1. Exacerbations of Severe Asthma While on Anti–IL-5 Biologics
- Author
-
David Dacal Rivas, Anurag Bhalla, Parameswaran Nair, Manali Mukherjee, L. Pérez de Llano, N Zhao, and Terence N. Ho
- Subjects
Male ,0301 basic medicine ,Exacerbation ,medicine.drug_class ,Severe asthma ,Immunology ,Antibodies, Monoclonal, Humanized ,Monoclonal antibody ,Leukocyte Count ,03 medical and health sciences ,0302 clinical medicine ,Eosinophilic ,medicine ,Animals ,Humans ,Immunology and Allergy ,Anti-Asthmatic Agents ,030223 otorhinolaryngology ,Aged ,Aged, 80 and over ,business.industry ,Sputum ,Antibodies, Monoclonal ,Disease Management ,Middle Aged ,Eosinophil ,Receptors, Interleukin-5 ,Asthma ,Optimal management ,Respiratory Function Tests ,Eosinophils ,Anti il 5 ,Treatment Outcome ,030104 developmental biology ,medicine.anatomical_structure ,Disease Progression ,Female ,Interleukin-5 ,Tomography, X-Ray Computed ,Airway ,business - Abstract
Anti-interleukin 5 (IL-5) and anti-IL-5 receptor α monoclonal antibodies markedly decrease airway and peripheral blood eosinophil numbers and are thus highly effective in reducing asthma exacerbations. Nonetheless, these biologics do not completely resolve exacerbations. There is very little information on the cellular nature of exacerbations during treatment with biologics. Using illustrative clinical case scenarios, we highlight the importance of carefully characterizing asthmatics at the time of exacerbation and recognizing neutrophilic causes of exacerbations to ensure optimal management. While an eosinophilic exacerbation may improve with more corticosteroids or by switching to another anti-IL-5 monoclonal antibody, a noneosinophilic exacerbation will likely not. An infective exacerbation needs to be recognized, and the pathogen must be identified and treated with the appropriate antimicrobial agent.
- Published
- 2020