Mansur Adel H
Birmingham Regional Severe Asthma Service, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Bordesley Green, Birmingham, West Midlands, B9 5SS, United Kingdom.
Respir Med Case Rep. 2021 Nov 27;35:101559. doi: 10.1016/j.rmcr.2021.101559. eCollection 2022.
Severe eosinophilic asthma is associated with a high corticosteroid burden, particularly in patients with comorbid chronic sinusitis/nasal polyps. This case study reports a 33-year-old woman who presented to the severe asthma center with uncontrolled severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Despite maximized asthma treatment, including maintenance oral corticosteroids (OCS) for 7 years, the patient experienced one to two hospitalizations per year, had daily symptoms that substantially impacted her quality of life, and elevated type 2 inflammatory markers (blood eosinophils, 0.72 × 10/L; fractional exhaled nitric oxide, 134 to 300 parts per billion). Her asthma worsened during her first pregnancy, in which she required five hospital admissions despite treatment with maintenance OCS. Mepolizumab treatment was commenced after pregnancy but showed limited efficacy (blood eosinophil levels up to 0.94 × 10/L); treatment was discontinued because of a second pregnancy. The patient's asthma worsened and resulted in four hospitalizations and an increase in monthly OCS dose. Mepolizumab was recommenced after pregnancy, but her asthma remained uncontrolled, symptoms persisted, and one hospitalization and nine OCS courses were required. The patient was switched to benralizumab treatment when it became available. Although her CRSwNP symptoms remained, benralizumab treatment resulted in a marked improvement in asthma control, zero hospitalizations, and suppressed blood eosinophil levels. Notably, the patient was successfully weaned off maintenance OCS after >11 years of treatment. In summary, these findings support the use of benralizumab as a corticosteroid-sparing treatment option in difficult-to-treat severe eosinophilic asthma refractory to mepolizumab treatment.
重度嗜酸性粒细胞性哮喘与高皮质类固醇负荷相关，尤其是在合并慢性鼻窦炎/鼻息肉的患者中。本病例研究报告了一名33岁女性，她因重度嗜酸性粒细胞性哮喘控制不佳以及慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）就诊于重度哮喘中心。尽管哮喘治疗已最大化，包括口服维持性皮质类固醇（OCS）治疗7年，但该患者每年仍有1至2次住院，每日症状严重影响其生活质量，且2型炎症标志物升高（血嗜酸性粒细胞，0.72×10⁹/L；呼出一氧化氮分数，134至300 ppb）。她在首次怀孕期间哮喘病情恶化，尽管接受了维持性OCS治疗，仍需住院5次。妊娠后开始使用美泊利珠单抗治疗，但疗效有限（血嗜酸性粒细胞水平最高达0.94×10⁹/L）；因再次怀孕而停药。患者哮喘病情恶化，导致4次住院且每月OCS剂量增加。妊娠后重新开始使用美泊利珠单抗，但她的哮喘仍未得到控制，症状持续存在，还需要1次住院和9个OCS疗程。当贝那利珠单抗上市后，该患者改用此药治疗。尽管她的CRSwNP症状依然存在，但贝那利珠单抗治疗使哮喘控制情况显著改善，实现了零住院，并使血嗜酸性粒细胞水平得到抑制。值得注意的是，经过11年多的治疗，该患者成功停用了维持性OCS。总之，这些发现支持将贝那利珠单抗作为在美泊利珠单抗治疗难治的难治疗性重度嗜酸性粒细胞性哮喘中一种节省皮质类固醇的治疗选择。
