Background The 2013 NHS England service specifications for severe asthma aimed to develop a limited number of high volume specialist hub centres. These centres would have a multi-disciplinary team (MDT) working to improve patient outcomes and reduce healthcare costs. In the North West we have developed a networked approach to specialised severe asthma services; the first Operation Delivery Network (ODN) for a chronic disease. Representatives from 11 NHS Trusts and a central hub undertake a monthly virtual MDT meeting with physicians, nurses, pharmacists, physiotherapists, clinical psychologists, speech and language therapists, and radiologists represented. All patients being considered for specialised treatments undergo MDT discussion for consensus approval of treatment. Aim To summarise the experience and case-mix encountered during the first 4 years of operation of our regional virtual severe asthma MDT. Methods We reviewed all cases discussed at the MDT between January 2015 and June 2018. Proformas are submitted via nhs.net accounts and data entered into a central database by MDT coordinator. All biologic proformas are pre-assessed by the ODN Pharmacist and Specialist nurse to ensure compliance with the NICE guidelines. Results During this period 41 meetings were held, with 933 cases discussed. Omalizumab was approved in 78% of cases submitted, BT in 39%, mepolizumab in 84% and reslizumab in 94%. The most common reasons for non-approval of omalizumab were insufficient steroid requirement, poor adherence and lack of allergy to perennial allergen. The most common reasons for non-approval to mepolizumab and reslizumab were poor adherence and lack of evidence of raised eosinophil levels within the stated 12 month period. The potential 5 year cost saving of high cost therapies not approved at the Central hub is estimated to be £7.5 million. Conclusion A multi-site virtual severe asthma MDT meeting facilitates expert care across a wide geographical area, ensures governance in the use of novel and expensive therapies, strengthens collaboration and aims to improve patient care. Reference Ryan D, et al. The UK's largest severe asthma multidisciplinary team meeting; experience from the first 18 months. ThoraxDec 2016:71(3);A5.

Background Severe asthma comprises 5% of all asthma, but over 50% of the asthma healthcare burden. With multi-disciplinary team (MDT) working there is potential to improve patient outcomes and reduce healthcare costs. In 2013 NHS England produced service specifications for severe asthma aiming to develop a limited number of high volume specialist centres. In the North West we have developed a networked approach to specialised severe asthma services; the first Operation Delivery Network for a chronic disease. Representatives from 11 NHS Trusts and a central hub undertake a monthly virtual MDT meeting, with physicians, nurses, physiotherapists, clinical psychologists, speech and language therapists, allergists, pathologists and radiologists represented. All patients being considered for specialised treatments undergo MDT discussion for consensus approval of treatment. Aim To summarise the experience and case-mix encountered during the first 18 months of operation of our regional virtual severe asthma MDT Methods We reviewed all cases discussed at the MDT between January 2015 and June 2016. Cases were submitted online via nhs.net accounts, and data entered into a central database managed by two MDT coordinators for MDT discussion. Results During this period 17 meetings were held, with 208 case-submissions representing 185 patients, mean (SD) 12 (7) discussions per meeting. Indications for case submission included proposals for use of omalizumab, bronchial thermoplasty (BT), and steroid-sparing therapies, and for the discussion of patients with complex clinical issues, often managed across multiple sites. Omalizumab was approved in 81% of cases submitted, and BT in 39%, with more of the latter requiring multiple discussions (30% versus 2%) The most common reasons for non-approval of omalizumab were insufficient steroid requirement, poor adherence, and lack of allergy to a perennial allergen. Thermoplasty was not approved or listed for re-discussion for a variety of reasons, including 10 (43%) that required further investigation. Conclusion We describe our early experience of a multi-site virtual severe asthma MDT meeting facilitating expert care across a wide geographical area. This ensures governance in the use of novel and expensive severe asthma therapies, strengthens regional collaborations and ultimately aims to provide better patient care.

RATIONALE: In this study we analyzed family history, ethnicity, body mass index, allergic rhinitis, and eczema and assessed their risk for persistent asthma.METHODS: The study population included 381 children who were 5-18 years old that were treated on the Breathmobile, a fully equipped mobile asthma clinic. Patients who were taking controller medications were excluded due to possible confounding factors.RESULTS: A greater percentage of African-American children had moderate to severe persistent asthma (16.7%) compared to Hispanic children and other ethnicities, 5.8% and 8.1% respectively (p = .019). Children with obesity (BMI > 30) were more likely to have moderate to severe asthma (37.9%) compared to normal (21.6%, BMI < 25) and overweight children (21.5%, BMI25-30), p = .043. In terms of family history, a significantly greater proportion of children had persisent disease who had 2 parents with asthma compared to the mean of all other categories combined (58.3% vs. 31%, p = .048). Other categories that had persistent asthma included 1 parent (37%), distant relatives only (33%), siblings only (11.1%), siblings and distant relatives only (25%), and no family history of asthma (22%). Children with chronic nasal symptoms were more likely to have persistent asthma compared to children with intermittent or no nasal symptoms (47.3%, 22.9%, and 9.8% respectively, p < .001). Children with eczema had more persistent asthma compared to children with no eczema (p = .009).CONCLUSIONS: Persistent asthma was observed significantly more often in children with 2 asthmatic parents, and children with chronic rhinitis and eczema. Moderate to severe persistent asthma was observed significantly more often in African-American children, and obese children with BMI > 30. RATIONALE: In this study we analyzed family history, ethnicity, body mass index, allergic rhinitis, and eczema and assessed their risk for persistent asthma. METHODS: The study population included 381 children who were 5-18 years old that were treated on the Breathmobile, a fully equipped mobile asthma clinic. Patients who were taking controller medications were excluded due to possible confounding factors. RESULTS: A greater percentage of African-American children had moderate to severe persistent asthma (16.7%) compared to Hispanic children and other ethnicities, 5.8% and 8.1% respectively (p = .019). Children with obesity (BMI > 30) were more likely to have moderate to severe asthma (37.9%) compared to normal (21.6%, BMI < 25) and overweight children (21.5%, BMI25-30), p = .043. In terms of family history, a significantly greater proportion of children had persisent disease who had 2 parents with asthma compared to the mean of all other categories combined (58.3% vs. 31%, p = .048). Other categories that had persistent asthma included 1 parent (37%), distant relatives only (33%), siblings only (11.1%), siblings and distant relatives only (25%), and no family history of asthma (22%). Children with chronic nasal symptoms were more likely to have persistent asthma compared to children with intermittent or no nasal symptoms (47.3%, 22.9%, and 9.8% respectively, p < .001). Children with eczema had more persistent asthma compared to children with no eczema (p = .009). CONCLUSIONS: Persistent asthma was observed significantly more often in children with 2 asthmatic parents, and children with chronic rhinitis and eczema. Moderate to severe persistent asthma was observed significantly more often in African-American children, and obese children with BMI > 30.