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touchMDT Management of severe paediatric asthma: From hospital to home

Members of the MDT and a patient advocate discuss the optimal management of severe asthma in children

 Overview & Learning Objectives

Child with severe asthma and their parents or carers
Paediatric pulmonologist, paediatric immunologist, primary care physician and patient advocate
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Diagnosing severe asthma in children Dr Gupta, Dr Phipatanakul, Dr Tsiligianni, Ms Cooper

Watch members of the MDT and a patient advocate discuss the challenges of diagnosing severe type 2 asthma in children.

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Paediatric immunologist, paediatric pulmonologist and patient advocate
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Biologics for paediatric severe asthma Dr Phipatanakul, Dr Gupta, Ms Cooper

Members of the MDT discuss with a patient advocate the use of biologics in children with severe asthma and their impact on the quality of life of patients and their family.

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Paediatric immunologist, primary care physician, paediatric pulmonologist and specialist asthma nurse
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The MDT and severe paediatric asthma Dr Phipatanakul, Dr Tsiligianni, Dr Gupta, Ms Marsh

Watch members of the MDT discuss how they coordinate their efforts to optimize the management of paediatric patients with severe asthma.

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Primary care physician, paediatric immunologist, specialist asthma nurse and patient advocate
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Supporting families to optimize outcomes Dr Tsiligianni, Dr Phipatanakul, Ms Marsh, Ms Cooper

Watch members of the MDT and a patient advocate discuss the best practices to support families of children with severe asthma.

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Paediatric pulmonologist, paediatric immunologist, primary care physician and patient advocate

Watch members of the MDT and a patient advocate discuss the challenges of diagnosing severe type 2 asthma in children.
Expert Spotlight
Dr Atul Gupta
King’s College Hospital, London, UK
Dr Wanda Phipatanakul
Boston Children’s Hospital, Harvard, MA, USA
Dr Ioanna Tsiligianni
University of Crete, Crete, Greece
Ms Monique Cooper
Miami, FL, USA

Dr Atul Gupta, Dr Wanda Phipatanakul and Dr Ioanna Tsiligianni discuss the challenges of diagnosing severe type 2 asthma in children; they are joined by Ms Monique Cooper, who provides her perspective as the parent of a child with severe asthma, and together they highlight unmet needs for patients.

Listen on the Go

 Learn more Back to MDT Hub Time: 13:13
 
Paediatric immunologist, paediatric pulmonologist and patient advocate

Members of the MDT discuss with a patient advocate the use of biologics in children with severe asthma and their impact on the quality of life of patients and their family.
Expert Spotlight
Dr Wanda Phipatanakul
Boston Children’s Hospital, Harvard, MA, USA
Dr Atul Gupta
King’s College Hospital, London, UK
Ms Monique Cooper
Miami, FL, USA

Dr Wanda Phipatanakul and Dr Atul Gupta provide practical insights on the use of biologics to treat children with severe type 2 asthma; in addition, Ms Monique Cooper shares her experience as the parent of a child with severe asthma and discusses the impact that biologics had on her son’s life.

Listen on the Go

 

 Learn more Back to MDT Hub Time: 12:18
 
Paediatric immunologist, primary care physician, paediatric pulmonologist and specialist asthma nurse

Watch members of the MDT discuss how they coordinate their efforts to optimize the management of paediatric patients with severe asthma.
Expert Spotlight
Dr Wanda Phipatanakul
Boston Children’s Hospital, Harvard, MA, USA
Dr Ioanna Tsiligianni
University of Crete, Crete, Greece
Dr Atul Gupta
King’s College Hospital, London, UK
Ms Viv Marsh
Dudley Respiratory Group, NHS, UK

Dr Wanda Phipatanakul, Dr Ioanna Tsiligianni, Dr Atul Gupta and Ms Viv Marsh share their views on how different members of the multidisciplinary team can work together to optimize the management and care of children with severe asthma.

