Naslov
Anti IL-5 therapy in the treatment of severe acute asthma available at a secondary hospital facility – experience of the Virovitica General Hospital

Autori
Marčetić Dejan, Liović Tatjana, Štajduhar Anamarija, Lampalo Marina, Popović-Grle Sanja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Skup
5th Forum of Southeast European Countries on Severe Asthma

Mjesto i datum
Šibenik, Hrvatska, 09.06.2023. - 11.06.2023

Vrsta sudjelovanja
Poster

Vrsta recenzije
Podatak o recenziji nije dostupan

Ključne riječi
teška astma, anti-IL5 terapija, telemedicina
(severe asthma, anti-IL5 therapy, telemedicine)

Sažetak
INTRODUCTION. Biologic therapy significantly improves the quality of life in severe asthma patients. CASE REPORT. A 66-year-old man, professional driver, smoker (45PY), with nasal polyposis was diagnosed with asthma and COPD at age 55. He was on ICS/LABA/LAMA therapy at a moderate dose in two inhalers, theophylline, LTRA, antihistamine, roflumilast and nasal corticosteroid. However, this combined therapy failed to produce good disease control (ACT 15/25), the patient suffered 4-5 exacerbations per year. Multi-slice computed tomography (MSCT) of the thorax showed bronchial deformation, diffuse hyperinflation, parenchyma without infiltrates, bronchiectasis and emphysema, total IgE 127 kIU/L, SpO2 94%, negative allergy skin test for inhalant allergens, and significant eosinophilia in peripheral blood (1.29x10E9/L), without confirmed parasitosis. Upon objectifying the pulmonary function parameters and considering the information on insufficient efficacy of previous therapy in spite of good patient compliance, along with history data on the patient’s excellent clinical response to short- term therapy with oral corticosteroids, severe asthma was diagnosed and phenotyping was carried out. The findings of functional testing indicated severe obstructive disorder of ventilation, as follows: FVC 74%, FEV1 44% (1.32L), FEV1/FVC0.46, PEF 37%, negative pharmacodynamic test. Diffusion finding suggested a mixed type disorder. Sinus MSCT suggested chronic sinusitis without newly formed polyps, as revealed by the ENT specialist report. Nasal swab and expectoration samples were negative for eosinophils, bacteria, and acid resistant bacilli. Considering prolonged exacerbation of the patient's condition during 2022, step 5 escalation therapy according to GINA guidelines for the management of severe asthma was introduced, along with high doses of ICS/LABA/LAMA, other previous chronic therapy with the addition of methylprednisolone 40 mg with gradual de- escalation to the maintenance dose of 5 mg. On the next follow up visit, the patient reported considerable cough reduction, better exercise tolerance, improved pulmonary function parameters, now with moderate obstructive ventilation impairments, FEV1 56%(1.65L), FVC 89%, positive pharmacodynamic test 16%, 260mL, better disease control (ACT22/25), and decrease in peripheral blood eosinophils to 430 cells/mm3. The patient was presented to the Severe Asthma Team, who issued their positive opinion on the patient as a candidate for IL-5 therapy. This was confirmed by the positive opinion of the Hospital Board, and management with a biologic mepolizumab was successfully initiated. CONCLUSION. Telemedicine with friendly collaboration of pulmonologists from secondary and tertiary institutions offers a winning scenario to relieve tertiary centers, to the satisfaction of healthcare users with the process of treatment.

Izvorni jezik
Engleski

Znanstvena područja
Biotehnologija u biomedicini (prirodno područje, biomedicina i zdravstvo, biotehničko područje)

POVEZANOST RADA