ArticleMultidisciplinary respiratory medicine2026
Delphi Consensus of the Italian Society of Pediatric Allergy and Immunology (SIAIP) on the management of severe asthma in children and adolescents.
Article in Multidisciplinary respiratory medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSevere asthma affects approximately 3-5% of the pediatric asthmatic population and is associated with substantial clinical, economic, and psychosocial burdens. Despite major advances in biological therapies, standardized guidance for their optimal use in children and adolescents remains limited.
objectiveTo establish experts' consensus on the management of severe pediatric asthma through a Delphi process promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), with particular focus on biological therapy selection, monitoring, and response assessment.
methodsA modified Delphi process involving 50 pediatric asthma experts was conducted. Twenty-seven statements addressing epidemiology, pathophysiology, biomarkers, biological therapies, monitoring strategies, and response definitions were developed through iterative rounds. Consensus was defined as ≥80% agreement (scores 4-5 on a 5-point Likert scale).
resultsAll 27 statements achieved consensus (agreement range: 82-100%; mean scores: 4.1-4.9). Complete consensus was reached on key issues, including the need for endotype-based therapy selection, the predominance of type 2 inflammation in severe pediatric asthma, the role of currently available biological therapies (omalizumab, mepolizumab, dupilumab, tezepelumab), multidimensional response assessment (clinical, functional, and biological), and the importance of patient and family engagement. Strong consensus also supported the use of Core Outcome Measures for Severe Asthma (COMSA) for monitoring, classification of responders/super-responders /non-responders, and the predictive value of selected biomarkers, including blood eosinophil counts (≥300 cells/µL), FeNO, and baseline oral corticosteroid dose.
conclusionsThis Delphi Consensus provides expert-endorsed, evidence-based recommendations for the management of severe pediatric asthma, emphasizing personalized selection of biological therapy guided by biomarkers and systematic response monitoring using standardized outcome measures.
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