Listen on the Go

 Learn more Back to MDT Hub Time: 11:39
 
Primary care physician, paediatric immunologist, specialist asthma nurse and patient advocate

Watch members of the MDT and a patient advocate discuss the best practices to support families of children with severe asthma.
Expert Spotlight
Dr Ioanna Tsiligianni
University of Crete, Crete, Greece
Dr Wanda Phipatanakul
Boston Children’s Hospital, Harvard, MA, USA
Ms Viv Marsh
Dudley Respiratory Group, NHS, UK
Ms Monique Cooper
Miami, FL, USA

Dr Ioanna Tsiligianni, Dr Wanda Phipatanakul and Ms Viv Marsh discuss with Ms Monique Cooper, the parent of a child with severe asthma, how the multidisciplinary team can work with parents and carers to optimize treatment outcomes.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:10
 
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Overview & Learning Objectives
Overview

In this activity, a paediatric immunologist, paediatric pulmonologist, primary care physician and specialist asthma nurse discuss the multidisciplinary management of paediatric patients with severe asthma, from diagnosis to treatment and long-term care. The discussion is enriched by the personal account of the parent of a child with severe asthma, who describes the challenges they face and their interaction with the multidisciplinary clinical team.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of allergists, immunologists, paediatricians, pulmonologists and general practice physicians involved in the management of paediatric patients with severe asthma.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Wanda Phipatanakul discloses: Advisory board or panel fees from AstraZeneca, Genentech, GlaxoSmithKline, Novartis, Regeneron Pharmaceuticals and Sanofi.

Dr Ioanna Tsiligianni discloses: Advisory board or panel fees from Boehringer Ingelheim (relationship terminated) and Novartis (relationship terminated). Grants/Research Support from AstraZeneca (relationship terminated) and GlaxoSmithKline (relationship terminated).

Dr Atul Gupta discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Novartis Pharmaceuticals. Grants/research support from Airosnett, Boehringer Ingelheim, GlaxoSmithKline and Novartis Pharmaceuticals.

Ms Viv Marsh discloses: Advisory board or panel fees from Allergy Therapeutics. Speaker’s bureau fees from Napp Pharmaceuticals

Ms Monique Cooper has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Karim Hanna, MD: No relevant financial relationship to disclose.

Touch Medical Directors

Adriano Boasso has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 13 February 2023. Date credits expire: 13 February 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recall the diagnostic workup for severe type 2 asthma in children
  • Explain the pathophysiology of severe type 2 asthma and how this can guide treatment decisions
  • Discuss the importance of the MDT in optimizing the management of children with severe asthma
Faculty & Disclosures
Dr Wanda Phipatanakul

Boston Children’s Hospital, Harvard, MA, USA

Wanda Phipatanakul is the director of the Division of Immunology Research Center at Boston Children’s Hospital and Westonian endowed professor of paediatrics at Harvard Medical School. read more

Dr Phipatanakul conducts both school- and home-based asthma studies in children and has had continuous National Institutes of Health (NIH) funding for 20 years. She leads the National Institute of Allergy and Infectious Diseases (NIAID) School Inner-City Asthma Intervention Study; the National Heart, Lung, and Blood Institute (NHLBI) Environment Assessment of Sleep in Youth; the NIAID-funded PARK study evaluating omalizumab in preventing the atopic march and asthma; and a NIAID IDEA study evaluating the response to dupilumab in patients carrying the Interleukin (IL)-4 receptor alpha R576 gene variant. She leads her centre as paediatric principal investigator in multiple NHLBI asthma and prevention networks, including the Severe Asthma Research Program, the Precise Severe Asthma Network, the Atopic Dermatitis Research Network and the Childhood Asthma in Urban Settings Network.

She has authored over 300 publications in scientific journals, including JAMA and the New England Journal of Medicine. She serves on the board of directors of the American Academy of Allergy, Asthma, and Immunology and the American Board of Allergy and Immunology. She also serves as associate editor for the Journal of Allergy and Clinical Immunology (JACI) and on the editorial board for several other journals including JACI: in Practice and Chest.

