D1.102 - Md
Case report
Severe non-allergic asthma in combination with granulomatosis with polyangiitis - A Case Report
Background
Approximately 3-10% of people with asthma have severe asthma, which carries a large physical, mental, and economic burden on patients and their families, often associated with social and career limitations.The new era of biological therapies has significantly improved the control of severe asthma.However, in patients with co-existing serious conditions who are more limited than other people it is important to find effective treatment for both conditions and ensure better quality of life?
Case Presentation
We present a 53-year-old female diagnosed with severe non-allergic asthma and PR3-ANCA positive vasculitis (granulomatosis with polyangiitis, GPA). Both diseases were with about 7-8 years duration. GPA presented with adynamia, muscle weakness, myalgias, episodes of erythrocyturia, epistaxis and hemoptysis, lower dyspeptic syndrome.
Our patient was working as a teacher and she was frequently exposed to various respiratory infections at the workplace, which lead to frequent and prolonged аsthma exacerbations, hospitalizations leading tolimitation of her working capacity and activity.
She was on therapy with ICS-LABA 2 puffs BD and as needed (MART) and LAMA 2 puffs OD for her asthma; and with methotrexate 20 mg weekly and methylprednisolone 12-20 mg daily for GPA.
She was admitted to our Clinic of allergology in June 2024 for asthma exacerbation. -She hadpoor asthma control (FEV 1: 58% predicted; ACT score: 7). She had neither blood eosinophilia (on steroids), nor elevated FeNO or other biomarkers.
Results
The patient was initiated on anti-TSLP monoclonal antibody tezepelumab, which significantly improved her asthma control, and resulted in FEV1 increase (71% predicted) and ACT score (20 points).
This treatment significantly reduced the frequency and severity of asthma exacerbations, and prevented virus infection-induced asthma exacerbations In addition, therapy with anti-TSLP improved symptoms of GPA as well, and she was able to reduce OCS dose to 6 mg daily and discontinued methotrexate therapy.
Conclusions
We achieved the primary endpoints,treatment with anti-TSLP Ab improved asthma control and patient's quality of life.
There is a need for future research to establish whether biological molecules for asthma treatment are also effective for treating various other immunological diseases.
