Transcription:

Tiffany Kaczorowski: Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Tiffany Kaczorowski. Today, we're talking with Dr. Terri Macgruder about asthma in children and the use of biologics, asthma biologics in children. Dr. Macgruder is an Associate Professor in the UAB, that's the University of Alabama at Birmingham Department of Pediatrics, the Division of Pulmonary and Sleep Medicine, and she's the Director of the Pulmonary Asthma Program and Director of the Pulmonary Technology Dependence Program at Children's. So welcome, Dr. Macgruder.

Dr. Terri Macgruder: Thank you, Tiffany, for having me.

Tiffany Kaczorowski: So we're talking about asthma, and then specifically we'll talk about asthma biologics. Let's just start with asthma and the different types of asthma. And then we can go into the details with the biologics.

Dr. Terri Macgruder: So as many know, pediatric asthma is a very common chronic disease of childhood. It affects over 6 million children in the US. That's about 8% of all children, so it's very common. The range of asthma, it's what we consider a heterogeneous disease. That there's a lot of different symptoms and ranges of disease. And so some children can have really mild symptoms that require medicines once or twice a year. And some children have much more severe symptoms that require frequent daily medications and still with those daily medications still struggle to achieve disease control.

And that's really where asthma biologics come in. So asthma biologics are a category of therapies that have been developed and targeted over the last several years that really target difficult to treat asthma. Asthma that's not well-controlled on standard therapies. Um, they're typically injectable, um, but they have really transformed the treatment of severe asthma for children. And in the last several years, they've become much more available, because some of them are able to be given at home, which transforms the access across a state like rural Alabama, for families not to travel to Birmingham or to larger cities to have to get this from their asthma specialist.

Tiffany Kaczorowski: Okay. Very recently, these different therapies have been developed.

Dr. Terri Macgruder: Well I think that we've had a few that have been around for several years, but what's new is that some of them are now FDA approved for children. So a lot of these medicines have been around a little bit longer for adults. Some of them have indications for additional diseases, such as eczema, eosinophilic esophogitis, eosinophilic pneumonia. So there's a range of diseases that some of these medicines are used for. But I think what's really transformed in the last couple years is the ability to have options available. We had one that was available for longer time. And then in the last couple of years, we've had three more added that are available for children and adolescent. And currently, three of the four are in certain age groups able to be given at home, which is again, really improves access for families.

Tiffany Kaczorowski:  Absolutely. So I would imagine that when you're talking about these kids with severe asthma and hard to control asthma, some of them would be the ones that would end up in our emergency department.

Dr. Terri Macgruder: Yes, absolutely. There are, uh, children that are really high risk for hospitalizations and missing a lot of school. Their parents often miss a lot of work. And in the past we've had great therapies for asthma and the majority of children can do very well with our standard therapies, but there's a subset of kids, just as the adults with asthma similarly, that don't respond as well. And so these class of medications really target those patients, also too these biologics target, uh, children and adults that have what we consider eosinophilic asthma or T2-high asthma, which is kind of the way your body's immune response kind of reacts to different irritants and viruses that some of them have a more kind of eosinophilic allergic response.

And these biologics really target certain inflammatory pathways in your immune system. And so they really are targeted therapies. Um, most of them are monoclonal antibodies that are injected or there's some that are available to adults that are IV form.

Tiffany Kaczorowski: So would you say that some of these kids are experiencing problems like around a certain time of year where the asthma flares up and it's extremely bad, so you can kind of predict when they might need the biologic therapy around.

Dr. Terri Macgruder: So typically children that have asthma, that's not as well controlled, can clearly have seasonal peaks and valleys in their symptoms. Typically, these biologics are given long-term. So once you start a therapy, depending on the therapy, some are given every two to four weeks. Some are given every eight weeks, depending on the biologic chosen by the asthma specialist.

Tiffany Kaczorowski: Let's talk about that when and where these patients would be able to get the injection. So some of them would come into the hospital on a regular basis?

