Omalizumab in middle-aged or older patients with severe allergic asthma-COPD overlap

Introduction
Biological therapies used for severe asthma may be useful even for middle-aged or older patients who have a history of severe allergic asthma with a chronic obstructive pulmonary disease (COPD) overlap phenotype.

Aim
To show omalizumab efficacy in severe allergic asthma-COPD overlap disease.

Material and methods
We report our data of a retrospective study on 11 patients (mean age: 67.18 years) with a positive history of severe allergic asthma treated with omalizumab. They all presented limited reversibility of airway obstruction and signs of chronic bronchitis at radiological examinations, as in asthma-COPD overlap. Omalizumab improved conditions in terms of reduced exacerbations as well as asthma control test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) scores.

Results
Clinical improvement was seen already in the first year with significantly increased ACT scores (p < 0.0001) and a significantly decreased number of exacerbations (p < 0.001). Furthermore, our data showed a significant inverse correlation over time between the number of exacerbations and ACT (r = –0.83, p < 0.0001), AQLQ symptoms (r = –0.87, p < 0.0001), forced expiratory volume in 1 s (FEV1) (r = –0.71, p < 0.001) and FEV1/forced vital capacity (FVC) (r = –0.43, p = 0.04). There also was a positive correlation between ACT and FEV1 (r = 0.74, p < 0.0001), ACT and AQLQ symptoms (r = 0.93, p < 0.0001), FEV1 and AQLQ symptoms (r = 0.67, p < 0.001). All parameters continued to improve during the second year of treatment.

Conclusions
Omalizumab may be relevant as a therapeutic option even in middle-aged and older patients with severe asthma.