Evidence-based clinical recommendations on the use of telemedicine for the management of children, adolescents and young adults with moderate-severe asthma

Asthma is among the most common chronic childhood diseases, with inadequate control leading to substantial morbidity, impaired quality of life, and high healthcare costs. Although severe asthma affects only around 10% of pediatric patients, this subgroup bears a disproportionate share of the clinical and economic burden. Long-term disease control relies on regular monitoring and education, yet traditional follow-up in specialist outpatient clinics may not be sufficient. Advances in telemedicine and digital health offer new opportunities for remote monitoring, treatment adherence assessment, and patient education, but evidence for their use in moderate-to-severe pediatric asthma remains fragmented. We systematically reviewed evidence on telemedicine and innovative technologies for moderate-to-severe asthma in children, adolescents, and young adults. Using GRADE, we assessed study quality and synthesized findings. A multidisciplinary panel applied a structured consensus process to develop tailored recommendations, considering evidence strength, feasibility, equity, resources, and patient preferences. Of the 27,551 records retrieved, 55 studies met the inclusion criteria (38 randomized controlled trials, 17 observational). Despite substantial heterogeneity in design, populations, and interventions, digital health tools—such as smartphone applications, online platforms, and remote monitoring devices—were generally feasible, well accepted, and often linked to improved quality of life, symptom control, treatment adherence, and reduced exacerbations and hospitalizations. Effects on pulmonary function were inconsistent. Increased healthcare contacts reported in some studies were interpreted by experts as earlier exacerbation recognition rather than clinical deterioration. Educational interventions via digital platforms were strongly valued by the panel, despite low-quality supporting evidence. Overall, evidence quality was limited by methodological weaknesses, varying outcome definitions, and heterogeneity in telemedicine tools, precluding meta-analysis. Sustainability challenges included costs, device access, provider workload, and the need for robust community-based care networks. Key barriers were unequal digital access, limited provider training, poor interoperability, and privacy concerns. Telemedicine may enhance adherence, empower self-management, and enable early detection of deterioration in moderate-to-severe pediatric asthma. Conditional recommendations were made for its use, particularly during exacerbations. Future high-quality studies with standardized outcomes, long-term follow-up, and economic analyses are needed to strengthen the evidence base and guide sustainable implementation.