BACKGROUND: Pediatric asthma remains a public health challenge with enormous impact worldwide. OBJECTIVE: The aim of this study was to identify and prioritize unmet clinical needs in pediatric asthma, which could be used to guide future research and policy activities. METHODS: We first identified unmet needs through an open-question survey administered to international experts in pediatric asthma who were members of the Pediatric Asthma in Real Life Think Tank. Prioritization of topics was then achieved through a second, extensive survey with global reach, of multiple stakeholders (leading experts, researchers, clinicians, patients, policy makers, and the pharmaceutical industry). Differences across responder groups were compared. RESULTS: A total of 57 unmet clinical need topics identified by international experts were prioritized by 412 participants from 5 continents and 60 countries. Prevention of disease progression and prediction of future risk, including persistence into adulthood, emerged as the most urgent research questions. Stratified care, based on biomarkers, clinical phenotypes, the children's age, and demographics were also highly rated. The identification of minimum diagnostic criteria in different age groups, cultural perceptions of asthma, and best treatment by age group were priorities for responders from low-middle-income countries. There was good agreement across different stakeholder groups in all domains with some notable exceptions that highlight the importance of involving the whole range of stakeholders in formulation of recommendations. CONCLUSIONS: Different stakeholders agree in the majority of research and strategic (eg, prevention, personalized approach) priorities for pediatric asthma. Stakeholder diversity is crucial for highlighting divergent issues that future guidelines should consider.

Allergy and Asthma Network Vienna Va; Global Allergy and Asthma Patient Platform Vienna Austria

Allergy Center CUF Descobertas Hospital Lisbon Portugal

Allergy Center CUF Descobertas Hospital Lisbon Portugal; Allergy Center CUF Infante Santo Hospital Lisbon Portugal; Chronic Diseases Research Center NOVA Medical School Faculdade de Ciências Médicas Universidade NOVA de Lisboa Lisbon Portugal

Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece

Allergy Department Hospital Infantil Universitario Niño Jesús Madrid Spain

Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh United Kingdom

Centre for Genomics and Child Health Blizard Institute Queen Mary University of London London United Kingdom

Centre of Academic Primary Care Division of Applied Health Sciences University of Aberdeen Aberdeen United Kingdom; Observational and Pragmatic Research Institute Singapore

Child Health Royal Aberdeen Children's Hospital and University of Aberdeen Aberdeen United Kingdom

CHU Lille Université Nord de France Unité de Pneumologie et Allergologie Pédiatriques Hôpital Jeanne de Flandre Lille France

Department of Allergy Helsinki University Skin and Allergy Hospital and University of Helsinki Helsinki Finland

Department of Cardiovascular and Thoracic Sciences Catholic University of the Sacred Heart Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy; National Heart and Lung Institute Imperial College London London United Kingdom

Department of Medicine and Pediatrics Penn State University Hershey Pa

Department of Paediatrics and Child Health Red Cross Children's Hospital and SA Medical Research Council Unit on Child and Adolescent Health University of Cape Town Cape Town South Africa

Department of Paediatrics Faculty of Medicine The Chinese University of Hong Kong Sha Tin Hong Kong

Department of Paediatrics Imperial College London London United Kingdom

Department of Paediatrics Turku University Hospital and University of Turku Turku Finland

Department of Pediatric Pulmonology and Allergy The Medical University Children's Hospital Warszawa Poland

Department of Pediatric Pulmonology Immunology and Intensive Care Medicine Charité University Medicine Berlin Berlin Germany

Department of Pediatrics and Medicine University of Wisconsin School of Medicine and Public Health Madison Wis

Department of Pediatrics School of Medicine Pontifical Universidad Catolica de Chile Santiago Chile

Department of Pediatrics University of Montreal Montreal QC Canada

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden; Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic; Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center of Groningen and QPS NL Groningen the Netherlands

Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden

Division of Allergy Immunology and Pulmonary Medicine Department of Pediatrics Washington University St Louis Mo

Division of Infection Immunity and Respiratory Medicine School of Biological Sciences The University of Manchester Manchester United Kingdom; Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece

Division of Infection Immunity and Respiratory Medicine School of Biological Sciences The University of Manchester Manchester United Kingdom; North West Lung Centre Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester Academic Health Science Centre Manchester United Kingdom

Division of Pediatric Pulmonology 1st Department of Pediatrics National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital Athens Greece

European Federation of Allergy and Airway Diseases Patient's Associations Brussels Belgium

Faculty of Medicine Transylvania University Brasov Romania

Family Physician Airways Group of Canada University of Toronto Toronto ON Canada

Health Planning Unit Department of Social Medicine Faculty of Medicine University of Crete Crete Greece

Laboratory of Respiratory Physiology Infant Center School of Medicine Pontifícia Universidade Católica do Rio Grande do Sul Porto Alegre Brazil

Paediatric Department 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey

Pediatric Allergy and Immunology Children's Hospital Boston Boston Mass

Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt

Pulmonology and Allergy Unity University Hospital La Fe Valencia Spain

School of Paediatrics and Child Health University of Western Australia Perth Australia

The David Hide Asthma and Allergy Research Centre St Mary's Hospital Newport Isle of Wight United Kingdom; Faculty of Medicine Clinical and Experimental Sciences and Human Development in Health Academic Units University of Southampton Southampton United Kingdom; NIHR Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton United Kingdom

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