Resolution of daytime and night-time respiratory symptoms but persistent sleep apnea in severe asthma with the add-on of benralizumab.

IF 2.3 Multidisciplinary Respiratory Medicine Pub Date : 2022-10-04 eCollection Date: 2022-01-12 DOI:10.4081/mrm.2022.853
Pasquale Tondo, Francesco Fanfulla
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Abstract

Introduction: The relationship between asthma and obstructive sleep apnea (OSA) is a widely debated topic in the scientific literature with the controversy surrounding the bi-directional nature of the correlation.

Case presentation: We report the case of a 59-year-old male being affected by severe allergic eosinophilic asthma and severe OSA (apnea-hypopnea index [AHI] 32 ev·hr-1). Due to a clinical worsening of asthma (aggravation of dyspnea, chest constriction and night-time respiratory symptoms), despite the optimal therapy for asthma and recurrent administration of systemic corticosteroids, we have added-on treatment with benralizumab (monoclonal anti-interleukin 5 antibody). After eight months, the patient reported an improvement in asthma control (asthma control test [ACT]= 25 points), in pulmonary function and a good control of nocturnal symptoms of both diseases (i.e., wheezing, snoring, etc.). Then, the follow up polysomnography (PSG) was performed resulting in a high reduction of OSA severity (~18% AHI) even if obstructive events persisted and almost resolution of nocturnal hypoxemia. So, a trial with positive airway pressure (PAP) was proposed to the patient, who declined.

Conclusions: In consideration of our experience, we suggest that the nocturnal profile of patients with severe asthma should be always studied by a sleep investigation to prevent the negative effects of interaction with OSA. However, further studies on larger samples are needed to better understand the pathophysiological mechanisms underlying the beneficial effects of benralizumab on obstructive events during sleep.

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贝纳利珠单抗治疗严重哮喘患者白天和夜间呼吸症状但持续性睡眠呼吸暂停
简介:哮喘与阻塞性睡眠呼吸暂停(OSA)之间的关系在科学文献中是一个广泛争论的话题,围绕着相关性的双向性存在争议。病例介绍:我们报告一例59岁男性,患有严重过敏性嗜酸性粒细胞性哮喘和严重OSA(呼吸暂停低通气指数[AHI] 32 ev·hr-1)。由于哮喘的临床恶化(呼吸困难、胸闷和夜间呼吸症状加重),尽管哮喘的最佳治疗方法和反复使用全身皮质类固醇,我们还是增加了贝纳利珠单抗(单克隆抗白细胞介素5抗体)的治疗。8个月后,患者哮喘控制改善(哮喘控制试验[ACT]= 25分),肺功能改善,两种疾病的夜间症状(喘息、打鼾等)控制良好。然后,进行多导睡眠图(PSG)随访,即使阻塞性事件持续存在,OSA严重程度也大幅降低(AHI约18%),夜间低氧血症几乎得到解决。因此,建议患者进行气道正压通气(PAP)试验,但患者拒绝了。结论:根据我们的经验,我们建议应始终通过睡眠调查来研究严重哮喘患者的夜间特征,以防止与OSA相互作用的负面影响。然而,需要对更大样本进行进一步的研究,以更好地了解benralizumab对睡眠障碍事件有益作用的病理生理机制。
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来源期刊
Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
自引率
0.00%
发文量
23
期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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