Severe Asthma in Children
There are different degrees of asthma. People with asthma are generally categorized as having mild-to-moderate asthma or moderate-to-severe asthma. There are two main types of medications for asthma. Both of them are inhaled into the airways. There are controllers, and there are relievers. If these medications are not controlling a child’s asthma despite being compliant, then it may mean that a child has Severe Asthma.
What to do if you suspect your child has Severe Asthma
There are some tell-tale signs to look for in a child who has Severe Asthma. If your child is having symptoms just about every day and their asthma is affecting their sleep—even though they are taking high doses of inhaled or oral corticosteroids to control their asthma and inflammation in their airways—that may mean that your child has Severe Asthma.
As a parent, you should ensure your child is taking their medication as prescribed. If your child is following their treatment plan and continues to have symptoms and is not well-controlled, your child may have Severe Asthma.
You should bring your child to a doctor like an allergist or to a specialist respiratory team if you suspect your child has Severe Asthma. The allergist or respiratory specialists may do several tests to confirm that your child has Severe Asthma. If your child does have Severe Asthma, there are now new medication options available for your child that will help them control their asthma. These medications are called biologics. Even though your child has Severe Asthma, it does not mean that they face a hard road ahead. They may be able to live a normal life and enjoy life to the fullest.
What is a biologic?
A biologic is a drug that is produced from the cells of living organisms, like plants or animals. There is now greater understanding of the immune system of a patient who has Severe Asthma. Biologics are medications that target the cells in the immune system that drive asthma. Specifically, there are white blood cells called eosinophils that are involved in the development of Severe Asthma.
If your child has Severe Asthma, a biologic may be the right medication to manage their asthma. Your child’s doctor can figure out if a biologic is the right choice for your child who has Severe Asthma and will discuss with you all that is involved with using a biologic treatment for your child.
Biologics are not inhaled or taken by mouth like a pill. They are given intravenously or given as a prick under the skin, which is called subcutaneously. Because of the way that biologics are given, they need to be given at a doctor’s office or a healthcare facility. If your child has a good response to a biologic, they may have to rely less often on oral steroids or inhaled steroids to help control their asthma. The use of biologic for your child with Severe Asthma may mean less asthma attacks, fewer trips to hospital emergency rooms because of asthma attacks, fewer school and work days will be missed, and overall quality of life may be improved for your child and for the whole family.
Available and emerging biologic treatment options for children with Severe Asthma
A child with Severe Asthma may not find benefit from using standard medications for asthma like inhaled or oral corticosteroids and their relievers. There are newer medications called “biologics” or biologic agents or biologic therapies that are becoming available to treat Severe Asthma. They can be used for adults who have Severe Asthma and for children who have Severe Asthma. The biologics are very safe medications, but some people who take biologic treatments experience soreness at the site on the body where they were injected.
Some of the biologics that are available and will become available in the future are aimed at eosinophils, which are white blood cells in the immune system. Another biologic targets an antibody called Immunoglobulin E (IgE), and still another targets two molecules that trigger allergic inflammation.
Omalizumab is a biologic that targets IgE, is injected under the skin (called subcutaneously), and can be used in children aged six and older who have severe asthma that is not controlled with inhaled corticosteroids. It has been studied in children as young as six years of age and can be used to treat asthma in children as young as six.
Mepolizumab is a biologic that became available in Canada in 2020. It comes in an auto-injector and can be used for children aged 6 and older. This treatment targets eosinophils, and too many eosinophils may lead to inflammation in your lungs. Inflammation can cause severe asthma attacks. Because mepolizumab targets eosinophils and the cytokine IL-5, it is called an inhibitor of IL-5. A simple blood test can measure the number of eosinophils in your child’s blood to know if there are too many and if your child can benefit from mepolizumab. Mepolizumab is another therapy to be used in addition to inhaled corticosteroids to control your child’s asthma.
Reslizumab is also a biologic that treats Severe Asthma that is driven by too many eosinophils in the blood. It also is an add-on therapy to inhaled corticosteroids. In Canada, for the moment, this biologic is only available for adults.
Benralizumab is also a biologic that gets rid of too many eosinophils that are in the blood of people who have severe asthma. In Canada, it is available as an add-on treatment to inhaled corticosteroids for adults at this time.
Dupilumab is a biologic approved in Canada for the treatment of adult patients with Severe Asthma in patients 12 years and older. This biologic is also used to treat a skin condition called atopic dermatitis or eczema and targets cytokines in the immune system. It targets IL-4 and IL-13. It can be an add-on therapy for children who continue to have asthma despite using inhaled corticosteroids. It is taken as an injection under the skin (called subcutaneous).
Learn more about biologic treatment for Severe Asthma:
Asthma & Allergy HelpLine
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Severe Asthma Patient Charter
Six guiding principles set out to define what people with Severe Asthma should expect for the management of their disease and what should constitute a basic standard of care, in line with the latest science and best practice understanding from existing Severe Asthma care services. [Click here to download in French].