Dr Wanda Phipatanakul discloses: Advisory board or panel fees from AstraZeneca, Genentech, GlaxoSmithKline, Novartis, Regeneron Pharmaceuticals and Sanofi.
Dr Ioanna Tsiligianni

University of Crete, Crete, Greece

Ioanna Tsiligianni is an associate professor in general practice and public health, in the Department of Social Medicine, Faculty of Medicine, University of Crete. She is the past president (2018–2020) of the International Primary Care Respiratory Group (IPCRG). read more

Dr Tsiligianni’s research centres mainly on public health and primary care issues, with a special focus on primary care respiratory medicine, chronic obstructive pulmonary disease (COPD), asthma and lung cancer.

Ioanna Tsiligianni was chair of the IPCRG World Conference in 2014, and coordinated the development of the first national guidelines for primary care in COPD and asthma in Greece. She is the editor-in-chief of Primary Care Respiratory Medicine. 

She is an active member of several organizations, including the European Rural and Isolated Practitioners Association (EURIPA), the International Institute of Compassionate Care and the European Respiratory Society (ERS).

She has more than 170 publications and she is the recipient of 17 awards at international and national level.

Dr Ioanna Tsiligianni discloses: Advisory board or panel fees from Boehringer Ingelheim (relationship terminated) and Novartis (relationship terminated). Grants/Research Support from AstraZeneca (relationship terminated) and GlaxoSmithKline (relationship terminated).
Dr Atul Gupta

King’s College Hospital, London, UK

Atul Gupta is a senior paediatric respiratory consultant at King’s College Hospital & King’s College London. read more

Dr Gupta is head of the department and specializes in all areas of paediatric respiratory medicine, including severe asthma. His research interests centre on asthma, airway disease and respiratory infections. He has published over 175 papers on a range of respiratory-related conditions.

Dr Gupta has received the Lorber Prize, awarded by the Royal College Of Paediatrics and Child Health; The James Fellowship, awarded by the British Medical Association; VASR Memorial Gold Medal; and S.S Manchanda Research Gold Medal.

Dr Atul Gupta discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Novartis Pharmaceuticals. Grants/research support from Airosnett, Boehringer Ingelheim, GlaxoSmithKline and Novartis Pharmaceuticals.
Ms Viv Marsh

Dudley Respiratory Group, West Midlands, UK

Viv Marsh qualified as a registered general nurse (RGN) in 1991 and as a registered sick children’s nurse (RSCN) in 1993, and since then has worked in acute paediatrics, school nursing, specialist nursing and clinical education. read more

In her current National Health Service (NHS) role, Ms Marsh works with the Dudley Respiratory Group supporting the development of integrated services and standards for paediatric asthma care. As the clinical lead for Children and Young People’s Asthma Transformation, she is responsible for the implementation and delivery of the national bundle of asthma care across the Black Country, West Midlands. In her role as the facilitation coordinator for the IMP²ART Trial, she works with the research team and general practitioner practices to deliver the implementation strategy to improve supported self-management of asthma.

Ms Marsh sits on the committee for the National Paediatric Respiratory and Allergy Nurses Group (NPRANG), and is a member of the Primary Care Respiratory Society’s Education Committee.

Ms Viv Marsh discloses: Advisory board or panel fees from Allergy Therapeutics. Speaker’s bureau fees from Napp Pharmaceuticals
Ms Monique Cooper

Miami, FL, USA

Monique Cooper is a parent advocate to those who have children with asthma, attention deficit hyperactivity disorder (ADHD) and anxiety. read more

Monique is co-author of a children’s book series about her son’s disabilities. She co-founded the Javan Allison Foundation after gaining certification to bring awareness to mental health and anxiety, and she is the founder of Success Starts with Me, a mentoring programme for children. Monique continues to tackle several projects empowering children like her son, Javan, who suffer from the three As (asthma, anxiety and ADHD).

Because of her great work in the community, Monique has been honoured by the city of Miami Gardens as one of the “Ordinary Women, doing Extraordinary Things”.

