Efficacy, cost effectiveness, and sustainability of a pediatric high risk asthma clinic

Krupp, Nadia; Weist, Andrea; Fiscus, Cindy; Slaven, James E.; Harner, Andrew; Montgomery, Gregory S.; Howenstine, Michelle S.

doi:10.1002/ppul.23967

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Our findings are consistent with other evidence from the USA, France, Australia and the Netherlands [7][8][9][10][11][12][13] which have demonstrated that specialist assessment can lead to improved asthma control, reduced exacerbations and a lowering of mOCS dose. Our results are also in broad agreement with evidence from the UK [24,25], including within the most recent study by Gibeon et al [14] which used data collected from UK severe asthma centres between 2009 and 2010.…”

Section: Discussionsupporting

confidence: 92%

“…There has been much interest investigating the benefits of specialist assessment and management since it was recommended for difficult to control asthma over thirty years ago [6]. Studies in the USA, France, Australia and the Netherlands [7][8][9][10][11][12][13] have demonstrated that specialist assessment can lead to improved asthma control, reduced exacerbations and a lowering of maintenance oral corticosteroid dose (mOCS) dose. These findings have been replicated within several UK-based studies and, most recently, Gibeon et.…”

Section: Introductionmentioning

confidence: 99%

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Benefits of specialist severe asthma management: demographic and geographic disparities

et al. 2022

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IntroductionThe benefits of specialist assessment and management have yet to be evaluated within the biologic era of UK severe asthma treatment, and potential disparities have not been considered.MethodsIn an uncontrolled before-and-after study, we compared asthma symptoms (asthma control questionnaire [ACQ6]), exacerbations, unscheduled secondary care use, lung function (FEV1) and oral corticosteroid (OCS) dose after one year. We compared outcomes by sex, age (18–34, 35–49, 50–64, 65+ years), ethnicity (Caucasian versus Non- Caucasian) and hospital site after adjusting for demographics and variation in biologic therapy use.Results1,140 patients were followed-up for 1,370 person-years from twelve specialist centres. At annual review, ACQ6 score was reduced by a median of 0.7 (IQR:0.0, 1.5), exacerbations by 75% (IQR: 33%, 100%) and unscheduled secondary care by 100% (IQR:67%, 100%). FEV1 increased by a median of 20 mL (IQR:-200, 340) while OCS dose decreased for 67% of patients. Clinically meaningful improvements occurred across almost all patients, including those not receiving biologic therapy. There was little evidence of differences across demographic groups, although those aged over 65 demonstrated larger reductions in exacerbations (69% versus 52%; p<0.001) and unscheduled care use (77% versus 50%; p<0.001) compared to patients aged under 34 years. There were more than 2-fold differences between the best and worst performing centres across all study outcomes.ConclusionsSpecialist assessment and management is associated with substantially improved patient outcomes which are broadly consistent across demographic groups, and are not restricted to those receiving biologic therapy. Significant variation exists between hospitals which requires further investigation.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Benefits of specialist severe asthma management: demographic and geographic disparities

et al. 2022

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“…Multidisciplinary asthma clinics have been shown to reduce visits to the emergency room, decrease hospitalizations, and improve asthma severity and quality of life. 8,9,11,12 We are currently working to create spaces where families and patients can meet, receive education, share their experiences, and provide peer support and empowerment. Thus far, we have had three virtual support group sessions that have been well attended.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Multidisciplinary care for complex medical issues has been well described in the pain literature 6 but has yet to be widely adopted for severe childhood asthma despite some supportive findings. [7][8][9][10][11][12] A multidisciplinary clinic provides a standardized approach for the management of children with severe asthma, as recommended by current guidelines. 1,7,13 To better understand and care for our pediatric patients with difficult-to-treat and severe asthma, we created a multidisciplinary Severe Asthma Clinic (SAC) by bringing together an Allergist and a Pediatric Pulmonologist.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with severe asthma incur higher healthcare utilization and costs, and thus improving the diagnosis and management of this condition is a critical healthcare need 4,5 . Multidisciplinary care for complex medical issues has been well described in the pain literature 6 but has yet to be widely adopted for severe childhood asthma despite some supportive findings 7–12 . A multidisciplinary clinic provides a standardized approach for the management of children with severe asthma, as recommended by current guidelines 1,7,13 …”

Section: Introductionmentioning

confidence: 99%

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Severe asthma in children: Description of a large multidisciplinary clinical cohort

Molina

Okoniewski

Puranik

et al. 2022

Pediatric Pulmonology

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Background Children with severe asthma have substantial morbidity and healthcare utilization. Pediatric severe asthma is a heterogeneous disease, and a multidisciplinary approach can improve the diagnosis and management of these children. Methods We reviewed the electronic health records for patients seen in the Severe Asthma Clinic (SAC) at UPMC Children's Hospital of Pittsburgh between August 2012 and October 2019. Results Of the 110 patients in whom we extracted data, 46% were female, 48% were Black/African American, and 41% had ≥1 admission to the pediatric intensive care unit (PICU) for asthma. Compared to patients without a PICU admission, those with ≥1 PICU admission were more likely to be non‐White (64.4% vs. 41.5%, p = 0.031) and more atopic (eosinophil count geometric mean = 673 vs. 319 cells/mm3, p = 0.002; total IgE geometric mean = 754 vs. 303 KU/L, p = 0.003), and to have lower pre‐bronchodilator FEV1 (58.6% [±18.1%] vs. 69.9% [±18.7%], p = 0.002) and elevated FeNO (60% vs. 22%, p = 0.02). In this cohort, 84% of patients were prescribed high‐dose ICS/LABA and 36% were on biologics. Following enrollment in the SAC, severe exacerbations decreased from 3.2/year to 2.2/year (p < 0.0001); compared to the year before joining the SAC, in the following year the group had 106 fewer severe exacerbations. Conclusions This large cohort of children with severe asthma had a high level of morbidity and healthcare utilization. Patients with a history of PICU admissions for asthma were more likely to be nonwhite and highly atopic, and to have lower lung function. Our data support a positive impact of a multidisciplinary clinic on patients with severe childhood asthma.

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Management of Severe Asthma in Children

Lin

Guilbert

2018

Curr Treat Options Peds

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Efficacy, cost effectiveness, and sustainability of a pediatric high risk asthma clinic

Abstract: A pediatric High Risk Asthma clinic model is efficacious in decreasing hospitalizations and Emergency Department visits for a difficult to treat population, and such a model can be cost-effective and sustainable.

Cited by 6 publications

References 16 publications

Benefits of specialist severe asthma management: demographic and geographic disparities

Benefits of specialist severe asthma management: demographic and geographic disparities

Severe asthma in children: Description of a large multidisciplinary clinical cohort

Management of Severe Asthma in Children

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