaled corticosteroid therapy in pediatric patients with asthma. This study was limited by its cross-sectional design, small sample size, and reliance on self-reported adherence, which may overestimate actual medication use. Due to inconsistencies in FEV1 measurements in pediatric patients, Filipow et al. investigated this variability to better understand its implications for monitoring symptomatically well controlled patients with asthma 4 . The authors conducted a retrospective analysis using data from five longitudinal studies involving 881 children with symptomatically well-controlled asthma. The study assessed paired FEV1 measurements when asthma symptoms were controlled at 3 months intervals, over 6 to 12 months. The variability of FEV1 was expressed using three methods: FEV1% predicted, FEV1 z-scores, and conditional z-scores for change (Zc). The analysis of 5,184 paired FEV1 measurements showed an expected variation range in repeated measurements in FEV1% from -20% to +21%. Regression to the mean and increased variability were observed in younger children for FEV1% and FEV1 z-scores, but not for Zc. The study concluded that due to the wide variability in FEV1 measurements, asthma treatment should primarily be guided by symptoms rather than changes in spirometry. Notable limitations of this study include its retrospective design based on secondary data. In addition, some of the results (especially in younger participants) may simply reflect a natural tendency for extreme scores to regress towards the mean over time, which may impact the applicability of findings to clinical practice. Treatment and Management The use of high-flow nasal cannula has become commonplace to treat pediatric respiratory conditions like bronchiolitis and pneumonia. Recent data has also shown an increase in use for HFNC for asthma exacerbations with conflicting data supporting its utility 5,6 . Two studies this year from Rogerson et al. looked at the use of HFNC in asthma exacerbations 7,8 . The first study is a retrospective case-control study comparing clinical outcomes for severe acute asthma (SAA) in children treated with high-flow nasal cannula (HFNC) to matched controls treated primarily with oxygen facemask. The cohort was sampled from a single quaternary care academic children’s hospital between the years 2015 and 2022. They found that patient encounters that used HFNC were associated with longer PICU and hospital length of stay (LOS), as well as slower improvement in physiologic signs including heart rate, respiratory and pediatric asthma symptom score (PASS). The authors postulated this increased LOS may be due to impaired delivery of nebulized medications through HFNC and noted that the use of HFNC and continuous albuterol required distinct weaning protocols with PICU admission at their institution. Even with the limitations of a retrospective, single center study observational study, the results suggest the need for prospective randomized control trials to determine if HFNC has benefits for the treatment of SAA or if it should be excluded from treatment. The second study by this group is also a retrospective observational study, however the authors utilized the Virtual Pediatric Systems (VPS) database to examine institutional practice differences in respiratory support devices used in status asthmaticus 8 . The study included 77,115 patient encounters for children older than 2 years admitted to 163 VPS intensive care units. There was notable variation in the type of respiratory support used and PICU LOS between institutions. Higher volume institutions were more likely to use CPAP or non-invasive bilevel positive pressure ventilation (NIV) and less likely to use HFNC or invasive mechanical ventilation (IMV). Time in the hospital was significantly increased with the use of HFNC. A major limitation in this study was the lack of data on medication use during the admission, which is known to vary widely between institutions, and may also impact the course of the asthma admission. Sielinou Kamgang et al. conducted a cohort study evaluating the association between inhaled corticosteroid (ICS) use and the risk of hospitalization for pneumonia 9 . Previous adult clinical studies suggest an increased risk of pneumonia for patients with asthma and COPD on ICS 10,11 . However, meta-analyses of randomized controlled trials in children (11,615 patients, 31 trials) found there was no difference in the risk of pneumonia between placebo and ICS groups 12 . This study evaluated 425,965 Swedish children with confirmed asthma using nationwide data from routine clinical practice between January 2007 through November 2021. They used pharmacy dispense records to identify 2 groups “episodes of new ICS use” (249,351) and “no use” (214,840). With a median follow-up time of 1 year, the authors found no association between ICS use and risk of hospitalization for pneumonia. A major limitation of this study was using dispense history for the definition of exposure to ICS as it does not account for actual adherence to dispensed medications. Despite this limitation, the findings of this study are consistent with previous RCT and observational studies in children investigating secondary effects of ICS use, and may be helpful for the clinician providing counseling to patients and families when initiating or continuing ICS therapy for their asthma. Telemedicine is increasingly being used to enhance care for high risk