Dr. Terri Macgruder: Typically, these biologics would be recommended or provided through asthma specialists, which would be pulmonologists, allergists typically are the ones that are going to be providing these. Historically, they've always been given in the office. We often start children and adolescents in the office. And then if they're able to, we transition them to home administration with support for them to do that. A lot of the biologics, their manufacturers provide some support for home as well in terms of if they're having trouble with injections, their shipments to homes, those kinds of things.

Tiffany Kaczorowski: So does that mean monetary support?

Dr. Terri Macgruder: Uh, we have to seek through, uh, insurance companies for, uh, these biologics and children typically may have to have allergy testing or blood work to see if they qualify or meet criteria for these biologic therapies. Depending on insurance, I think that oftentimes we can get it covered, but there are some support systems to help with co-pays for families that otherwise would have difficulty accessing them.

Tiffany Kaczorowski: So when you're talking about the biologics has really transformed the lives of children and families with severe asthma, give me a typical scenario and what that would mean for that family before this access to the biologics has become so readily available.

Dr. Terri Macgruder: For many of these children, there are children that often, um, despite really aggressive daily therapy still suffer from a lot of symptoms. So they often can't participate in PE, really struggled to participate in sports, often miss family events due to illness. Families will talk about how unpredictable it is and difficult to plan. And some of my families will say, "He's always in the hospital over Christmas," and those kinds of unpredictable exacerbations that asthma can cause.

I have a teenager who just said, "I just feel like I have normal asthma now." So he feels like, "Oh, this is what I can feel like. I still have asthma, but..." You know, there's a patient that I have taken care of him since he was probably five years old. And when he was first five years old, his asthma really has been severe the whole time, but these weren't available at the time. And so for him now to be able to do this at an adolescent, he's like, "I don't need these other medicines. I can just use these."

So it has really transformed some of these children's and family's lives. I think that we have some families that have had repeated hospitalizations. Many of these patients, their families, or their children are flown to Children's from rural areas of the state, causes lot of stress on families. And some of them have been hospitalized in over a year. And they just are so overwhelmed by that, because they are used to three or four times a year, maybe having to go to the ER. And this is despite doing everything right every day. Some cases children, even despite our best medicines, they don't work so well. And this class of medications has really transformed care for them.

Tiffany Kaczorowski: So you said about four medications now that are available and it just depends on that person, that child as to which type you'll recommend.

Dr. Terri Macgruder: Yes. Typically we have to do some allergy testing and blood work to see if you'll qualify for them. Again, tends to be what we consider a targeted towards allergic or eosinophilic type of asthma. And I would just recommend for families, if you're child is struggling with asthma management or your medicines, to talk to your primary care physician about seeing an asthma specialist, because they can really sort out kind of what type of asthma your child has, what therapies would be the most beneficial to you, and also too, depending on your age and your type of asthma and your other circumstances that may impact whether or not you want to come to the office and receive your medicine or be at home, there's options now that we can choose from for your child.

Tiffany Kaczorowski: I want to point out that we do have a website, a resource that people can go to on the Children's website, it's childrensal.org/asthma. And then you guys have a webinar coming up if people want to learn more information,

Dr. Terri Macgruder: I am super excited about this. So on Thursday, November 12th, we will do a webinar webcast partnering with the pediatric pulmonary centers here at UAB and the Alabama Department of Public Health. And we'll be focusing on the expanded use of biologics to treat pediatric asthma. I think one of the most exciting parts about this is you'll hear from a family. And I think it's super important to hear families' perspectives about how the use of this medications has impacted their family, kind of the before and after. So I'm super excited to have a family participate and share that with other families that might be interested.

Absolutely. We will post a link to that registration and to that webinar in the show notes. Any other asthma updates or information you want to share?

I would encourage everybody to get a flu vaccine. And if your doctor has prescribed daily asthma medications for your children, I would try to make sure you take them. It's our best chance of staying well through the winter months. Um, we don't know what flu season is going to look like with COVID-19. So we're just encouraging our families to keep their children's asthma as well-controlled as possible and get their flu vaccine and wear their mask and wash their hands and stay away from extra people.

Tiffany Kaczorowski: Well, thanks so much, Dr. Macgruder, for joining us.

Dr. Terri Macgruder: Thanks for having me.

Tiffany Kaczorowski: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at childrensal.org/insidepediatrics.