Omalizumab therapy in a patient with severe asthma and co-existing chronic obstructive pulmonary disease

Exposure to tobacco smoke in asthmatics is one of the significant causes of severe asthma [1]. It is generally known that passive and active smoke exposure may induce asthma symptoms and bronchoconstriction in asthmatic patients [2]. Moreover, asthmatics who are regular smokers develop more severe asthma symptoms, have a lower quality of life and more often require emergency medical intervention and hospitalization due to exacerbations [3, 4]; their forced expiratory volume in 1 s (FEV1) decline over time is faster [5] and their response to inhaled corticosteroids (ICSs) [6], even to higher doses [7, 8], is poorer. Apart from an active struggle with addiction, the treatment of an asthmatic smoker requires medications that overcome steroid resistance (long-acting 2-adrenergic receptor agonists – LABA [9–11]) and have different mechanisms of action to corticosteroids (leukotriene receptor antagonist – LTRA [8, 12] and long-acting muscarinic receptor antagonists – LAMA [13]). Little is known of the efficacy of anti-IgE biologic therapy in these patients.
The problem of smoking in asthmatics is not rare. Epidemiological data from the USA and Western Europe show that 17–35% of asthmatics [14] smoke cigarettes. In Poland, 17.9–19.7% of asthmatic patients are smokers, 16.9% ex-smokers and 31.86% [10, 15] passive smokers.
This article presents the case of a 54-year-old patient, with a long-term history of smoking, who has been suffering from allergic bronchial asthma for about 20 years. She was referred to the clinic in January 2016 due to severe uncontrolled asthma that had occurred for 3 years. She had been treated chronically with high doses of ICSs and LABA, LAMA, LTRA, with theophylline periodically, short-acting -agonist (SABA) as required and with oral corticosteroids for 3 months chronically. Despite the treatment, disease control was still unsatisfactory, with five acute exacerbations and two hospitalizations (in October and December) in 2015. An attempt was made to treat her with proton pump inhibitors (PPIs) despite the negative history of gastroesophageal reflux disease (GERD), but the therapy was ineffective. In addition, anxiolytic alprazolam treatment was introduced to alleviate mental state of the patient disturbed by recurrent exacerbations and hospitalization. The patient reported not smoking since January 2016, and before then smoking about 10 cigarettes a day for 20 years. Implementation of anti-IgE biologic therapy was...


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