Marked Variation in Paediatric Problematic Severe Asthma Services Across Australia and New Zealand

Abstract

AIMS: Asthma affects > 10% of children in Australia and New Zealand (NZ), with up to 5% of those having severe disease, presenting a management challenge. We aimed to survey tertiary paediatric respiratory services across Australia and NZ using a custom-designed questionnaire, to conduct a cross-sectional observational study of the numbers of children with problematic severe asthma (PSA) seen, the number treated with biologic therapy, outpatient clinic/multidisciplinary team (MDT) services available, investigations and tools routinely used and approaches utilised for transition to adult care. METHODS: A custom-designed online survey was distributed via email to Directors of public paediatric respiratory services across Australia and NZ (n = 14). Reminders to prompt completion were emailed regularly over 3 months. RESULTS: All sites provided survey responses. The estimated number of children with PSA across 12 sites was 561 (53 prescribed biologic treatment); two sites felt unable to provide accurate estimations. Most sites (n = 8) did not have a MDT approach either as MDT clinics or meetings; patients were managed in either asthma (n = 7, 50%) or general respiratory clinics. Most sites (85%) utilised questionnaires regarding asthma control for assessment, although some utilised additional questionnaires. Remaining tools and investigations varied widely across centres. Only four sites (29%) had established processes for transition to adult care. CONCLUSIONS: Given notable heterogeneity in service availability and PSA management across tertiary sites, children may experience variability in care dependent on their location. Most centres lack MDT models of care, which are considered the international best-practise standard for management of children with PSA.