Omalizumab as add‐on therapy in a patient with severe asthma and OSA

Scioscia, Giulia; Buonamico, Enrico; Barbaro, Maria Pia Foschino; Lacedonia, Donato; Sabato, Roberto; Carpagnano, Giovanna Elisiana

doi:10.1002/rcr2.518

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…Another important finding is the marked improvement in nocturnal hypoxemia (a ~90% reduction in T 90 ) with almost complete resolution of gas exchange alterations during sleep. This improvement is also significant in view of the result of the study by Scioscia et al [6]. Indeed, a slight proportion of nocturnal hypoxemia persists after treatment with omalizumab (T 90 ~12%), whereas benralizumab appears to resolve the profile completely (T 90 ~2%).…”

Section: Discussionmentioning

confidence: 76%

“…Another study evaluated the efficacy of omalizumab, a monoclonal antibody anti- IgE in the treatment of severe asthma, in a patient with an overlap syndrome of asthma and OSA. In that study the authors demonstrated that as asthma symptoms improved, polysomnographic indices also improved [ 6 ]. Similar to our case, a reduction in AHI was observed (~56%) even though OSA still persisted.…”

Section: Discussionmentioning

confidence: 99%

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

Tondo

Fanfulla

2022

Multidis Res Med

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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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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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

Tondo

Fanfulla

2022

Multidis Res Med

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“…A recent case series of five patients with severe asthma with chronic rhinosinusitis, nasal polyposis, and OSA found a remarkable reduction in OSA symptoms in all patients after 6 months of therapy with dupilumab, an IL-4 and IL-13 antagonist [54]. Similarly, in another case, AHI halved after 6 months of asthma therapy with the anti-IgE antibody omalizumab [55].…”

Section: How Asthma Treatments Affect Osamentioning

confidence: 87%

Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs

Saxena,

Imayama,

Adrish

2023

JCM

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Asthma and obstructive sleep apnea are highly prevalent conditions with a high cost burden. In addition to shared risk factors, existing data suggest a bidirectional relationship between asthma and OSA, where each condition can impact the other. Patients with asthma often complain of sleep fragmentation, nocturnal asthma symptoms, daytime sleepiness, and snoring. The prevalence of OSA increases with asthma severity, as evidenced by multiple large studies. Asthma may lower the threshold for arousal in OSA, resulting in the hypopnea with arousal phenotype. Epidemiologic studies in adults have shown that OSA is associated with worse asthma severity, increased frequency of exacerbation, and poor quality of life. The current literature assessing the relationship among OSA, asthma, and CPAP therapy is heavily dependent on observational studies. There is a need for randomized controlled trials to minimize the interference of confounding shared risk factors.

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Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome

et al. 2022

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Obstructive sleep apnea syndrome (OSAS) in childhood is a complex disease primarily due both to adenotonsillar hypertrophy and pediatric obesity. Notably, in ammation has been recognized as one of the most important shared pathogenic factor between obesity and OSAS resulting in an increased cardiometabolic risk for these patients. To date, evidence is still limited in non-obese population with OSAS.We aimed to evaluate the cardiometabolic risk pro le of a pediatric population of non-obese subjects affected by OSAS. A total of 128 school-aged children (mean age 9.70 ± 3.43) diagnosed with OSAS and 213 non-OSAS children (mean age 9.52 ± 3.35) as control group were enrolled. All subjects underwent a complete clinical and biochemical assessment (including white blood cell count (WBC), platelet count (PLT), mean platelet volume (MPV),% of neutrophils (NEU%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), uric acid, fasting insulin, iron, ferritin, and transferrin levels) .A signi cant association between in ammation markers (including WBC, PLT, MPV, NEU%, ferritin, CPR, and ESR) and OSAS was found (all p < 0.001). Children with OSAS also showed increased transaminase, glucose, uric acid, and insulin levels (all p < 0.001) compared to healthy controls. Conclusion: Taken together, these ndings suggested a worse cardiometabolic pro le in non-obese children with OSAS. Given the pivotal pathogenic role of in ammation both for hypoxiemia and metabolic derangements, therapeutic strategies for OSAS might also counteract the increased cardiometabolic risk of these patients, by improving their long-term quality of life.

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Omalizumab as add‐on therapy in a patient with severe asthma and OSA

Cited by 8 publications

References 4 publications

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

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

Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs

Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome

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