and low resourced populations. Halterman et al. enrolled over 380 children 5 years and older, who presented to two different Emergency Departments (ED) for asthma using a school-based telemedicine-based program (TEAM-ED) 13 . The goal of the program was to enhance delivery of evidenced based care and improve follow-up with a primary care physician. They compared the intervention group to an enhanced usual care group (eUC), which received similar reminders for follow up visits without telemedicine encounters. The program had a 68% participation rate, and the study period crossed the COVID-19 pandemic. When analyzing the entire study period, no significant difference was noted for the primary outcome of symptom free days (SFD); however, children enrolled in the TEAM-ED group prior to the pandemic did show significant improvement. The TEAM-ED group also reported more use of preventative medication at 3 months and completion of a follow-up appointment with their primary care provider. The program was less effective for children exposed to smoke in the home, which may suggest more intensive interventions are necessary for this cohort. While this study used an established school-based telemedicine program, the increased use of telemedicine since the pandemic provides a framework for other groups to implement similar programs at their own institutions. Genetics and Biomarkers Pediatric pulmonologists have a wide range of tools, diagnostic tests, and validated symptom surveys to assess the degree of asthma control in their patients. Innovative biomarkers to assess control of symptoms would allow for less reliance on subjective measurements during a clinical visit. Khamas et al. aimed to assess if exhaled breath volatile organic compounds (VOCs) can be used as a marker for disease control in pediatric asthma 14 . Children aged 6-17 years old with a physician-confirmed diagnosis of asthma were enrolled from three European cohorts. Initially, VOCs were identified in the SysPharmPediA cohort and then validated in the U-BIOPRED and PANDA cohorts. The authors identified three compounds in their exploratory analysis: acetophenone, ethylbenzene, and styrene. After identification, these VOCs were trained on a set of patients within SysPharmPediA and then tested on a separate group of patients within the same cohort. This initial training set was found to have an AUROCC of 0.83 (95% CI, 0.65–1.00) and the test set had an AUROCC of 0.77 (95% CI, 0.58–0.96). This equated to a sensitivity of 0.90 and 0.82 within the test set to discriminate between controlled and uncontrolled asthma. One notable strength of this study was the inclusion of multiple cohorts with variable ethnicities across four different European countries. A limitation is the observational design used in this study, and future work may look at more experimental and/or prospective methods to discriminate asthma control in a clinical setting. MicroRNAs (miRNAs) are non-coding RNAs that can influence and regulate gene expression through suppression of target mRNAs. Previous work has shown that miRNA expression may help predict severe asthma exacerbations and thus be a useful biomarker 15 . Wong et al. hypothesized that these miRNAs may be a predictor of increased SABA use 16 . To test this hypothesis, children aged 6-14 years old were recruited from the Genetics of Asthma in Costa Rica study (GACRS) between 2001 and 2011. Small RNA sequencing was performed on 1159 serum samples that were collected at the time of asthma phenotypic assessment. 21 unique miRNAs showed a significant association with SABA use; 15 were associated with increased usage while 6 were inversely associated. A further analysis assessed the association between these miRNAs and bronchodilator response. The authors found miR-378a-3p and miR-144-3p were statistically significant for both associations, however increasing expression of miR378a-3p showed less bronchodilator response, whereas miR-144-3p showed increased bronchodilator response. The authors postulated that these different findings may be due to patients having a sub-therapeutic effect from bronchodilators or may indicate room for increased controller therapy. This study was limited by its inclusion of a small cohort of Costa-Rican children, and further work to determine if these miRNAs are present in other populations would increase applicability to a general population. Serum genetic analyses using miRNA to differentiate between bronchodilator responders has the potential to provide useful information for practitioners when trying to determine optimal medication regimens for asthma control. Imaging modalities, such as high-resolution computed tomography (HRCT), provide a potential mechanism to assess severe asthma that avoids invasive diagnostic modalities such as bronchoscopy or bronchial biopsy. De Fillipo et al. aimed to develop a machine learning analysis model to identify features most indicative of severe asthma in children 17 . Children aged 6-17 with severe asthma were included if they had a HRCT performed as part of their routine clinical assessment (n=20). A control group with children of the same age were included if they had no history of asthma or respiratory symptoms (n=21). The authors identified six radiologic features present in severe asthma and not in controls: bronchial thickness score, AWT%, bronchiectasis grading and severity score, mucus plugging, and centrilobular