Paediatric severe asthma biologics service: from hospital to home

Abstract

Children with severe asthma may be treated with biologic agents normally requiring 2–4 weekly injections in hospital. In March 2020, due to COVID-19, we needed to minimise hospital visits. We assessed whether biologics could be given safely at home. The multidisciplinary team identified children to be considered for home administration. This was virtually observed using a video link, and home spirometry was also performed. Feedback was obtained from carers and young people. Of 23 patients receiving biologics, 16 (70%) families agreed to homecare administration, 14 administered by parents/patients and 2 by a local nursing team. Video calls for omalizumab were observed on 56 occasions, mepolizumab on 19 occasions over 4 months (April–July). Medication was administered inaccurately on 2/75 occasions without any adverse events. Virtually observed home biologic administration in severe asthmatic children, supported by video calls and home spirometry, is feasible, safe and is positively perceived by children and their families

Expert meeting report: towards a joint European roadmap to address the unmet needs and priorities of paediatric asthma patients on biologic therapy

“…The introduction of mAb agents in asthma treatment is a milestone in the application of personalised medicine. However, comparative studies and standardised algorithms for the management of paediatric severe asthma to guide the best therapeutic option for paediatric patients with severe asthma are lacking [ 14 ]. More personalised medicine approaches may benefit the patient by better matching patients with the most appropriate therapy.…”

COVID-19 and delivery of difficult asthma services

“…The pharmacy team initiated the homecare service for medications including biologics. 3 Repeat prescriptions continued to be supplied by primary care but urgent changes to medication were dispatched by pharmacy.…”

Topic Sessions

“…Children with severe asthma may be treated with biologic agents which need to be administered as 2–4 weekly injections, usually in hospital. However, due to COVID‐19, the Royal Brompton Hospital was forced to minimize in‐person hospital visits 4 . There was an urgent need to adapt the biologics service and arrange for administration at home, especially because families were concerned about the risk of cross‐infection and were shielding, thus were unwilling to come to the hospital.…”

“…Virtually overnight, consultations became remote by telephone and then video link. There were three important consequences which will be carried forward after the pandemic: Increased capacity for remote monitoring: in principle, smartphones can be used to Bluetooth spirometry, height, weight, oxygen saturation, exhaled nitric oxide and even lung sounds Travelling kept down to a minimum: tests planned with a remote call, and results given also remotely, where possible Asthma biologicals (omalizumab, mepolizumab) which are conventionally given by injection in hospital every 2‐4 weeks with two hours post‐injection monitoring, are now given at home by the parents [1]. The first three doses and training are given in hospital.…”

“…Asthma biologicals (omalizumab, mepolizumab) which are conventionally given by injection in hospital every 2‐4 weeks with two hours post‐injection monitoring, are now given at home by the parents [1]. The first three doses and training are given in hospital.…”