Severe Asthma Program (SAP)
Asthma and Allergy Foundation of America (AAFA) — Severe Asthma Program
The AAFA Severe Asthma Program (SAP) clinic is a specialized clinic to evaluate patients with severe asthma who may benefit from comprehensive evaluation, therapy and education. This is a collaborative program of the Rady Children’s Hospital and UC San Diego Health divisions of Allergy & Immunology and Pulmonary/Respiratory Medicine, and is led by Bob Geng, M.D., Sydney Leibel, M.D., M.P.H., and Mateja Cernelc-Kohan, M.D.
Clinics are held on the second and third Friday of each month and involve evaluations by a pulmonologist, allergists, clinical pharmacists, a nurse practitioner, research associates and patient educators. The evaluation includes an assessment of the history of asthma and allergies, assessment of prior therapies and clinical response, review of patient and family perspectives on their disease, physical examination and assessment of disease severity and impact on the quality of life. Approaches to evaluation and management are discussed both by the team and the patient and family to determine the most appropriate diagnostic and therapeutic options.
How to Get a Referral
Our SAP clinic is designed to help patients and families with severe/difficult to manage asthma AND allergic rhinitis, food allergies or other lung disorders. In order to be seen in our clinic, your child must be referred by either a Rady Children’s pulmonologist or allergist. Once we have received your referral, we will contact you and help you schedule your appointment. If you believe your child would benefit from being seen at our SAP clinic, please talk to your Rady Children’s pulmonologist or allergist.
What to Expect
The SAP clinic visit is more comprehensive than a typical office visit and will take about two hours. During the visit, you or your child will be evaluated by the pulmonologist, allergist and clinical pharmacist along with other individuals who will assist with the evaluation of asthma severity and educate you or your child and family about the disease. We ask that you come to the clinic open to discussing different treatment options, including inhaled and systemic therapies.
Understanding asthma is vital to successful treatment, and our team has worked together to create educational materials to share with our patients. During your visit, you will meet with a patient educator to review these materials and help answer any additional questions you might have regarding asthma. The frequency of your visits will be determined by the clinic team during your visit, but typically range from once every two to three months.
The clinic uses a standardized set of evaluation tools in order to consistently compare the extent and severity of asthma between visits.
Asthma evaluations include:
- Spirometry – Pulmonary Function Testing
Spirometry is an apparatus that measures the amount of air inhaled and exhaled by the lungs. It measures the movement of air into and out of the lungs, and can identify two different types of abnormal ventilation patterns: obstructive and restrictive. It measures FEV1 (the amount of forced expiratory volume) and FVC (the amount of forced vital capacity). These measurements allow the doctors to evaluate how well the lungs are functioning.
- IOS – Impulse Oscillometry
This apparatus measures the resistance of the airways and lungs to multiple sound frequencies. The IOS allows doctors to assess obstruction in the large and small peripheral airways and to measure bronchodilator response. This is a non-invasive method to assess the mechanics of the lungs using oscillations delivered to the respiratory system by loudspeakers or piston.
- FeNO – Fractional Exchanged Nitric Oxide
The FeNO apparatus measures the amount of nitric oxide in the breath. Nitric oxide is an indicator of inflammation in the lungs; by measuring this molecule the doctors can evaluate the extent of inflammation in the lungs. This is a quick and non-invasive test that is easy for both kids and adults.
- Exercise Provocation (Trigger) Test
This test, which is also called the challenge or trigger test, indicates the sensitivity of the lungs. During this test you will be asked to run on a treadmill while your heart and oxygen levels are monitored. This test helps the doctors determine if exercise triggers asthma symptoms.
- Lung Plethysmography
This is an instrument that can measure changes in volume in the lungs and indicates how much air a person can hold in their lungs. It can also measure how much air is left in your lungs after you exhale for as long as you can.
