Severe Asthma Program

Clinicians in the Severe Asthma Program at Boston Children’s Hospital are leaders in caring for children and young adults with difficult-to-control asthma symptoms or frequent asthma attacks who have not responded to the typical asthma medications and treatments. Our mission is to improve the health of children affected by severe and difficult-to-control asthma by providing a collaborative approach to management and promoting innovative clinical care, research, and education. We want to get your child’s asthma under control so that it does not interfere with their ability to participate in everyday activities such as attending school, participating in sports, and getting a good night’s rest, and to prevent future asthma attacks.

What is severe asthma?

Severe asthma is asthma that is difficult to control and has not responded to the typical medications and treatments. Situations that may indicate your child has severe asthma are:

  • experiencing asthma symptoms (coughing, wheezing, shortness of breath, or chest pain) several times a week despite being on multiple asthma medications, including high dose inhaled steroids
  • having more than one visit to the emergency room or hospitalization for asthma in the last year
  • needing to take oral steroids for asthma symptoms two or more times in the last year

When should my child be seen by the Severe Asthma Program?

If your child has been seen by a pulmonologist or allergist and continues to struggle controlling their asthma (frequent ER visits or oral steroid use), or if they have been hospitalized repeatedly or ever needed care in the ICU for breathing issues related to their asthma, they should consider making an appointment with the Severe Asthma Program.

What makes the Boston Children’s Severe Asthma Program unique?

Our Severe Asthma Program brings together clinicians from an array of specialties to take a coordinated, patient-centered approach to address severe asthma in children. Our team consists of pulmonologists, allergists, asthma nurses, and social workers. Because there are several coexisting conditions, such as chronic sinus infections, airways disorders, gastroesophageal reflux disease (GERD), and sleep apnea, that can either mimic asthma or make asthma harder to control, we also consult with specialists in otolaryngology (ear, nose, and throat), gastroenterology (stomach), and endocrinology (growth and adrenal gland health).

What can you expect when you come to the Severe Asthma Program?

Severe asthma is different for each child, therefore, we take a personalized and comprehensive approach with each patient and family to identify their child’s asthma triggers, develop a treatment plan, and provide emotional and educational support to ensure the best chance of success. An evaluation in the Severe Asthma Program typically takes one to three visits.

Severe asthma evaluation

On the first visit, your child will meet with a pulmonologist and an allergist, a nurse educator, and a social worker. Each member of the team will learn about your child’s experience with asthma and the doctors will examine your child.

Testing for severe asthma

Your child may receive these or other procedures to evaluate your child’s airways, lung function, immune system, and sinuses:

Asthma medication review

We will review the asthma medications your child is taking and will ask questions to understand the effects they are having on your child. We will also ask questions about inhaler use and techniques, and any barriers to taking medications. We will partner with your pharmacy, and sometimes the school nurse, to ensure your child receives the appropriate therapies.

Results review and treatment plan

The doctors will then discuss any available results with you. They will decide if further testing is needed and together they will work with you to establish the best asthma treatment plan for your child, including medications, environmental changes, and education. Subsequent visits are an opportunity to discuss how your child is doing on the recommended treatment plan, any obstacles to the treatment plan, any other tests that might be needed, or any results that might be available.

What type of severe asthma treatments do we offer?

We offer cutting-edge treatments for difficult-to-control asthma including the latest biologic therapies (injectable asthma medications, such as Omalizumab (Xolair), Mepolizumab (Nucala), Benralizumab (Fasenra), Reslizumab (Cinquair), and Dupilumab (Dupixent)). Our treatment plan is carefully customized to meet your child’s specific needs and situation.

Emotional effects of severe asthma

Living with difficult-to-control asthma can take a severe toll on a child’s mental health. That’s why our focus is not only on your child’s physical health but also on their emotional health and wellbeing. We have a dedicated social worker and nurse educator who are committed to helping children and families manage the psychological effects of living with severe asthma.

Supporting patients with severe asthma

Our commitment to your child’s overall health extends beyond our clinic walls. Our team takes a hands-on approach to assess each patient’s asthma triggers in their home. We partner with the Community Asthma Initiative and other services to provide in-home evaluations, and can also perform virtual home assessments. If needed, we will work with landlords to advocate for a safer and healthier living environment for all children.

We also partner with school nurses to guide them on assessing our patients and delivering medications for asthma in school. Since medication adherence (taking medication as directed by the doctor) is a key part of success with an asthma management plan, we provide advice and tips to help ensure your child is taking their asthma medication as directed. In addition, we provide an array of educational resources to help you support your child’s treatment plan.

Experts in severe asthma treatment

Our specialists are known throughout the country for their expertise in treating severe asthma in children and identifying challenging triggers in their home or school environment. They teach other clinicians around the country how to manage some of the most challenging and difficult-to-control cases and improve outcomes. We are also a leader in training the next generation of clinicians.

A leader in severe asthma research and innovation

We are helping to advance the field through our cutting-edge research on severe asthma and effective asthma medicines. Our doctors are senior investigators in the Asthma Clinical Research Center and leaders of their own separate research labs. Our recent and ongoing efforts include:

  • investigating home and school indoor environmental triggers specific to asthma and developing new ways to reduce exposure
  • conducting research funded by the National Institutes of Health to understand asthma and respiratory symptoms in children born prematurely
  • assessing the role of anxiety, depression, and sleep disorders in severe asthma symptoms
  • evaluating virtual home visits to understand potential asthma triggers in individual patients’ homes
  • participating in NIH-funded clinical trials for new therapies for patients with severe asthma
  • understanding how the COVID-19 pandemic affects asthma attacks in children
  • evaluating school-based interventions to improve asthma care