What is severe asthma?
Any child or young person with asthma who has troublesome symptoms or frequent asthma attacks despite being on lots of treatment for their asthma – has problematic severe asthma.
What are the symptoms of severe asthma?
Troublesome symptoms may include cough, wheeze or difficulty breathing, and experiencing these symptoms frequently, on most days, and can result in having to attend the GP or hospital regularly.
How many children experience severe asthma?
Around 5% of children and adolescents with asthma are thought to have asthma which is severe. Even though severe asthma is rare, it uses up a large proportion of healthcare resources and is known to have a negative effect on both mental and physical health, and can have a big impact on school attendance and quality of life.
Why do some children and young people get severe asthma?
There are many reasons that some children may have asthma that is more severe than others. But we know that one of the main reasons that children may have troublesome symptoms is if they are not taking their asthma inhalers very regularly, or if they have not been shown how to take their inhalers properly, and are unsure of the correct inhaler technique.
The TREAT trial uses smartinhalers - what are they?
A smartinhaler is an electronic monitoring device that fits snugly and securely onto an inhaler. It records the number of times an inhaler has been used, and the time and date that it was used.
In severe asthma, it can be helpful to have a period of time to monitor adherence to prescribed inhaled therapies, before further escalating treatment. This is because we know that not all people with severe asthma manage to take their inhalers properly, and there are a variety of reasons for this. A period of adherence monitoring (using an electronic monitoring device) can help people to remember to take their inhalers better, which in some cases can result in better asthma control.
How does a smartinhaler work?
A smartinhaler works by recording every occasion the inhaler is actuated (used), by recording the date and time. It does not help us to assess if correct inhaler technique is being used, so it is important that someone explains this to the patient, especially when they are starting a new inhaler. When the monitoring period is over, the patient simply returns the device and the trial team will download the data. It can be really helpful for the patient and the trial/doctor nurse to look at the data and discuss any strategies that may help to improve adherence.
Does a smartinhaler always help?
Unfortunately, even when taking their inhalers correctly, some people continue to have lots of symptoms and asthma attacks. This is known as Severe therapy resistant asthma (STRA). There are some factors (such as inhaler technique and exposure to allergens) which can be improved and can result in better asthma control. If asthma control improves after addressing these factors, then this is known as Difficult Asthma (DA). Despite our best efforts, it is sometimes not possible to modify such factors and then we need to think about using other medicines to help control their asthma.
What treatments are available for severe asthma?
There are lots of treatments available for severe asthma, including inhalers, tablets and more recently, injections. However, some of these medicines (such as steroids taken as tablets) can have unpleasant side effects if they are used regularly, such as stunting growth. To minimise the potential harmful side effects of high dose steroids, several new medicines, which are given by injections have recently been developed. Two such medicines are currently licenced for children with severe asthma. These medicines are called biologics.
What biologics treatments are available?
The two injections currently available for children with severe asthma are Omalizumab (Xolair) and Mepolizumab (Nucala).
Omalizumab is safe for children and has been used in the NHS for about 10 years, but unfortunately it can only be used in 60% of children with severe asthma, and even then, it doesn`t help all patients. It only helps about half of all children in whom it can be used.
Mepolizumab was licensed for use in children with severe asthma in 2018 and we also know that this is a safe drug. However, no studies have been done in children with severe asthma, so we do not know how well it works in this patient group.
Both of the medicines have been shown to work really well for adults with severe asthma. However, it is difficult to know which treatment will work best in children, and also because there are different treatment options available, it is difficult to know which treatment will work best in each child.
How often are the biologics injections administered?
The Mepolizumab injections are given every 4 weeks. Omalizumab is given either every 2 weeks or every 4 weeks - the frequency of the Omalizumab injections depends on the patient's weight and blood results.
Do the biologics injections have side effects?
Omalizumab can cause pain in arms and legs, make the patient feel dizzy or tired, give a rash, or pain in ears. Mepolizumab may give the patient a headache, skin reactions where the injection was administered, back pain and tiredness.
For more information on Severe Asthma please visit Asthma+Lung UK