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In our specialist clinic we emphasise the importance of healthy living but evidence around prevalence of obesity & fitness in this group is sparse Aim: To explore the prevalence of obesity & poor fitness levels in our asthma clinic & identify risk factors for poor fitness Method: Database analysis of routinely collected data for children who attended clinic since July 2018. BMI percentiles were calculated according to the National Child Measurement Programme, UK (93rd-97th percentile=overweight, 98th-99th percentile=very overweight). Fitness levels were assessed using the Chester step test, giving a valid approximation of VO2 max score. Poor fitness and overweight/very overweight were compared (chi-square or Person’s correlation) against demographic details, socioeconomic status (Postcode index of multiple deprivation index), and markers of asthma control, airway obstruction, and airway inflammation. Results: 99 children (median 12 years IQR 10-15;64% male),of whom 79 (80%) completed a fitness test. 44/99 (44%) were overweight/very overweight (15/99 (15%) and 29/99 (29%) respectively). 31/79 (39%) had sub-average or very low fitness levels. This was associated with female sex (p 0.047), older age (p 0.017) & baseline BMI category (p 0.03). Poor fitness was not associated with clinical or physiological markers of asthma severity, or socioeconomic status. Conclusion: Obesity & poor fitness are highly prevalent in children with asthma. Those at risk include girls, older teenagers & overweight children. Proactive screening to identify poor fitness should be conducted in clinics managing children with severe asthma.The impact of improved fitness on asthma control should also be explored.

Asthma is the most common chronic condition of childhood. In this review, we discuss an overview of strategies to empower children and young people with asthma. The key aspects of empowerment are to enable shared decision making and self-management, and help children minimise the impact of asthma on their life. The evidence behind these strategies is either sparse or heterogenous, and it is difficult to identify which interventions are most likely to improve clinical outcomes. Wider determinants of health, in high-resource and low-resource settings, can be disempowering for children with asthma. New approaches to technology could help empower young people with asthma and other chronic health conditions.

Introduction: There is interest in new therapies for severe asthma, and how network clinics can facilitate this. Aims and Objectives: We aimed to: 1) explore comorbidities and adherence issues in children referred to our regional multidisciplinary (MDT) asthma clinic 2) describe the interventions utilised by the specialist medical, psychology, nursing, pharmacy, and physiotherapy teams. Method: Retrospective casenote review of referrals into the clinic since July 2018. We extracted data on demographics, co-morbidities, and issues with inhaler technique and adherence. We summarised medical and non-medical interventions used in the clinic. Results: 52 patients were referred (Median age 13 years [IQR 10-15], 37/52 male; 17/52 (32%) demonstrated persistently low FEV1, and 29/52 (55%) had persistently high FeNO. 45/52 (86%) had suboptimal inhaler technique and/or adherence issues. 31/52 (60%) had concurrent medical issues such as allergy, obesity and adrenal insufficiency. 44/52 (85%) had dysfunctional breathing or low fitness on formal step testing. 40/52 (77%) had psychological comorbidities such as anxiety, depression, and low self-esteem. We changed inhalers in 14 patients and utilised methylprednisolone in 1 patient. Due to these interventions we have not needed to start any patient on biologic therapies, immunomodulators or maintenance oral steroids for asthma, and we successfully stopped these in 4 patients. Conclusion: Inhaler competency and adherence, breathing technique, fitness, and psychological problems are common in children with poor asthma control. Addressing these fundamental issues using an MDT specialist clinic can usually negate the need to step up medical treatment, even in children with severe asthma.