From hospital to home: virtually observed administration of biologics in children with severe asthma during covid-19

Introduction and ObjectivesChildren with severe asthma receiving biologic injections, require 2–4 weekly hospital visits Omalizumab and mepolizumab are licensed for home use, however data on the safety of home administration in children is lacking In March 2020 due to Covid-19, services urgently needed to be redesigned to reduce footfall within the hospital and protect shielding patients and we trialled home administration MethodsFamilies suitable for home-administration were identified by the multidisciplinary team (MDT) If they accepted, they were then consented and attended hospital for a face to face, two-hour training session with the Clinical Nurse Specialist (CNS) Subsequent injections were supervised by video call with the CNS Spirometry, measured using a home spirometer (Nuvoair®), Asthma Control Test (ACT), Paediatric Asthma Quality of Life Questionnaire (PAQLQ), oral corticosteroid (OCS) requirement and unscheduled healthcare visits were documented 4 weekly ResultsOf 23 patients, 16 (70%) were identified by the MDT as suitable for home-administration;14 families agreed to this recommendation and 2 patients agreed to local services administering it All were trained within four weeks 7 patients were unsuitable (dose not licensed for home administration n=1;parent not wanting to administer n=2;safeguarding concerns n=2, previous mild reaction n=1;not fully established on biologic, n=1) We initially encountered some problems including parents not giving a full dose (1) and breaking the syringe (1) However, video call supervision ensured issues were addressed in real time and appropriate action taken There were no adverse effects Forced expiratory volume in one second (FEV1) remained unchanged, unscheduled healthcare visits and OCS courses did not increase with virtually observed home-administration of biologics ACT and PAQLQ scores improved during the first 4 months of home-administration ConclusionsVirtually observed home-administration of omalizumab and mepolizumab is a feasible and safe option To our knowledge we were the first UK paediatric centre to implement this model, with home spirometry and video calls supporting home-administration Consequently, this has changed our practice and once established, virtually observed home-administration can be offered to suitable families, being mindful of the financial and time implications this high level service requires