Metabolomic Approaches to Lung Function in Pediatric Asthma: A Narrative Review

Introduction: Asthma is one of the most common chronic diseases in childhood and represents a major global public health concern due to its high prevalence, healthcare burden, and impact on quality of life. Pediatric asthma is characterized by clinical and biological heterogeneity, reflected in variable airflow limitations and distinct inflammatory endotypes. Conventional diagnostic tools do not fully capture the metabolic mechanisms underlying lung function impairment and disease variability. Aim: This narrative review aims to synthesize evidence published linking metabolomic and breathomic signatures to lung function parameters in children with asthma. Methods: We searched PubMed, Scopus, and Google Scholar using predefined keywords including pediatric asthma, metabolomics, breathomics, volatile organic compounds, exhaled breath condensate, and lung function. The search covered publications from January 2015 to January 2026. Earlier studies were included when necessary for the conceptual or methodological context. We included human studies evaluating metabolomic or breathomic profiles in children (≤18 years) and reporting associations with lung function, severity, endotypes, or exacerbations. Duplicate records, adult-only studies, animal models, non-English publications, and conference abstracts without full data were excluded. Results: Alterations in lipid and sphingolipid metabolism, oxidative stress pathways, and purine metabolism were associated with airflow limitation and reduced FEV1. Breathomic analyses revealed associations between volatile profiles, small airway dysfunction, and inflammatory patterns. However, findings remain heterogeneous across biological matrices and analytical platforms. Conclusions: Metabolomic and breathomic profiling may complement conventional lung function assessment by providing additional mechanistic insight into pediatric asthma heterogeneity. Standardized methodologies, longitudinal validation, and integration within multi-omics approaches are required before routine clinical implementation.