UCLH is running a severe asthma service for patients who need extra help to manage their condition.
Around five percent of the nearly five million asthmatics in the UK have symptoms that are not controlled by standard inhaled treatments.
These patients are at risk of asthma attacks requiring steroid tablets, hospital admissions, or in over 1000 cases every year of death from asthma. Many run into side effects from long term use of oral steroids including osteoporosis, diabetes, hypertension and weight gain.
Excitingly we now have monoclonal antibody treatment that can greatly reduce the morbidity suffered by these patients, and can reduce their need for oral steroids.
Currently we have Omalizumab, an antibody that blocks the allergic cascade and can reduce the frequency of asthma attacks and requirement for steroids by more than 50%.
Soon we will have other biologics. Clearly it is important to confirm diagnosis and adherence with inhalers before using these new agents.
We now know that different asthma patients have different patterns of airway inflammation, so it is important to fully characterise these before selecting who to treat with potentially expensive biologics in order to optimise outcomes.
For example only those with allergic asthma and a certain blood level of allergic antibodies might benefit from omalizumab (anti-IgE), whereas others might benefit from intervention in a different pathway such as Mepolizumab for eosinophilic disease which should be later this year.
The UCLH team includes two consultant physicians, a dedicated clinical nurse specialist, a physiotherapist, a dietician, a psychologist and a pathway coordinator.
The team works closely with the allergy and rhinology department at the Royal National Throat Nose and Ear Hospital and the senior respiratory pharmacist at UCLH as well as key related specialties including rheumatology, gastroenterology and bariatrics.
After outpatient review selected patients are invited to attend for two day case visits: one to the RNTNEH for CNS, psychology, allergy and ENT assessment, the other at UCLH for CT scan, lung function and physiotherapy input. Results are discussed at our MDT, where a treatment plan is suggested for later discussion with the patient.
We are happy to assess:
- adults (16 and over)
- uncontrolled asthma (2 or more courses of prednisolone in the last year)
- the diagnosis is in doubt after spirometry and assessment of bronchodilator reversibility
after hospital admission or two or more A&E visits.
Contact: Rachel Parratt, asthma service pathway coordinator
020 3447 9476 (fax).