Improvement of Mucoid Impaction with Dupilumab in a Severe Asthma Patient.

Different from intrabronchial mucus accumulation in bronchiectasis caused by chronic inflammation, mucoid impactions are observed in patients with allergic bronchopulmonary aspergillosis (ABPA) and bronchial asthma. A 62-year-old man was referred to our hospital for treatment of bronchial asthma. Five years ago, he had a coronary stent insertion for myocardial infarction and was diagnosed with bronchial asthma. The stent was suspected to be related to the onset of asthma. Inhaled corticosteroid/long-acting beta agonist was not sufficient to control the condition. He received dupilumab, a humanized anti-human IL-4/13 receptor monoclonal antibody (biologic therapy). Bronchial mucoid impactions disappeared by single administration of the biologic therapy and there has been no recurrence of mucoid impactions for over a year. Although very rare, we do believe that information regarding asthma phenotype in this patient, indication and administration method for dupilumab, and changes before and after administration of dupilumab will provide some suggestive information on treatment for patients with a similar course in the future.