A new regional multidisciplinary clinic for children with difficult asthma

Introduction: There is interest in new therapies for severe asthma, and how network clinics can facilitate this. Aims and Objectives: We aimed to: 1) explore comorbidities and adherence issues in children referred to our regional multidisciplinary (MDT) asthma clinic 2) describe the interventions utilised by the specialist medical, psychology, nursing, pharmacy, and physiotherapy teams. Method: Retrospective casenote review of referrals into the clinic since July 2018. We extracted data on demographics, co-morbidities, and issues with inhaler technique and adherence. We summarised medical and non-medical interventions used in the clinic. Results: 52 patients were referred (Median age 13 years [IQR 10-15], 37/52 male; 17/52 (32%) demonstrated persistently low FEV1, and 29/52 (55%) had persistently high FeNO. 45/52 (86%) had suboptimal inhaler technique and/or adherence issues. 31/52 (60%) had concurrent medical issues such as allergy, obesity and adrenal insufficiency. 44/52 (85%) had dysfunctional breathing or low fitness on formal step testing. 40/52 (77%) had psychological comorbidities such as anxiety, depression, and low self-esteem. We changed inhalers in 14 patients and utilised methylprednisolone in 1 patient. Due to these interventions we have not needed to start any patient on biologic therapies, immunomodulators or maintenance oral steroids for asthma, and we successfully stopped these in 4 patients. Conclusion: Inhaler competency and adherence, breathing technique, fitness, and psychological problems are common in children with poor asthma control. Addressing these fundamental issues using an MDT specialist clinic can usually negate the need to step up medical treatment, even in children with severe asthma.