INTRODUCTION: Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted. METHODS AND ANALYSIS: Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence. ETHICS AND DISSEMINATION: Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank. PROSPERO REGISTRATION NUMBERS: CRD42020132990, CRD42020171624.

1st Department of Pediatrics Aghia Sofia Children's Hospital University of Athens Athens Attica Greece

3rd Department of Paediatrics National and Kapodistrian University of Athens School of Health Sciences Athens Greece

Acute Intensive Care Unit University Hospital of South Manchester NHS Foundation Trust Manchester Greater Manchester UK

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

Allergy and Asthma Global Patient Platform Virginia Virginia USA

Allergy and Asthma VN Chennai India

Allergy and Clinical Immunology Transylvania University Brasov Romania

Allergy Asthma and Immunology Penn State University Hershey Pennsylvania USA

Allergy Center CUF Infante Santo Hospital Lisbon Portugal

Allergy Center Hospital CUF Descobertas Lisboa Portugal

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

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

Athens Breath Centre Athens Greece

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

Centre of Academic Primary Care University of Aberdeen Aberdeen UK

Chronic Diseases Research Center NOVA Medical School Faculdade de Ciências Médicas Universidade NOVA de Lisboa Lisbon Portugal

Department of Allergy Immunology and Pulmonary Medicine University of Washington Seattle Washington USA

Department of Allergy University of Helsinki Helsinki Uusimaa Finland

Department of Biomedical Sciences University of West Attica Egaleo Attica Greece

Department of Cardiovascular and Thoracic Sciences Catholic University of the Sacred Heart Milano Lombardia Italy

Department of Child Health University of Aberdeen Aberdeen Aberdeen UK

Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center of Groningen and QPS NL Groningen Netherlands

Department of Paediatrics and Child Health Red Cross War Memorial Children's Hospital University of Cape Town Rondebosch Western Cape 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 UK

Department of Paediatrics University of Turku Turku Finland

Department of Pediatric Pulmonology and Allergy Medical University of Warsaw Warszawa Poland

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

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

Department of Pediatrics Pontifical Universidad Catolica de Chile Santiago Chile

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund Hematological Clinic Lund Skåne Sweden

Department of Respiratory Medicine and Department of Pediatric Pulmonology University of Amsterdam Amsterdam Netherlands

Department of Social Medicine Faculty of Medicine University of Crete Rethimno Greece

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

Division of Infection Immunity and Respiratory Medicine The University of Manchester Manchester UK

Faculty of Medicine Clinical and Experimental Sciences and Human Development in Health Academic Units University of Southampton Southampton UK

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

Institute of Infection and Global Health University of Liverpool Liverpool UK

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

National Heart and Lung Institute Imperial College London London UK

NIHR Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK

North West Lung Centre Manchester University NHS Foundation Trust Manchester UK

Observational and Pragmatic Research Institute Singapore

Paediatric Department Motol University Hospital Praha Czech Republic

Pediatric Allergy and Asthma Unit Hacettepe Universitesi Ankara Turkey

Pediatric Allergy and Immunology Children's Hospital Boston Boston Massachusetts USA

Pediatric Allergy and Immunology Unit Ain Shams University Cairo Egypt

Pediatrics University of Montreal Montreal Quebec Canada

Pulmonology and Allergy Unity La Fe University and Polytechnic Hospital Valencia Comunidad Valenciana Spain

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

The David Hide Asthma and Allergy Research Centre St Mary's Hospital Newport Isle of Wight UK

Unit on Child and Adolescent Health Medical Reaserch Council Cape Town South Africa

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

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