A Medical Home for Challenging Asthma Patients

For the third time since 2010, the Asthma and Allergy Foundation of America put Richmond and the surrounding area at the top of the list of worst places to live for asthmatics. According to UVA pediatric pulmonologist and asthma researcher W. Gerald Teague, MD, the AAFA “Asthma Capitals” report reveals that, in this area, asthma is poorly controlled among children and adults. “These results indicate that there is a real need in Central Virginia for severe asthma treatment,” says Teague.

“Those with severe asthma are a challenge to manage,” he explains. “Even with the right medication, they still have poorly controlled asthma. They have frequent exacerbations or attacks, and they consume a lot of healthcare resources. Approximately 20 percent of asthma patients require 80 percent of asthma resources.”

To respond to the needs of young asthmatics in our area, UVA Children’s Hospital started its Severe Asthma Program in 2009. The comprehensive program includes both clinical services and research efforts specifically tailored to the needs of pediatric patients. “There are few programs like this one in the country. It takes a high level of experience and skill to provide the comprehensive services these patients need,” says Teague. Highlights of the program include:

Comprehensive Diagnostics
Patients referred to the Severe Asthma Program receive a thorough assessment that includes a detailed lung function evaluation, in addition to pulse oximetry to measure oxygen levels and blood tests to identify specific markers that may indicate asthma triggers. Pediatric allergists and immunologists provide further insight into allergic mechanisms. More in-depth tests include a diagnostic bronchoscopy to examine airways and a bronchial lavage to identify areas of inflammation, infection or aspiration.

Tailored Treatments
These comprehensive diagnostic tests inform which combination of medication and therapy will be most effective for each individual patient. “We are able to tailor treatment to suit each child’s condition, adapting as necessary,” says Teague.

Because of UVA’s active participation in asthma research, some of the treatments offered at UVA are not widely available elsewhere. For example, those with allergic asthma may receive omalizumab, an injectable medication shown to be effective for this patient population. Bronchial Thermoplasty, approved for use in adults and young adults, is another novel treatment option under review at UVA that Teague says will become available as a research procedure to pediatric patients within the next year.

“Bronchial Thermoplasty involves three bronchoscopies, during which a probe applies direct heat or thermal energy to the smooth muscle within the dividing airways. This changes the muscle so that it isn’t as twitchy and doesn’t restrict airflow,” explains Teague. “It isn’t a cure, but for severe patients with life-threatening asthma, it is one promising option to control symptoms.”

Ongoing Research
The Severe Asthma Program at UVA Children’s Hospital has a robust clinical trials component, with studies funded by both the American Lung Association and the National Institutes of Health. “We have dedicated resources to explore improved treatments for children with asthma,” says Teague.

One of the studies currently open is a longitudinal study funded by the NIH evaluating how well asthma patients respond to steroids. “Steroids are given all the time to treat asthma,” says Teague. “But how well do they really work for individual patients?” UVA is one of only nine U.S. centers participating in the steroid response trial, which will follow patients for three years, characterizing their asthma in a detailed way that will hopefully shed light on when steroids are the best option and when an alternative therapy should be used.

See a complete list of asthma clinical trials by searching “asthma” within the UVA Clinical Trials database.

Commitment to Quality
The Severe Asthma Program has grown steadily over the past five years. Along the way, Teague and his colleagues have maintained a consistent quality focus, keeping careful safety records on each of the patients treated. The team also created an inpatient quality program for admitted asthma patients. “We chose key indicators of good asthma management and we met those guidelines with 100 percent compliance,” says Teague. A video highlighting their quality efforts received a national award from the Robert Wood Johnson Foundation. Watch it here.

Once it transitions into its new location at the Battle Building, the Severe Asthma Program will have a dedicated day (Thursday) to see patients with uncontrolled asthma. “If you have a patient who is not responding to treatment, we want to see him or her,” says Teague. “Our focus is children, but we will see young adults up to age 30 if asthma is their primary issue.”

To reach those patients outside of the Charlottesville area, UVA Children’s Hospital is establishing satellite offices for this program. One consult location is in Lynchburg and another, to come later this year, will serve patients in the Shenandoah Valley. For more information, contact the clinic at 434.982.3654.