Pioneering Home Monitoring for the Follow-Up of Biologics in Children with Severe Asthma

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Meera Montan

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For children and adolescents with severe asthma, biologic treatments offer an alternative to high doses of corticosteroids, which can present unacceptable side effects such as reduced growth velocity and reduced bone mineral density.* Close monitoring of biologics is crucial to assess if a treatment is working, and if not, to change the asthma management plan as soon as possible. Matthew Atkinson, Respiratory Technician at Royal Manchester Children’s Hospital, shares how his team uses NuvoAir Home with young patients and their parents to help evaluate biologic treatments remotely.

How has remote spirometry worked for you and your young patients?

We started home spirometry with children on biologics in the fall of 2020 as Covid-19 presented challenges for frequent hospital lung function tests to be performed for the follow-up and evaluation of the treatment. We use the NuvoAir platform with both those newly started and already on biologic treatments. I introduce young people to the platform during a face-to-face visit when they are at the hospital seeing their doctor or receiving their biologic treatment injection. We start the process together with downloading the app and setting up an account. I then offer flexible options for further training around the home spirometer and app, so children don’t have to miss additional school time. We may set up a video call after school hours, for example. So far, we haven’t faced any problems with the technology and most find NuvoAir rather intuitive and easy to use. Parents usually support younger children at home with the app as well.

We ask patients to take a lung function test every 2-4 weeks or if they are feeling unwell, which is appreciated by patients and their families. These children are used to doing spirometry, and generally, their technique is quite good. We have found no difference in results compared to our office spirometry.

The NuvoAir provider portal is also easy to use. I review patients' lung function daily in the portal and use the video feature to meet with children and their families as well as the portal’s SMS feature for reminders to take a lung function test or for a video meeting. Going forward I plan to use the SMS feature to provide feedback to patients about recently taken tests. As I gain experience with the platform, I find new ways of working to expand the overall patient experience and journey. I find it has helped in relationship-building with patients with severe asthma who generally have poor lung function. I can start to understand what their normal range or personal best is. I also see how home spirometry motivates some patients to be more proactive. Helping our patients to be more motivated with their own care is so important. This is especially true for older teenagers who need to learn to take a more vital individual role in their own care as they transition to adult services.

The ability to perform lung function results on a more regular basis without compromising quality helps us to keep a better eye on patients and to quickly catch those with decreasing lung function. We can even more closely monitor biologic response which also gives us the ability to monitor if a certain biologic hasn’t had desired effects so a patient can switch to an alternate biologic treatment.

Do you have any advice for other severe asthma pediatric programs that are considering home spirometry with NuvoAir?

I would strongly recommend considering NuvoAir Home for use with young patients and their families. In addition to our severe asthma patients, we also support children with primary ciliary dyskinesia (PCD) in using the platform in coordination with the Leeds Children’s Hospital.

We find there are many pros to consider, which greatly outweigh the cons with starting a new service. These include:

  • ability to monitor lung function more closely,
  • reduction in hospital footfall,
  • less time off school for children and work for parents/guardians,
  • encouragement for patients across different age and ability ranges to become more involved and motivated with their care,
  • further improvement of existing relationships between the hospital team and patient, and
  • improvement of the patient journey and experience with a dedicated centered care alternative.

There are clear opportunities for adult severe asthma care as well. Remote spirometry can help prioritize incoming referrals to specialist care in the UK, support treatment plan decisions and help to monitor biologic treatments.

*Reference: Marseglia G, et al. 2020, 'Biologics to Treat Severe Asthma in Children and Adolescents: A Practical Update', Pediatric Allergy, Immunology, and Pulmonology Vol. 33, No. 4