000672 - Benralizumab as treatment in a patient with Near-Fatal Asthma exacerbation
Background
Biologicals have significantly reduced exacerbation rates and corticosteroid use in patients with severe asthma. However, some patients still face near-fatal exacerbations. We present a case of one such patient treated with benralizumab.
Method
A 52-year-old male previously diagnosed with moderate persistent allergic asthma and treated with LABA on-demand presented in the emergency room with heavy respiratory work, intense sweating, inability to speak, tachycardia, tachypnea, and auscultatory silencing. A PEFR showed 80 L/min (20% predicted). Arterial blood gas at entry was pH 7.23, paCO2 73 mmHg, paO2 45 mmHg, HCO3 32.8 mEq/L. An eosinophilia of 700 cells/µl with neutrophilia was observed. Oxigenotherapy, intravenous perfusion of salbutamol, and intravenous magnesium and OCS were administered. The patient worsened, with a new gasometry of pH 7.08 and paCO2 109 mmHg, so orotracheal intubation was decided. As ventilation was impossible, VV-ECMO therapy was chosen.
A rhinovirus infection was diagnosed via PCR from tracheal aspirates.
Despite intensive therapy during the following seven days, the patient maintained intense bronchospasm when weaning was attempted. Since the administration of volatile anesthetics using the inhaled sedation device AnaConDa (Anesthetic Conserving Device) was unavailable the administration of a biological was decided after consultation with the Allergy Service. Benralizumab was selected due to previous eosinophil levels and existing bibliography. A dose of 30 mg subcutaneously was administered after approval by the Hospital Board.
Results
With otherwise unchanged therapy, improvements were seen in the expiratory flow curve within 24 hours, and stepwise reduction in VV-ECMO support levels in the following days was allowed. The patient was successfully weaned from VV-ECMO therapy on day three after benralizumab administration. From the third day, eosinophil levels were significantly reduced. The patient was extubated after one week.
Conclusion
This case demonstrates that benralizumab can effectively manage a near-fatal asthma exacerbation, suggesting its potential role in similar cases despite limited clinical trial data.
