“Severe Asthma in Paediatrics” presented by Dr. Louisa Owens
As part of our ongoing seminar series, the Centre of Excellence in Severe Asthma hosted Dr. Louisa Owens, for a webinar “Severe Asthma in Paediatrics” on 17 April 2019.
Please note that at the request of the presenter, individual case studies have been removed from the seminar recording to protect patient anonymity.
Presentation Summary
Dr. Louisa Owens provided an overview of issues to consider for the effective diagnosis, treatment and management of severe asthma in the paediatric and adolescent population.
Key Points:
- Detailed diagnosis and assessment are important to ensure appropriate treatment, while limiting the negative side effects of over-treatment
- While asthma is quite common, severe asthma is relatively rare in a paediatric population and contributing factors and alternative diagnoses should be carefully assessed
- Management issues relevant to each age group are highlighted, including preschool age (2-5 years old), school age (6-11 years) and adolescents
- Recommendations for the initial escalation of asthma therapies in children are available in the Australian Asthma Handbook. Referral is required prior to escalation to specialised add-on therapies
- The Severe Asthma Toolkit provides relevant materials for healthcare professionals treating paediatric patients with severe asthma
- Initial assessment should consider alternative diagnoses and an objective measurement of lung function and reversibility (spirometry), when the child is old enough to perform assessment
- Assessment for co-morbidities is important to make sure all issues are considered and appropriately treated
- Assessment and correction of inhaler technique and adherence, including use of a spacer must be explored, to ensure prescribed treatments are appropriate and being taken as directed
- In studies of preschool-aged children, approximately 50% of patients in an asthma centre were adherent to ICS treatment. Uncontrolled symptoms were associated with lower rates of adherence (Klok ERJ 2014)
- Trigger exposure should be assessed, and strategies supported to reduce exposure (e.g. smoking cessation & allergen avoidance)
- It is important to be wary of and check for side effects of steroid treatment and psychiatric side effects of montelukast treatment in children
- Home visits can be useful to identify relevant exposures and psychosocial stresses that may be impacting on disease management and symptom control
- Add-on treatment and alternative device / regimens should be considered if symptoms remain uncontrolled
- It is important to monitor response to treatment (e.g. asthma control questionnaire, lung function, school attendance) to determine whether progress is being achieved or additional factors need to be assessed
- In a 2-5-year-old population: Asthma cannot routinely be diagnosed using lung function testing, respiratory viral infections are frequent and impact on lung function, and symptom reports largely rely on parental observation. Limited add-on treatment options are available, in part because this age group is rarely included in severe asthma clinical trials
- In school-aged children (6-11 years): Trigger exposure at school becomes more common (e.g. virus infection during the back-to-school period) and co-morbidities are an increased issue. Add-on treatment options are limited with 1 ICS/LABA combination, 1 monoclonal antibody (omalizumab; >6-years) and tiotropium currently available
- In adolescents: A period of rapid physical growth, increasing school stress and increasing independence and desire to fit-in can impact symptoms and treatment adherence. Mental health issues (e.g. anxiety), risky behaviours (e.g. drug use) and hormonal changes (e.g. peri-menstrual and pubertal changes) can also impact symptom severity. Effective communication may also become more difficult
- Limited inclusion of young patients in clinical trials (particularly <12 years old) means that little is known about the effects of treatments on asthma symptoms or long-term safety
- It is particularly important to be aware of and consider long-term side effects of oral corticosteroid (OCS) use in paediatric and adolescent populations
- A range of risk factors are associated with increased risk of life-threatening asthma attacks in children (e.g. poor asthma control, adherence, smoke exposure, obesity, parental psychological problems)
About Dr. Louisa Owens:
Dr Louisa Owens is a Paediatric Respiratory Specialist and Consultant at Sydney Children’s Hospital. She is also a Conjoint Lecturer with the School of Women and Children’s Health at the University of New South Wales. Louisa completed her medical degree and paediatric training in Ireland before moving to Perth, Western Australia in 2012 to complete a Fellowship in Paediatric Respiratory Medicine. She took up a position as Staff Specialist at Sydney Children’s Hospital in 2016. She also serves on an expert advisory committee for Asthma Australia’s GASP program and is a Lecturer for the Diploma in Child Health/International Postgraduate Paediatric Certificate.
More information about severe asthma in paediatrics is also available in the Severe Asthma Toolkit – click here
