Initiation of Monoclonal Antibodies for Severe Asthma in Primary Care

Download a pdf version of this information here – Version updated 17 January 2019

Specialists are responsible for assessing suitability for monoclonal antibody treatment in severe asthma, and for preparing written applications to the PBS for supply of these medications. Initial injections will generally be administered in the specialist’s clinic or private rooms, day hospital or day procedure unit. If there are no untoward reactions after the first 2 or 3 injections, the specialist will often arrange for subsequent injections to be administered in primary care by a practice nurse, or in a local health care facility.

In some instances, it may be reasonable to initiate monoclonal antibody injections in primary care or local health care facility, especially where the patient might have to travel long distances to the specialist’s clinic or office, or where there is no ready access to a day procedure unit or hospital outpatient clinic.

For this to occur in a way that optimises good patient care, the following criteria should be met:

• The prescribing specialist maintains oversight of the treatment program and is readily contactable in the event of an asthma exacerbation or adverse reaction.
• The prescribing specialist communicates clearly to the general practitioner about what is involved in giving the injections, the necessary precautions, and what to do in the event of an adverse reaction.
• The patient is fully informed and involved in the decision making.

Specialist review

1. It is recommended that the prescribing specialist review the patient 2 to 3 months after starting monoclonal antibody treatment to:
   1. Assess asthma control and lung function,
   2. Review inhaler therapy, adherence and oral steroid use
   3. Document adverse events.
2. The prescribing specialist will review the patient again at around 5-7 months after starting the monoclonal antibody to determine if the treatment has had the desired impact on asthma control and if so, prepare a written application to the PBS for ongoing supply of medication (see (see “Assessing Response” in the Centre of Excellence Clinical Recommendation documents).).