Asthma Clinical Case Review

Roshni Naik, MD, allergist at Mount Sinai Health System, discusses the results after treating a case of severe asthma with nasal polyps:

"After five months of starting Dupilumab frequency of asthma symptoms decreased significantly with no asthma symptoms at rest, no nighttime awakenings, no prednisone use and no ER visits. His nasal congestion and postnasal drip improved and he was continued on Dupilumab.

Variety of biological pathways have been identified in asthma types in particular type 2-high asthma endotypes, which include allergic asthma and eosinophilic asthma. Eosinophilic asthma commonly starts in adulthood and patients tend to have more sinus disease. Monoclonal antibody therapies or biological therapies have been developed to alter the immune response in eosinophilic asthma and nasal polyps.

Biologic therapies have been shown to reduce asthma exacerbations, oral steroid use and ER visits and hospitalizations. Certain biological therapies such as Dupilumab, Mepolizumab and Omalizumab have been shown to decrease nasal polyp size, reduce nasal congestion, reduce the need for repeat sinus surgery and/or reduce systemic steroid use in nasal polyposis.

Dupilumab specifically binds to IL-4 receptor alpha, which leads to decreased signaling of IL-4 and IL-13, which then results in decreased type two inflammation. Biological therapies should be considered in severe asthma not well controlled with controller therapy with concomitant nasal polyposis."