Abstract
BackgroundUncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC).MethodsThis retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student’s t-test, or analysis of variance (ANOVA) as appropriate.ResultsTwenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%).ConclusionOver time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.
Highlights
Uncontrolled severe asthma in children is burdensome and challenging to manage
Subject characteristics Twenty-five children were managed in the severe asthma clinic (SAC) between 2014 and 2019
While the median age was 10 to 12 years in all cohorts, the range was greater in the SAC cohort as expected, with the youngest child being 4 years of age and the oldest 16 years of age
Summary
Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC). Patients with severe asthma (SA) pose a significant challenge to healthcare professionals as it is a complex clinical problem with multiple contributing factors [1]. Uncontrolled SA in children encompasses those who are difficult to treat or have comorbidities, as well as those. This report, aims to retrospectively describe our “real world” experiences and outcomes managing children with severe asthma in the nurse-led severe asthma clinic (SAC) at the John Hunter Children’s Hospital, Newcastle, Australia
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