Ms Monique Cooper has no interests/relationships or affiliations to disclose in relation to this activity.
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This Activity Is Funded By:

An independent medical education grant from Sanofi and Regeneron Pharmaceuticals. This activity is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 13 February 2023. Date credits expire: 13 February 2024.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Which of the following tests can be conducted in most primary care settings and can identify a risk factor for children with severe type 2 asthma?
 Correct

The GINA strategy recommends assessing patients risk factors for future exacerbations, such as blood eosinophil levels. Blood eosinophil count can also be used to guide the choice of biologic treatment and may be predictive of response to treatment.

Abbreviation

GINA, Global Initiative for Asthma.

Reference

Global Initiative for Asthma. Available at: www.ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf (accessed 26 January 2023).

Question 2/5
Which of the following is a key mediator of type 2 inflammation and a target for biological therapy in severe asthma?

IgA, immunoglobulin A; IgE, immunoglobulin E; IL-2, interleukin 2; TNF, tumour necrosis factor.
 Correct

Type 2 inflammation is mediated by cytokines such as IL-5 (which promotes eosinophil maturation, activation and trafficking), IL-4 and IL-13, which both stimulate B-cell class switching to produce IgE.1,2 Omalizumab is an anti-IgE monoclonal antibody approved by both the FDA and the EMA for the treatment of children with severe asthma aged 6 years and older.3,4

Abbreviations

EMA, European Medicines Agency; FDA, Food and Drug Administration; IgE, immunoglobulin E; IL, interleukin.

References

  1. Busse WW, et al. Eur Respir J. 2021;58:2003393.
  2. Maspero J, et al. ERJ Open Res. 2022;8:00576-2021.
  3. FDA. Omalizumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/103976s5238lbl.pdf (accessed 26 January 2023).
  4. EMA. Omalizumab SmPC. Available at: www.ema.europa.eu/en/documents/product-information/xolair-epar-product-information_en.pdf (accessed 26 January 2023).
Question 3/5
As a member of the MDT, how can you support parents and carers in order to reduce the risk of exacerbations in a child with severe asthma who is receiving biologic treatment?

MDT, multidisciplinary team.
 Correct

When managing children with severe asthma, even after they are prescribed biologic therapy, the GINA strategy recommends assessing patients for modifiable risk factors (e.g. exposure to food and aeroallergens) as part of routine follow-up. In addition, if poor response to biologic therapy is observed, modifiable risk factors, such as environmental exposures, should be monitored and managed.

Abbreviation

GINA, Global Initiative for Asthma.

Reference

Global Initiative for Asthma. Available at: www.ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf (accessed 26 January 2023).

Question 4/5
Your 10-year-old patient has been diagnosed with asthma and is currently receiving treatment with an ICS and a LABA. His parents explain that he has experienced three exacerbations in the last 5 months, two of which have resulted in ICU admission. He also suffers from atopic dermatitis that has flared up in the past 5 months. How would you advise his parents when proposing treatment with a biologic agent?

ICS, inhaled corticosteroid; ICU, intensive care unit; LABA, long-acting beta agonist.
 Correct

Atopic dermatitis is a common comorbidity in children with asthma.1 As atopic dermatitis and asthma share a common type 2 inflammatory pathophysiology, biologic agents targeting type 2 inflammatory mediators can help to improve symptoms of both asthma and atopic dermatitis.2,3

References

  1. Kumar P, et al. Sudan J Paediatr. 2019;19:88–92.
  2. Maspero J, et al. ERJ Open Res. 2022;8:00576-2021.
  3. Kavanagh JE, et al. Breathe (Sheff). 2021;17(4):210144.
Question 5/5
Which of the following would you consider to be a notable risk factor for severe asthma in your paediatric patients?

COVID-19, coronavirus disease 2019.
 Correct

Perennial allergic rhinitis is considered to be the most severe phenotype of rhinitis and the most likely to be associated with difficult-to-treat asthma.1 Treating coexisting allergic rhinitis in children with asthma can improve asthma control.1,2 Viral respiratory infections may trigger asthma exacerbations, but are not listed as risk factors for difficult-to-treat or severe asthma.2

References

  1. Arasi S, et al. Front Pediatr. 2019;7:28.
  2. Global Initiative for Asthma. Available at: www.ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf (accessed 26 January 2023).
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