At Bielefeld Bethel Hospital, majority of asthma patients in Germany are treated. Prof. Hamelmann is here a chief physician. © Evangelical Hospital Bethel Bielefeld

Prof. Dr. Hamelmann works as a chief physician at the Children’s Hospital of the Protestant Hospital Bethel in Bielefeld. Most patients from all over Germany are treated there for bronchial asthma.

Prof. Hamelmann has not only experience with patients, he is also an author and co-author of the National Care Guideline, where amongst other things, he determines which medications should be given in asthma.

Clinic Compass: Asthma became widely common in children and adolescents. How did this growth happen?

Prof. Dr. med. Hamelmann: In general, allergic diseases have risen sharply in recent decades. Asthma is one of the two, three most common chronic diseases in children and adolescents. The latest KIGGS study by the Robert Koch Institute shows that 4 percent of children and adolescents between the ages of 3 and 17 suffer from asthma, so we arrived at a high level.
Although the number of hospitalized patients is also increasing, asthma is actually not an inpatient but an outpatient problem. We treat asthma mainly in the outpatient setting. Only when severe problems occur, the asthma patients are hospitalized. This is usually the case for patients with a combination of infections. In the case of older children, it may be due to an allergic reaction or food allergy plus asthma.

Clinic Compass: Which technical equipment do you use in your house?

Prof. Dr. med. Hamelmann: Employees who can do asthma training and inhalation training are the real nuts and bolts of asthma care. If you don’t show children and parents correctly how to inhale, therapy is not successful. That’s why all our doctors are optimally trained. As far as the technique is concerned, a proper pulmonary function diagnosis is necessary for the care of asthma patients, i.e. one must have a body plethysmograph, with which one can completely map the lung function. Then, a test for exertion is needed, either a bicycle ergometer or a treadmill, to get patients stressed for a lung function underload. It would be important if you had a complete allergological diagnosis connected, in any case, you must be able to do appropriate skin tests. In addition, they should be able to head for an allergy lab, to hold a molecular allergy diagnosis. It is also important for the differential diagnosis that you can offer a sweat test with a chloride measurement, to safely rule out cystic fibrosis in patients with frequent bronchitis / pneumonia. For these patients, the exclusion of immunodeficiencies as the cause of the accumulated infections is important. What is also necessary is an imaging. You must be able to take at least one chest X-ray and for difficult patients, you must also be able to do CT chest scan. In the future, MRI will become more important for chronic lung diseases, because it has no radiation exposure and therefore allows an annual follow-up without a radiation exposure.

Clinic Compass: You are also an author and co-author of the National Guidelines on Asthma and Asthma Prevention. What can you say about essentials for asthma patients? Which medication could be interesting in the future?

Prof. Dr. med. Hamelmann: We treat according to the guidelines of the National Health Care Guideline. The most important therapeutic principle is an anti-inflammatory therapy with inhaled steroidides as a basic therapy and, if necessary, a rapid-acting bronchodilator, usually salbutamol. What’s new, is a long-acting muscarinic receptor antagonist called tiotropium, because it’s the only thing offered in this class. This has been approved for children over the age of six with difficult and poor asthma control. For young patients over the age of 6 and adolescents with severe allergic asthma, we still have the anti-IgE therapy, the omalizumab as a biologic drug for the highest treatment level.

Clinic Compass: Which measures beyond the medical infrastructure and the pharmaceuticals will become more important in the treatment of inpatient asthma patients in the future?

Prof. Dr. med. Hamelmann: Far ahead, in 10 to 20 years, we will treat asthma differently than now. In the future, we will try to phenotype the asthma patient earlier, that is, determine what type of asthma he has. If it is an asthma due to infections, due to allergies or obesity etc., we will  be able to select a more targeted therapy, according to this division into different types of asthma subtypes. Chronic, severe asthma will lead to a limitation of lung function in adulthood, which is likely to become COPD. These patients have poor prospects if they already have childhood asthma. We have to prevent that from happening sooner in the future.

Clinic Compass: Prof. Hamelmann, thank you for the interview!

Since 2014 Prof. Hamelmann has been a Senior Physician at the Department of Pediatric and Adolescent Medicine at the Children’s Center Bethel of the Protestant Hospital Bielefeld. As Vice President of the German Society for Allergology and Clinical Immunology (DGAKI) and author / co-author of the National Guidelines on Asthma (NVL) and Asthma Prevention (AWMF), he is an internationally recognized specialist in allergies and asthma.