emphysema. Machine learning also identified AWT% and bronchial thickness scores as the most significant discriminators of disease severity. Most notably, AWT% \(\geq\)39 and <38 differentiated severe asthmatics and controls. For participants with measurements between this range, bronchial thickness in the right upper lobe provided further differentiation. This study was limited by its single center retrospective design. Additionally, differentiation was only performed between severe asthmatics and healthy respiratory controls, and future work should aim to be prospective with participants who have variable asthma severity classifications. Despite these limitations, the potential for objective measurements with machine driven calculations in HRCT could provide earlier diagnoses and more targeted therapy for children with severe asthma. Environmental and Social Factors Social determinants of health (SDoH) and routine environmental exposures may confound the delivery of care to children with asthma. Fitzpatrick et al. aimed to determine the differences in characteristics between groups of children that perceived their symptoms correctly versus those that had an altered perception 18 . Altered perception was defined as a discordance between symptom questionnaires and elicitation of symptoms by a medical provider. Three hundred and seventy-one (371) children aged 6 to 18 years old were provided a 6-item Asthma Control Questionnaire (ACQ) to determine asthma symptom control. A licensed medical provider then classified each enrollee as controlled or uncontrolled if symptoms occurred more or less than 2 days per week. Fifty-four children (15%) were noted to have incongruent ACQ and provider assessments and subsequently labeled as having “altered symptom perception”. Children with altered symptom perception were similar to children with questionnaire and provider congruent uncontrolled asthma. They had higher healthcare utilization, increased prescriptions for controller medication, and lower lung function. Additionally, these children were more likely to identify as a race other than white, have more hospitalizations, and more intubations when compared to both symptom congruent controlled and uncontrolled groups. The altered perception group was also noted to live in zip codes with a lower overall Child Opportunity Index (COI), reflecting reduced scoring across education, health and environment, and social and economic domains. The combination of altered symptom perception, increased healthcare utilization, and lower neighborhood opportunity are more examples of the complex interaction of the environment and asthma. This study highlights a potential group of patients that could be identified through symptom screening and provider cross-examination. Altered symptom perceivers could then be highlighted for more specialized multi-disciplinary care. Combating social determinants of health in asthma care requires creative programs that help mitigate the external factors that may worsen disease. One type of program is school-supervised asthma therapy (SST), where medications are delivered to patients at schools they regularly attend. Al-Halbouni et al. sought to explore the relationship between SDoH and SST through qualitative interviews of receivers (patients, families), deliverers (physicians, school nurses), and system-level partners (practice managers, school leadership, pharmacists, public health and health insurance officials) 19 . Participants in Asthma Link, a school-based partnership program for children with poorly controlled asthma in Massachusetts, were enrolled between the years 2017-2020 for a total of 52 participant interviews. Two authors used an inductive approach to code responses into relevant themes and subthemes. The three major themes from participants were 1) SST mitigates adverse SDoH, 2) SST benefits children experiencing specific adverse SDoH, and 3) Specific adverse SDoH interferes with SST implementation. These major themes show that SST can help children that suffer from underlying SDoH, however, there are also SDoH that can impair implementation of this type of school-based program. These barriers include limited health literacy, cultural/language barriers, and financial constraints to provide medication. Targeting these barriers would optimize participation and uptake of this type of intervention. It is important to note these barriers can also extend into regular clinical practice and may provide targetable interventions that can help improve asthma care. Asthma incidence differs between different racial and ethnic groups. Gaffney et al. aimed to identify changes and plot the trajectory of asthma prevalence amongst different racial/ethnic groups 20 . The authors aggregated three national datasets from 2015 to 2021: Behavioral Risk Factor Surveillance System Child Asthma Call-Back Survey, pooled National Children’s Health Surveys, and pooled data from the National Inpatient Sample. Using population denominators from the Census Bureau’s 2018-2019 American Community Survey, cumulative asthma prevalence and hospitalization rates were calculated annually through 17 years of age. When compared to White children, Black children and Hispanic children were diagnosed 0.9 years and 0.79 years earlier respectively (p<0.01). Children with families that had household yearly incomes between $15,000 and $25,000 were diagnosed 0.9 years before similar children who lived in households