The care of children with asthma benefits from the close links between Royal Brompton Hospital and the National Heart and Lung Institute, part of Imperial College London’s Faculty of Medicine.
The starting point is multidisciplinary care; children with severe asthma have far more than just disordered airway function as their problem.
Assessments by specialist nurses, psychologists and a physiotherapist are just as important as a detailed medical work up. Children come from all over England because they can be offered such a high standard of assessment by the multi-disciplinary team.
Team support for patients
Professor of paediatric respirology and consultant paediatric chest physician, Andy Bush, explains: “Children with severe asthma may in fact have an alternative diagnosis; or be finding it difficult to take their treatment.
“Thankfully, the idea that asthma is caused by stress has long been abandoned; but stress does worsen airway inflammation, and any chronic illness that interrupts the daily life of the child may cause further stresses and strains.
“However, many children referred to the team in fact have truly therapy resistant asthma. Current guidelines for treatment are unhelpful, being a mere haphazard catalogue of treatments that can be tried, with no logical progression.”
Professor Bush continues: “We have pioneered an alternative approach. Using fibre-optic bronchoscopy (a procedure during which a flexible fibre-optic tube is used to evaluate a patient’s lung and airways) we determine why the child is not responding to treatment.
The first series of studies demonstrated the safety of this revolutionary approach: bronchoscopy was found to be safe when performed under general anaesthesia, even in these very fragile children.
“In collaboration with colleagues in lung pathology, thoracic medicine, leukocyte biology, the clinical studies unit, and a number of specialist registrars and visiting fellows, we have begun to understand the different patterns of severe asthma.”
Exciting new therapies
Professor Bush adds: “Whereas many children will respond to steroid tablets, we have found that others have a different sort of inflammation, and appear to respond better to antibiotics. Others have symptoms and very irritable airways, but no inflammation at all; this group do well with drugs that dilate the air passages in the lungs.
“We also discovered that airway scarring is already established to the same degree as adults, in children as young as six years old.
“We plan to extend collaborations within Europe and further afield. We will be applying for European funding for these studies, so we can move to studying the exciting new therapies in carefully defined populations of children with severe asthma.
This is not one disease but many; and a one-size fits all approach to treatment is guaranteed to fail. International collaboration has to be the way forward.”