Complex asthma service

Our service is led by Dr Katy Pike and Joanne Miles who is an asthma clinical nurse specialist.

We take a team approach and also ask other professionals to help children and young people with asthma. These include colleagues from

• lung function
• psychology 
• dietetics
• ear, nose and throat (ENT)
• speech and language therapy
• physiotherapy.

The majority of children and young people with asthma will have their symptoms controlled with low-dose inhaled corticosteroids. These children and young people can be managed in primary and or secondary care. A minority of children and young people have difficult asthma and remain uncontrolled despite being prescribed high doses of conventional therapy. For these children and young people systematic specialist evaluation and treatment by a multi-disciplinary team is needed.

The majority of children and young people with difficult asthma have potentially modifiable causes for poor control and most will improve once the basics of asthma management are addressed. It may then be possible to reduce the amount of asthma medication prescribed. Children and young people with difficult asthma can benefit from specialist assessment of alternative diagnoses, aggravating factors and barriers to adherence. Equally important is support across primary, secondary and tertiary care.

Children and young people with on-going poor control despite attention to the basics of asthma management have severe asthma. These children and young people benefit from targeted specialist therapy which can reduce symptoms, hospital admissions, and improve long term health.

• To find out whether asthma is the main or only cause of symptoms
• To recommend treatments for asthma and other causes of symptoms 
• To annually review all aspects of care for children and young people with difficult asthma, including monitoring of side effects and difficulties associated with taking prescribed medication
• To assess the need for and provide where necessary novel drug therapies, including monoclonal therapy, and non-pharmacological treatments, including breathing control exercises and laminar airflow devices
• To liaise with primary and secondary care teams to support the care of individual patients and education and service development

We are happy to receive referrals for children and young people meeting any of the following criteria:

• Prescribed maintenance or frequent courses of oral steroids 
• Under consideration for monoclonal antibody or immunosuppressive treatment 
• On-going poor control despite daily high dose inhaled steroid treatment and at least one additional asthma therapy
• PICU admission, two or more hospital admissions, or three or more courses of oral steroids within the last year
• Uncertainty about asthma diagnosis or suspicion of significant exacerbating factor or additional diagnosis

Please outline in your referral the main reason for referral, current medication and past medication trials, details of previous investigations and of any recent admissions to hospital. Please let us know the name of the consultant responsible for the patient in secondary care and if possible a secure nhsmail contact email.

Our clinic is on Friday mornings. You will see a specialist nurse and doctor and at most appointments we would like you to do lung function tests to test your breathing.

Your appointment will last 45 minutes if you are a new patient and 30 minutes for follow-up appointments. Your letter will outline instructions about lung function testing if you need this. If you are not sure about when or where to attend or any special information about your medication on or before your appointment date please email
Gos-tr.ComplexAsthma@nhs.net or phone us on mobile 07740 545041.

This clinic runs on a Wednesday morning four times a year. Transition clinics are attended by an adult asthma consultant as well as the Great Ormond Street asthma team. This allows for a gradual process of planning, preparing and moving on from children’s services to adult services when the time comes.

Please see the following links for more information about the transition process:

• Video: preparing for adult health services on GOSH website
• Transition to adult health services (202.89 KB)

The clinic runs in a similar way to the routine outpatient appointments. Your appointment will last approximately 45 minutes. It is helpful if you can arrive 30 minutes prior to your appointment time to accommodate lung function/breathing tests to take place first. It may be that during these appointments we can see the young person on their own for part of the consultation.

It can be busy getting in to London in the mornings so leave lots of time and be prepared that you may need to have other tests on the day such as x-rays or visit the pharmacy. It would be very helpful to bring all your medications and devices such as spacers with you.

Find out how to get to GOSH.

It also helps to bring your asthma plan if you have one and any letters you might have from recent hospital visits. Please let us know as early as you can if you would like to change your appointment date or time.

Contacts:

Dr Katharine Pike
Senior Lecturer and Honorary Consultant in Paediatric Respiratory Medicine

Joanne Miles
Asthma Clinical Nurse Specialist
Telephone 020 7405 9200 ext 5914
Mobile 07740 545041
Gos-tr.ComplexAsthma@nhs.net

Resources:

Asthma UK 
Information for health professionals, schools, patients and families, including symptom diaries, food alerts and advice on living with allergy diaries.

Allergy UK
Information for health professionals, schools, patients and families, including what is asthma? How to manage asthma, asthma plans and diaries.

Healthy London Partnership London Asthma Toolkit
Information for health professionals, schools, patients and families, including advice on flu vaccination, smoking cessation, asthma plans and diaries.