Biologics for paediatric severe asthma: trick or TREAT?

While most asthma in UK children can be controlled with low-moderate dose inhaled corticosteroids (ICS), there remains a small group with severe disease and poor control despite maximal treatment whose needs are unmet because of discrimination compared to adults. Severe asthma is a commissioned service for adults with only named specialist centres able to assess patients and prescribe biologics. A systematic assessment at a dedicated severe asthma centre is associated with improved quality of life and asthma control and a reduction in health-care utilisation(1). This multidisciplinary assessment helps to identify remediable factors such as poor adherence and ensures that appropriate patients are started on costly biologics. In contrast, although international guidelines exist(2), there is no such service provision or specification for children, despite clear evidence of their long-term morbidity, including development of chronic obstructive pulmonary disease in adulthood(3), and the potential risks associated with the prescription of biologics.