Drug treatments only for severe asthma
Children with severe asthma are likely to take multiple drugs (mentioned elsewhere in the Asthma treatment guidance), in addition to one or several of the drugs in this section. Children taking drugs in this section will always be classified in the severe asthma category. It is usually vital that the drugs in this section are taken regularly, as prescribed.
Immunomodulating drugs
These drugs reduce asthma associated inflammation of the lungs and thereby improve asthma control. These drugs have serious side effects and treatment will be carefully monitored -:
- Ciclosporin e.g. Neoral
- Tacrolimus
- Azathioprine e.g. Imuran
- Mycophenolate mofetil e.g. Cellcept
These drugs are given in tablet form and will be taken regularly once or twice daily. Side effects such as kidney failure do occur and are serious. Such treatment is likely to be given at a specialist centre with these drugs being carefully monitored by a Consultant Paediatrician.
Regular oral steroids
The main drug used is prednisolone. In severe asthma, oral steroids are given every day e.g. prednisolone 5mg once a day. The lowest dose that controls asthma is used. Steroids are used like this only as a last resort because side effects can be serious. The most common side effect is weight gain. Other effects include diabetes, osteoporosis and growth retardation.
Terbutaline subcutaneous continuous infusion
This treatment is used for severe asthma which is uncontrolled with maximal therapy including high dose inhaled steroids and/or oral steroids. Children using a terbutaline pump are likely to be on multiple other medications as well as the terbutaline subcutaneous pump. The drug is administered using a syringe and pump device approximately the size of a mobile telephone. The drug is given as a 24 hour infusion through a needle placed under the skin and the dose is adjusted depending on asthma control. The device and care needs associated with it are the same as looking after an insulin pump for a child with difficult to control diabetes.
Monoclonal Antibody treatment (Omalizumab)
This treatment is given every few weeks as an injection in a hospital setting. The monoclonal antibodies combine with Immunoglobulin E (IgE), the antibody which is responsible for recognising and binding with allergens and causing allergic symptoms from asthma to anaphylaxis (severe allergic reaction). Regular treatment with Omalizumab can improve asthma control in children over 12 who have uncontrolled asthma despite maximal treatment on step 3 of the SIGN guidelines.
