Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature
Eosinophilic granulomatosis with polyangiitis is a rare systemic vasculitis associated with asthma, eosinophilia and multi-organ involvement. This case report describes a 69-year-old male with severe, poorly controlled asthma who was diagnosed with eosinophilic granulomatosis with polyangiitis. Desp...
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| Format: | Article |
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BioExcel Publishing Ltd
2025-04-01
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| Series: | Drugs in Context |
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| Online Access: | https://www.drugsincontext.com/switching-from-multiple-inhaler-triple-therapy-to-single-extra-fine-inhaler-triple-therapy-in-severe-refractory-asthma-with-egpa-beyond-control-case-report-and-review-of-the-literature/ |
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| author | Francesco Menzella Marcello Cottini Silvia Tonin Lorenzo Corsi Annamaria Bosi Andrea Ballarin Ariel Floriani Cristina Dartora Matteo Tacconi Carlo Lombardi |
| author_facet | Francesco Menzella Marcello Cottini Silvia Tonin Lorenzo Corsi Annamaria Bosi Andrea Ballarin Ariel Floriani Cristina Dartora Matteo Tacconi Carlo Lombardi |
| author_sort | Francesco Menzella |
| collection | DOAJ |
| description | Eosinophilic granulomatosis with polyangiitis is a rare systemic vasculitis associated with asthma, eosinophilia and multi-organ involvement. This case report describes a 69-year-old male with severe, poorly controlled asthma who was diagnosed with eosinophilic granulomatosis with polyangiitis. Despite treatment with mepolizumab 300 mg and optimized inhaled therapies, comprising high-dose inhaled corticosteroids and long-acting β2-agonists and a long-acting muscarinic antagonist in two separate inhalers, the patient exhibited poor asthma control, accompanied by exacerbations of symptoms, increased reliance on oral corticosteroids, and a decline in lung function. Consequently, a comprehensive, multidisciplinary approach targeting comorbidities was deemed necessary, including the management of chronic rhinosinusitis with nasal polyps. Following a switch to a single-inhaler triple therapy, the patient demonstrated significant improvements in terms of asthma control, respiratory function, oscillometric measurements and fractional exhaled nitric oxide reduction. This report underscores the significance of personalized treatment strategies and a treatable-traits approach targeting small airway dysfunction, persistent airflow limitation and type 2 inflammation for effective disease management. A literature review on therapeutic advancements and clinical implications is also presented to provide clinicians with useful insights into managing severe asthma and single-inhaler triple therapy placement. |
| format | Article |
| id | doaj-art-41f3dadfb7954f59a57aa1aeeb2a09af |
| institution | OA Journals |
| issn | 1740-4398 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BioExcel Publishing Ltd |
| record_format | Article |
| series | Drugs in Context |
| spelling | doaj-art-41f3dadfb7954f59a57aa1aeeb2a09af2025-08-20T02:29:59ZengBioExcel Publishing LtdDrugs in Context1740-43982025-04-011411110.7573/dic.2025-2-3Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literatureFrancesco MenzellaMarcello CottiniSilvia ToninLorenzo CorsiAnnamaria BosiAndrea BallarinAriel FlorianiCristina DartoraMatteo TacconiCarlo LombardiEosinophilic granulomatosis with polyangiitis is a rare systemic vasculitis associated with asthma, eosinophilia and multi-organ involvement. This case report describes a 69-year-old male with severe, poorly controlled asthma who was diagnosed with eosinophilic granulomatosis with polyangiitis. Despite treatment with mepolizumab 300 mg and optimized inhaled therapies, comprising high-dose inhaled corticosteroids and long-acting β2-agonists and a long-acting muscarinic antagonist in two separate inhalers, the patient exhibited poor asthma control, accompanied by exacerbations of symptoms, increased reliance on oral corticosteroids, and a decline in lung function. Consequently, a comprehensive, multidisciplinary approach targeting comorbidities was deemed necessary, including the management of chronic rhinosinusitis with nasal polyps. Following a switch to a single-inhaler triple therapy, the patient demonstrated significant improvements in terms of asthma control, respiratory function, oscillometric measurements and fractional exhaled nitric oxide reduction. This report underscores the significance of personalized treatment strategies and a treatable-traits approach targeting small airway dysfunction, persistent airflow limitation and type 2 inflammation for effective disease management. A literature review on therapeutic advancements and clinical implications is also presented to provide clinicians with useful insights into managing severe asthma and single-inhaler triple therapy placement.https://www.drugsincontext.com/switching-from-multiple-inhaler-triple-therapy-to-single-extra-fine-inhaler-triple-therapy-in-severe-refractory-asthma-with-egpa-beyond-control-case-report-and-review-of-the-literature/asthmachronic rhinosinusitis with nasal polypsegpaeosinophilic granulomatosis with polyangiitisfenoinhaled therapymepolizumabsmall airway dysfunctiontype 2 inflammation |
| spellingShingle | Francesco Menzella Marcello Cottini Silvia Tonin Lorenzo Corsi Annamaria Bosi Andrea Ballarin Ariel Floriani Cristina Dartora Matteo Tacconi Carlo Lombardi Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature Drugs in Context asthma chronic rhinosinusitis with nasal polyps egpa eosinophilic granulomatosis with polyangiitis feno inhaled therapy mepolizumab small airway dysfunction type 2 inflammation |
| title | Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature |
| title_full | Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature |
| title_fullStr | Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature |
| title_full_unstemmed | Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature |
| title_short | Switching from multiple-inhaler triple therapy to single, extra fine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature |
| title_sort | switching from multiple inhaler triple therapy to single extra fine inhaler triple therapy in severe refractory asthma with egpa beyond control case report and review of the literature |
| topic | asthma chronic rhinosinusitis with nasal polyps egpa eosinophilic granulomatosis with polyangiitis feno inhaled therapy mepolizumab small airway dysfunction type 2 inflammation |
| url | https://www.drugsincontext.com/switching-from-multiple-inhaler-triple-therapy-to-single-extra-fine-inhaler-triple-therapy-in-severe-refractory-asthma-with-egpa-beyond-control-case-report-and-review-of-the-literature/ |
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