Respiratory medicine case reports
Successful clinical remission of severe asthma with small airway dysfunction and eosinophilic gastrointestinal disease using dupilumab after benralizumab failure
Door Nakatani Y, Tsuji K, Ito A en 3 anderen.
Inhoud in het Engels
Abstract
Background
Small airway dysfunction (SAD) is an underrecognized but important feature of severe asthma, contributing to persistent symptoms and treatment resistance. Biologics targeting type 2 inflammation vary in their efficacy for SAD, and comorbid eosinophilic gastrointestinal disease (EGID) may further complicate management.
Case presentation
A 65-year-old woman with severe, type 2-high asthma and eosinophilic esophagitis had uncontrollable symptoms despite inhaled triple therapy and benralizumab. She exhibited impaired ventilatory parameters, with markedly reduced maximum mid-expiratory flow (%MMF), elevated difference in respiratory resistance between 5 Hz and 20 Hz (R5-R20), and area of reactance (AX), and mucus plugs on chest CT, along with gastrointestinal symptoms that required long-term corticosteroid therapy. Intervention and outcomes: Given her insufficient response and comorbid gastrointestinal symptoms, therapy was switched to dupilumab. Following treatment initiation, the patient demonstrated marked improvements in SAD parameters with markedly elevated %MMF (50 to 79%), reduced R5-R20 (1.20 to 0.53 kPa/L/s), AX (4.06 to 0.81 kPa/L) and resolution of mucus plugging. Her dyspnea and gastrointestinal symptoms also improved, allowing discontinuation of oral corticosteroids within one year.