Successful Benralizumab treatment in acute near-fatal asthma with ECMO support: a case report

Abstract

Introduction

Near-fatal asthma (NFA) is a severe condition that can lead to respiratory arrest or high carbon dioxide levels, often requiring mechanical ventilation. Biologics have revolutionized the management of severe asthma, significantly improving symptom severity, reducing the number of exacerbations and hospitalizations, and decreasing the need for oral corticosteroids. However, their effectiveness in acute settings, particularly for ICU patients experiencing severe respiratory failure, is not well-studied. More research is needed to determine if biologics can improve recovery during severe asthma exacerbations.

Case Study

We report a case of NFA in a patient with severe allergic eosinophilic asthma, who experienced global respiratory failure necessitating hospitalization, intubation, and veno-venous extracorporeal membrane oxygenation (VV-ECMO). Given the severity of the clinical condition, compassionate administration of Benralizumab, which targets the IL-5 receptor, was attempted.

Results

Five days from anti-IL5 receptor treatment start, the patient was extubated and the ECMO stopped. After the stepdown to the respiratory intensive care unit (RICU), the patient was weaned from oxygen therapy and subsequently discharged from hospital.

Conclusion

Benralizumab demonstrated rapid effectiveness in improving respiratory failure leading to successful weaning from VV-ECMO and subsequent extubation.

Keywords:

• Asthma
• IL-5
• ECMO
• respiratory failure

Author contributions

• Francesca Montagnolo: conceptualization, data curation, writing – original draft

• Salvatore Grasso: conceptualization, project administration, supervision

• Lidia Dalfino: methodology, supervision, investigation

• Andrea Portacci: supervision, visualization, writing – review and editing

• Francesca Romana Viterbo: data curation, investigation, resources

• Vitaliano Nicola Quaranta: investigation, resources, supervision

• Giovanna Elisiana Carpagnano: conceptualization, project administration, supervision

Declaration of interest

• Francesca Montagnolo: no conflicts of interest to declare;

• Salvatore Grasso: fee and educational event from Getinge (Svezia) and Estor (Mirandola, Italy);

• Lidia Dalfino: no conflicts of interest to declare;

• Andrea Portacci: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astrazeneca, GSK, Sanofi, Vitalaire, Chiesi, Zambon;

• Francesca Romana Viterbo: no conflicts of interest to declare;

• Vitaliano Nicola Quaranta: no conflicts of interest to declare;

• Giovanna Elisiana Carpagnano: reported grants or contracts from Astrazeneca, Chiesi, GlaxoSmithKline, Sanofi, Grifols; payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi; support for attending meetings and/or travel from Astrazeneca, Menarini, Chiesi;

Consent to participate statement

Written informed consent was obtained from the participant to participate in the study.

Consent to publish statement

Written informed consent was obtained from the participant for publication of the details of their medical case and any accompanying images.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.