Abstract
Telemedicine has the potential to substantially improve the care of children and adolescents with chronic respiratory diseases, including asthma, cystic fibrosis, bronchiectasis, and chronic respiratory failure. Digital health interventions-such as remote monitoring, virtual consultations, adherence-support tools, and educational platforms-can enhance disease control, continuity of care, and access to specialized services. Despite these opportunities, the implementation of telemedicine in pediatric respiratory care remains fragmented and uneven across healthcare systems. A central barrier to progress is the marked heterogeneity of outcome measures used to evaluate telemedicine interventions. Inconsistent definitions, variable endpoints, and limited follow-up reduce comparability across studies, hinder evidence synthesis, and impede translation into clinical guidelines, reimbursement models, and policy decisions. Consequently, telemedicine is often confined to isolated pilot projects rather than embedded within standard care pathways. This narrative review issues a Call to Action for the coordinated implementation and harmonization of telemedicine in pediatric chronic respiratory diseases. We advocate for the urgent development and adoption of a Core Outcome Set (COS) to standardize outcome measurement across clinical trials and real-world evaluations. In addition, we highlight the importance of integrating implementation science, economic evaluation, ethical oversight, and equity considerations into telemedicine research and deployment. Addressing regulatory fragmentation, ensuring interoperability, and aligning accreditation with reimbursement and Health Technology Assessment requirements are essential for sustainable scale-up. Finally, we emphasize the need for international collaboration among clinicians, researchers, policymakers, payers, technology developers, and patient advocacy groups to accelerate learning and promote equitable, evidence-based digital care models. Through coordinated action, telemedicine can evolve from a promising innovation into a reliable and accessible standard of care for children with chronic respiratory diseases.