Many asthma patients also experience problems with allergies. If the patient is experiencing troubling symptoms due to allergies, the allergist can order different testing to assess the cause(s) and evaluate the impact on asthma. Testing includes, but is not limited to:
- Skin prick testing
- Blood (serum) testing
- Patch testing
Additional blood tests may be ordered to evaluate the immune system, multiple organ systems, screening prior to initiation of certain medications and any other specific tests based on the patient’s needs and conditions. For more information regarding the relationship between asthma and allergies and the evaluations listed here, please refer to “Asthma and Triggers” listed under the educational materials.
Our clinic also uses the following questionnaires to gain a broader understanding of the effect asthma plays in the patient’s life:
There are many different therapies available for the treatment of asthma, including a variety of inhaled and systemic therapies. During your visits to the clinic, the physicians will be able to discuss what therapeutic options are best for you or your child’s specific treatment. For more information about the therapies available, please refer to “Asthma Maintenance, Medicines and Rescue” and “Asthma Systemic Therapies” listed under the educational materials.
Shared-decision making involves physicians and other health care professionals discussing options for evaluation and treatment with the patient and family in order to incorporate their perspectives in determining the best course of action. Incorporating the patient and family in the decision making can improve the comfort level in undergoing evaluation and treatment as well as increase the likelihood of successful disease management.
Education About Asthma
If you are interested in being seen at the clinic or want to learn more about asthma, please see the links below to access the patient education materials that we use in clinic. If you are seen in the clinic, you will be provided with a physical copy and review these materials with the patient educator during your visit.
- Asthma Overview
- Asthma Diagnosis
- Asthma Maintenance, Medicines and Rescue
- Asthma Triggers
- Asthma Systemic Therapies
The divisions of Allergy & Immunology and Pulmonary/Respiratory Medicine support a variety of clinical research projects, some of which might be relevant to your condition(s). See our active clinical trials.
Our clinic routinely conducts studies for the treatment of asthma. Some of the ongoing studies regarding asthma are listed below:
- Study regarding the impact of Dupilumab on the immune system titled: “Tracking the Effect of IL-4 and IL-13 on T Cells by Lineage Tracing” – Dr. Bob Geng, Dr. Ben Crocke
- Study regarding the microbiome of prematurely born infants titled: “The Association Between Milk Feedings in the Preterm Population, The Microbiome and Risk of Atopic Disease” – Dr. Bob Geng, Dr. Sydney Leibel, Dr. Sandra Leibel
- Study regarding prevention of asthma in 2-3 year old toddlers titled: “Controlling and Preventing Asthma Progression and Severity in Kids with Omalizumab” – Dr. Bob Geng, Dr. Wanda Phipitanikul, National Institutes of Health
If you are interested in participating in any of these studies, you can either contact the study coordinator listed below or discuss potential involvement with the clinic team at your next visit.
Dr. Bob Geng is a co-director of the SAP clinic and an assistant professor of pediatrics and medicine in the divisions of Adult and Pediatric Allergy and Immunology at UC San Diego. Dr. Geng coordinates allergic and immunologic evaluation and management.
Dr. Sydney Leibel is a co-director of the SAP clinic and an assistant professor in the Division of Pediatric Allergy and Immunology at UC San Diego. Dr. Leibel directs the Community Approach to Severe Asthma asthma home visit program and coordinates allergic and immunologic evaluation and management.
Dr. Mateja Cernelc-Kohan is a co-director of the SAP clinic and an assistant professor of pediatric pulmonology at UC San Diego. Dr. Kohan coordinates pulmonological evaluation and comprehensive respiratory disease management.
Samantha Nigrelli is a licensed nurse practitioner who has been trained in allergy and immunology. Samantha helps the physicians in seeing the patients and obtaining a detailed and comprehensive history. She helps coordinate care before, during and after the appointment. She assists both Dr. Geng and Dr. Leibel with patient evaluations and treatment plans.
Alyssa Hobby is a board-certified pediatric pharmacist. She ensures patients are compliant by verifying medication refills with their outpatient pharmacy. During the clinic visit, she conducts interviews with the patients and families and administers subcutaneous medications as needed.
Diba Mortazavi is a coordinator in the Division of Allergy & Immunology and is the patient educator for the clinic. She meets with patients to review the questionnaires and education materials, and assists with introducing the patients to research studies.