with greater than $50,000 yearly income. The authors also noted that Black children had a sharp increase in asthma prevalence early in life that plateaued after 9 years old. Hispanic children demonstrated an “intermediate” growth trajectory in asthma prevalence, however by adolescence, their prevalence was similar to White children. Disparities in asthma hospitalizations mirrored those in prevalence early in life; however, relative hospitalization disparities between Black and White children persisted and widened in the first decade of life. This study highlights racial/ethnic disparities that clinicians are likely to encounter in their practice, as well as how early the divergence in prevalence and hospitalizations occur for different groups of children. Continued work assessing the impact of in-utero or early life exposures such as genetic variability, maternal exposures, or early viral exposures may provide insight into the disparity we see in this study and in clinical practice. Ryan et al. sought to assess whether the legacy of historical redlining might explain the persistent disparities in asthma observed in clinical practice today 21 . Redlining is the historical practice used by the Home Owners’ Loan Cooperation (HOLC) of drawing neighborhood level boundaries around “unacceptable” areas/neighborhood for home mortgages. These “redlined” neighborhoods were deemed Grade D “hazardous” and were predominantly inhabited by Black families 22 . The authors collected data from children with asthma (n = 4,839) who participated in the Children’s Respiratory and Environmental Workgroup (CREW) consortium. Birth data was geocoded to census-level tracts and historical HOLC maps that were used for redlining. Black and Hispanic children were noted to reside in Grade C “declining” or Grade D “hazardous” HOLC tracts more than half of the time. White children were noted to be in these tracts less than 17% of the time. When organized by census-tract HOLC categories, Category C and D tracts had significantly higher percentage of low-income households, lower median household income, higher unemployment percentage, higher percent without a high school diploma, and higher social vulnerability index (SVI). It is important to note that the authors did not find significant direct effects of HOLC tract designations on asthma. However, there was a significant indirect effect of higher odds ratio of asthma when accounting for percentage of low-income households, median household income, percentage of population without a high school diploma, and SVI. The authors concluded the primary drivers for the increased risk of asthma in these cohorts were mediated by neighborhood level poverty leading to a higher level of vulnerability. This work adds to previous works describing the impact of SDoH and neighborhood level poverty on asthma disparities 23 . It poses a larger call to action by providers to acknowledge these external factors that can impact patient care, and work with families to accomplish shared goals in their child’s health. Innovative Programs and Health Policy As described in the previous section, there are multiple risk factors and underlying social determinants that require creative solutions to improve asthma care. One solution to combat these variables includes using community health workers (CHW) to assist families and children with asthma navigate appropriate care. In a low income, poorly resourced community in Philadelphia, Pennsylvania, Bryant-Stephens et al. hypothesized that better asthma control can be achieved with CHW assistance across schools and clinics, versus either setting alone 24 . To test this hypothesis, children aged 5-13 years old with a previous asthma exacerbation requiring steroids or emergency department visits were recruited for randomization. Using a 2x2 factorial design, patients were randomized to one of six groups: a combination of CHW school and clinic programs, CHW school or clinic program, or no CHW school and clinic program. Recall of symptom free days, as well as electronic health data at 3-month intervals, were used to track asthma control. They enrolled 626 patients who identified as primarily black race (96%) and were insured by Medicaid (87%). All randomized groups had their greatest absolute improvement in asthma control scores at 3 months, and all groups showed statistically significant improvements at 12 months. However, when improvements in intervention groups were compared against each other, there was no significant difference in improvement in asthma control scores. Unfortunately, this study overlapped with the COVID-19 pandemic, which led to limitations in the ability to optimize CHW school-based interventions. A sub-analysis of participants that completed the study prior to the pandemic showed a statistically significant improvement in asthma control scores for the CHW school and clinic group when compared to usual care (−0.79; 95%, CI −1.4 to−0.18). Taken as a whole, this integrated school and clinic community health worker model is a feasible methodology to bridge social factors that may impair appropriate asthma control and care. Given the statistically significant improvement in the intervention group prior to the COVID-19 pandemic, it would be reasonable to pursue further studies validating this intervention without the confounding effects of a pandemic. As described earlier in this review, Al-Halbouni et al. showed financial