{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T07:38:21Z","timestamp":1765438701220,"version":"build-2065373602"},"reference-count":134,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Asthma is the most frequent chronic condition in childhood and a current concern exists about asthma in the pediatric population and its risk for severe SARS-CoV-2 infection. Although all ages can be affected, SARS-CoV-2 infection has lower clinical impact on children and adolescents than on adults. Fever, cough and shortness of breath are the most common symptoms and signs in children; wheezing has not been frequently reported. Published studies suggest that children with asthma do not appear to be disproportionately more affected by COVID-19. This hypothesis raises two issues: is asthma (and\/or atopy) an independent protective factor for COVID-19? If yes, why? Explanations for this could include the lower IFN-\u03b1 production, protective role of eosinophils in the airway, and antiviral and immunomodulatory proprieties of inhaled steroids. Additionally, recent evidence supports that allergic sensitization is inversely related to ACE2 expression. Obesity is a known risk factor for COVID-19 in adults. However, in the childhood asthma\u2013obesity phenotype, the classic atopic Th2 pattern seems to predominate, which could hypothetically be a protective factor for severe SARS-CoV-2 infection in children with both conditions. Finally, the return to school activities raises concerns, as asymptomatic children could act as vectors for the spread of the disease. Although this is still a controversial topic, the identification and management of asymptomatic children is an important approach during the SARS-CoV-2 epidemic. Focus on asthma control, risk stratification, and medication adherence will be essential to allow children with asthma to return safely to school.<\/jats:p>","DOI":"10.3390\/ijerph18031093","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T23:01:28Z","timestamp":1611702088000},"page":"1093","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["COVID-19 and Pediatric Asthma: Clinical and Management Challenges"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9738-8210","authenticated-orcid":false,"given":"Jos\u00e9 Laerte","family":"Boechat","sequence":"first","affiliation":[{"name":"Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine, Universidade Federal Fluminense, Niter\u00f3i 24070-035, Brazil"},{"name":"Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto 4200-319, Portugal"},{"name":"Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2173-4380","authenticated-orcid":false,"given":"Gustavo Falbo","family":"Wandalsen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Universidade Federal de Sao Paulo, S\u00e3o Paulo 04025-002, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1432-2396","authenticated-orcid":false,"given":"Fabio Chigres","family":"Kuschnir","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20943-000, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2375-9071","authenticated-orcid":false,"given":"Lu\u00eds","family":"Delgado","sequence":"additional","affiliation":[{"name":"Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto 4200-319, Portugal"},{"name":"Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1111\/apa.15270","article-title":"Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults","volume":"109","author":"Ludvigsson","year":"2020","journal-title":"Acta Paediatr."},{"key":"ref_2","unstructured":"Boechat, J.L., Chora, I., and Delgado, L. 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