Current Practices and Variations Among Pediatric Severe Asthma Programs in the United States-The North American...

Severe and difficult to treat asthma in children is a complex condition causing significant morbidity and associated healthcare costs. While treatment guidelines exist for severe asthma, optimal treatment approaches for the pediatric population are less well established. Furthermore, best practices regarding real world management and implementation of guidelines for the severe pediatric asthma population are lacking. In order to provide care for this population, institutions around the United States have developed multidisciplinary severe pediatric asthma programs (SPAPs). In recent years, the North American Severe Pediatric Asthma Consortium (NASPAC) was established as a mechanism for SPAPs to collaborate and share expertise in pediatric severe asthma. We describe the structure of the individual programs within NASPAC, as well as similarities and differences between them.

Study design consisted of a cross-sectional observational framework model, utilizing a Redcap survey that was distributed to sixteen SPAPs in 2024. Survey questions included total and new patient volume, type of staff, frequency of SPAP sessions, eligibility criteria for enrollment in the SPAP, and typical initial evaluation once enrolled. Twelve centers had completed prior surveys regarding patient volume in 2018 and 2021, and this data was used for comparison.

Fourteen centers responded to the 2024 survey. The centers were most similar in their incorporation of core personnel (pulmonologists, allergists, social workers, asthma educators), and the morbidity measures used for their clinic inclusion criteria. Almost all SPAPs had a basic initial evaluation including medication and technique review, adherence evaluation/discussion and spirometry. Significant variability was seen in presence of additional staff (psychologists, endocrinologists, nutritionists), and additional radiologic and laboratory testing at initial evaluation.

Significant similarities exist among fourteen independent severe pediatric asthma programs throughout the United States. However, practice variability was evident between centers. The formation of NASPAC provides opportunities for research and collaborative initiatives, as well as to establish best practices for real world management of the severe and difficult to treat pediatric asthma population.