constraints and access to controller medications were a sub-theme for impairments to success of a school-based therapy program. Johnson et al. examined if eliminating out of pocket costs for asthma medications could increase medication adherence and decrease excessive reliever therapy in children and adults 25 . The authors used a policy change in Fair PharmaCare, a universal drug plan in British Columbia, Canada, to test this hypothesis. Changes to the benefit structure in 2019 led to elimination of copayments and 100% drug coverage for the lowest income group (<$13,750). Prior to this change, the lowest income group was responsible for a 30% copayment up to a household maximum of 2%. Patients included in the study were diagnosed with asthma and received their first dispensed maintenance therapy within the 2-year window prior to the policy change. Cases were defined as patients in the lowest income group who experienced the change in their pharmacy benefits, and controls were defined as patients in the $45,000–$61,667 income bracket who did not have a change in their pharmacy benefit reimbursement. The mean age for this cohort was 30.3 years; however, children made up 3,206 (24.7%) and 20,738 (29.1%) of cases and controls, respectively. Overall, when out of pocket costs were removed from patients/families, children were noted to have an increase in filling prescriptions for ICS-containing medications relative to other asthma medications (7.26%; 95% CI, 0.24% to 14.28% vs 3.72%; 95% CI, 0.40% to 7.04% in adults) and a larger proportion of ICS and leukotriene receptor antagonists (LTRA) to total medications (9.46%; 95% CI, 0.70% -18.21% vs 5.43%; 95% CI, 1.59% to 9.27% in adults). There was also a decrease in refills for reliever therapy after the policy change, however this did not meet statistical significance. The association between higher drug costs and increased cost-sharing for families may contribute to reduced asthma medication disbursement, suggesting that policy interventions could play a role in improving adherence and asthma control. This 2024 review highlights significant contributions from international researchers across multiple domains of asthma care. There continues to be innovative and novel mechanisms for monitoring and diagnosing asthma, and the prospect of more precise genetic phenotyping may provide further insight into the diversity of asthma presentations. The persistent correlation between social determinants of health and asthma morbidity underscores the need for targeted interventions. Addressing these variables is essential, as they can undermine the effectiveness of diagnostic tools and therapeutic strategies. The future of asthma care remains dynamic, and we look forward to following its continued evolution in the years ahead. https://ncrc.org/holc/ 1. Yuan L, Tao J, Wang J, et al. 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High flow nasal cannula use is associated with increased hospital length of stay for pediatric asthma. Pediatric Pulmonology . 2023;58(11):3046-3053. doi:10.1002/ppul.266176. Pilar J, Modesto I Alapont V, Lopez-Fernandez YM, Lopez-Macias O, Garcia-Urabayen D, Amores-Hernandez I. High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study. Medicina Intensiva . 2017;41(7):418-424. doi:10.1016/j.medin.2017.01.0017. Rogerson C, Abusultaneh S, Sanchez‐Pinto LN, et al. A matched analysis of the use of high flow nasal cannula for pediatric severe acute asthma. Pediatric Pulmonology . 2024;59(12):3457-3466. doi:10.1002/ppul.272338. Rogerson CM, White BR, Smith M, et al. Institutional Variability in Respiratory Support Use for Pediatric Critical Asthma: A Multicenter Retrospective Study. Annals of the American Thoracic Society . 2024;21(4):612-619. doi:10.1513/annalsats.202309-807oc9. Sielinou Kamgang K-H, Rhedin SA, Almqvist C, Wintzell V. Use of inhaled corticosteroids and the risk of hospitalisation for pneumonia in children with asthma: a nationwide cohort study. Thorax . 2024;79(5):395-402. doi:10.1136/thorax-2023-22074210. Calverley PMA, Anderson JA, Celli B, et al. Salmeterol and Fluticasone Propionate and Survival in Chronic Obstructive Pulmonary Disease. New England Journal of Medicine . 2007;356(8):775-789. doi:10.1056/nejmoa06307011. McKeever T, Harrison TW, Hubbard R, Shaw D. Inhaled Corticosteroids and the Risk of Pneumonia in People With Asthma. Chest . 2013;144(6):1788-1794. doi:10.1378/chest.13-087112. Cazeiro C, Silva C, Mayer S, Mariany V, Wainwright CE, Zhang L. Inhaled Corticosteroids and Respiratory Infections in Children With Asthma: A Meta-analysis. Pediatrics . 2017;139(3):e20163271. doi:10.1542/peds.2016-327113. Halterman JS, Fagnano M, Tremblay P, Butz A, Perry TT, Wang H. 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Annals of the American Thoracic Society . 2024;21(11):1542-1549. doi:10.1513/annalsats.202402-130oc Information & Authors Information Version history Peer review timeline Published Pediatric Pulmonology Version of Record28 Nov 2025Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection

Authors Metrics & Citations Metrics Article Usage 393views 172downloads Citations Download citation Andre Espaillat, Meera Jairath, Ceila Loughlin. Pediatric Pulmonology 2024 Year in Review: Asthma. Authorea. 26 August 2025. DOI: https://doi.org/10.22541/au.175622778.85120767/v1 DOI: https://doi.org/10.22541/au.175622778.85120767/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu.