D3.119 - Saving the Caregiver: Humanitarian Access to Dupilumab in a Physician with Severe Non-Allergic T2 Asthma in a Frontline Ukrainian City

Severe asthma associated with chronic rhinosinusitis (CRS) represents a challenging clinical phenotype, particularly in patients without IgE-mediated sensitization. Access to biologic therapies remains limited in low-resource and conflict-affected settings, significantly impacting disease control and patients’ quality of life.

We report the case of a 36 y.o. female neurologist living and working in the frontline city of Sumy, Ukraine. The patient had a history of severe, uncontrolled asthma and severe persistent chronic rhinosinusitis for more than 10 years. Comprehensive allergological evaluation revealed no evidence of allergic sensitization, consistent with a non-allergic T2 inflammatory asthma endotype associated with CRS. The patient has consented to the publication of this case and her CT scan results.

Despite long-term treatment, disease control was not achieved. Therapy included high-dose inhaled corticosteroids+long-acting β2-agonists, intranasal corticosteroids and montelukast at the initiation of treatment. The patient experienced 3–5 severe asthma exacerbations per year, requiring repeated courses of systemic corticosteroids. Unfortunately, in Ukraine, access to biologic therapy is extremely limited. Omalizumab is the only officially available biologic agent for asthma patients; however, it must be purchased at the patient’s own expense, making it largely inaccessible. Due to disease severity and stable negative progression, low-dose oral corticosteroids were added as maintenance therapy; however, this didn't lead to the expected result — radiological evaluation (CT of paranasal sinuses and chest) demonstrated progressive changes over time. Lung function tests consistently showed obstructive impairment with a progressive decline in FEV₁: 78% predicted in 2016, 70% in 2019, 67% in 2022, and 62% in 2025.

 In 2025, within a humanitarian medical aid program, dupilumab became available in the Sumy region and was initiated in this patient. Following the initiation of 3 months of dupilumab therapy, the patient experienced a rapid and near-complete regression of asthma and CRS symptoms, marked clinical improvement (Image 1), and stabilization of respiratory function. Systemic corticosteroids were discontinued, and quality of life improved substantially. Importantly, the patient was able to resume full professional activity, continuing to provide neurological care to civilian and military patients in a frontline region during ongoing armed conflict.

This case highlights the effectiveness of dupilumab in severe non-allergic T2 asthma associated with chronic rhinosinusitis, even after long-term steroid-dependent disease. It also underscores the critical role of equitable access to biologic therapies, particularly through humanitarian programs, in restoring health and preserving the medical workforce in conflict-affected areas.