Pediatric Pulmonary Research Gaps Highlighted for Global Health

Pediatric respiratory conditions, including pneumonia, asthma, tuberculosis, and chronic lung disease of prematurity, contribute significantly to childhood morbidity and mortality worldwide.¹ The World Health Organization estimates that pneumonia alone accounts for approximately 700,000 deaths annually in children under five years of age, with the vast majority occurring in LMICs.² Despite this substantial disease burden, research infrastructure and funding for pediatric pulmonary investigations are often concentrated in high-income countries, leading to a paucity of evidence directly applicable to the unique epidemiological and resource-constrained environments of LMICs.³ This disparity results in diagnostic and therapeutic strategies that may not be feasible, affordable, or culturally appropriate for the populations most affected by these diseases.⁴

Addressing the Research Imbalance

The ATS 2026 session, "PEDIATRIC PULMONARY RESEARCH IN GLOBAL HEALTH AND UNDERSERVED POPULATIONS: IT’S A SMALL WORLD," aims to highlight these critical research gaps and foster collaborative efforts to address them. The session emphasizes the need for research that focuses on prevalent conditions in LMICs, such as severe acute respiratory infections, the long-term pulmonary sequelae of early childhood infections, and the impact of environmental exposures like household air pollution.⁵ For instance, while significant advancements have been made in managing asthma in high-income settings, the diagnosis and management of asthma in LMICs are often complicated by limited access to spirometry, inhaled corticosteroids, and specialist care.⁶

The session will also explore the specific challenges in diagnosing and managing chronic lung disease of prematurity (CLD) in LMICs. Premature birth rates are high globally, and while survival of extremely preterm infants has improved in high-income countries, access to advanced neonatal intensive care, including mechanical ventilation and surfactant therapy, remains limited in many LMICs. This leads to a higher incidence and severity of CLD, often complicated by recurrent infections and malnutrition. Research is needed to develop context-appropriate interventions for preventing and managing CLD in these settings, considering factors such as oxygen availability, nutritional support, and infection control. Furthermore, understanding the long-term pulmonary outcomes of children who survive severe respiratory infections in early childhood, such as bronchiolitis or pneumonia, is crucial. These children often experience persistent respiratory symptoms, reduced lung function, and an increased risk of developing chronic respiratory diseases later in life. Longitudinal studies in LMICs are essential to characterize these sequelae and identify effective interventions.

Furthermore, the session is expected to discuss the importance of developing and validating diagnostic tools that are suitable for low-resource settings. Current diagnostic methods for conditions like pediatric tuberculosis often rely on sophisticated laboratory techniques that are unavailable in many parts of the world.⁷ Research into point-of-care diagnostics and simplified clinical algorithms could significantly improve early detection and treatment initiation.⁸ The session will also likely underscore the necessity of implementation science research, which focuses on translating effective interventions into routine clinical practice within specific contexts, considering local health systems and community factors.⁹ This includes evaluating the effectiveness of vaccination programs, improved nutrition, and access to clean cooking fuels in reducing the burden of pediatric respiratory disease.¹⁰

Methodological Considerations for Global Pediatric Pulmonary Research

Conducting research in global health settings requires careful consideration of methodological approaches. Studies must be designed to be culturally sensitive, ethically sound, and feasible within existing resource constraints. This often involves adapting research protocols, utilizing community health workers for data collection, and ensuring that informed consent processes are appropriate for diverse populations. For example, validating diagnostic tools in LMICs necessitates robust study designs that account for varying disease prevalence, co-morbidities, and access to confirmatory tests. Similarly, intervention studies must consider the scalability and sustainability of proposed solutions within local health systems. The session will likely address strategies for building research capacity within LMICs, including training local researchers, establishing equitable research partnerships, and developing sustainable funding mechanisms that empower local institutions to lead and conduct relevant research.

The session is a call to action for the global pediatric pulmonology community to reorient research priorities. It advocates for increased investment in research capacity building within LMICs, fostering equitable partnerships, and ensuring that research outcomes directly inform policy and practice in the regions where they are most needed.¹¹ The goal is to move beyond simply acknowledging disparities to actively generating the evidence required to improve respiratory health outcomes for all children, regardless of their geographic location or socioeconomic status.¹²