Improving outcomes for patients with asthma: how the Asthma Biologics pathway is helping children with asthma in Oldham

A child's hands holding a blue asthma inhaler.

Health Innovation Manchester, alongside expertise from Secondary Care partners and other community organisations in Greater Manchester, is working with local communities to identify, address and minimise healthcare inequalities through projects to improve access to the latest health technologies and medicines.

As part of this, an innovative pilot has launched in Oldham to transform services for children and young people living with asthma and related conditions as well as reduce avoidable harms caused by smoking or second-hand smoke inside the home.

This work links directly to the Innovation for Healthcare Inequalities Programme (InHIP), which is a unique collaboration between the Accelerated Access Collaborative (AAC)NHS England’s National Healthcare Inequalities Improvement Programme and the Academic Health Science Network (AHSN) and delivered in partnership with Greater Manchester Integrated Care System (ICSs).

The pilot, taking place at Royal Oldham Hospital, offers patients Fractional Exhaled Nitric Oxide (FeNO) testing on the ward to monitor inflammation of the lungs, and offers advice and nicotine replacement therapy with support to be smoke-free and ultimately become healthier as a result.

Continued support is provided for the patient, with a repeat test offered in a community-based setting as part of a follow-up asthma consultation. If the child or young person’s asthma is determined to be uncontrolled despite optimising treatment and addressing triggers, they will be referred onto the Asthma Biologics pathway to assess whether they are eligible for biologic therapy medication – these are specialist treatments using antibodies produced from cells in a laboratory which can target specific cells in the body.

Victoria Abbott, Paediatric Asthma Nurse Specialist at The Royal Oldham Hospital, part of the Northern Care Alliance NHS Foundation Trust (NCA), has been supporting a child and his family in Oldham who has a history of asthma and multiple hospital attendances due to exacerbation.

Kai is 8 years old, and his asthma started to deteriorate in December 2020, therefore, he was reviewed by a paediatric consultant with a specialist interest in asthma. Kai was then referred to the severe asthma clinic for further investigation in line with the BTS/SIGN British Guideline on the Management of Asthma. Despite several assessments and optimising treatment, Kai continued to require High Dependency Unit (HDU) admissions at The Royal Oldham Hospital with continued exacerbations.

Following further investigations in the severe asthma service, Kai was commenced onto the Asthma Biologics pathway, and placed on Mepolizumab in March 2023 – one of four NICE approved biologics drugs for severe asthma treatment. The benefits since this course of treatment was taken include:

  • Kai experiences less frequent exacerbations
  • exacerbations are less severe
  • quicker recovery after exacerbations
  • exacerbations are now managed away from HDU (at GP or on the ward)

Victoria Abbott, Paediatric Asthma Nurse Specialist at The Royal Oldham Hospital, part of the Northern Care Alliance NHS Foundation Trust (NCA), said: “Due to the effort professionals have made with raising concerns regarding the quality of the property, the family are due to change address within the next month. This will hopefully continue to have a positive impact on Kai’s asthma. His school attendance has also improved since starting this treatment.

“The objectives for this treatment have been met and hopefully will continue to improve over the coming months. These objectives were measured by the frequency, severity and duration of Kai’s asthma exacerbations and the quantity of the oral steroids that were required. Since starting this treatment, the courses or oral steroids have reduced significantly. This subsequently, reduces the risk of systemic side effects such as adrenal suppression, weight gain, faltering growth and immunosuppression, along with the psychosocial benefits of improved mood, improved sleep which results in improved concentration, therefore achieving improved outcomes at school.

“Taking all these benefits into consideration, Kai has a better quality of life and can enjoy normal childhood activities which is essential for children to grow and develop physically, mentally and emotionally with their peers.”

Kai’s mother said: “I feel like it has improved Kai’s asthma, he is staying out of hospital for longer periods of time and attending school more.”

Dr Prakash Kamath, Divisional Clinical Director at Bury Care Organisation, Northern Care Alliance NHS Foundation Trust (NCA), said: “Kai is one of the few patients who can be described as Severe Asthma. We have an established pathway with colleagues at Royal Manchester Children’s Hospital (RMCH) led by Professor Clare Murray who is an expert in this area.

“Prior to biologics, he has been on the top of asthma treatment ladder and all aspects of care were addressed including compliance, technique, home environment & smoking along with education to both him and his parents.

“His quality of life has improved hugely with this new treatment, and we have rarely seen him since then. Biologics have been a game changer for children in the severe asthma spectrum allowing them to enjoy what a child of their age should be able to do so.”

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