Tezepelumab in a case of severe asthma exacerbation and influenza-pneumonia on VV-ECMO.

E. Grasmuk-Siegl, E. Xhelili, D. Doberer, M.H. Urban, A. Valipour, Respiratory Medicine Case Reports, 2024, 102057, https://doi.org/10.1016/j.rmcr.2024.102057.

Abstract

We present a case of 43-year-old male patient with broadly by Omalizumab, Mepolizumab and Benralizumab pretreated allergic asthma, who suffered a near fatal exacerbation, triggered by an influenza A infection. Due to massive bronchoconstriction with consecutive hypercapnic ventilatory failure veno-venous ECMO therapy had to be implemented. Hence, guideline directed asthma therapy a substantial bronchodilatation could not be achieved. After administration of a single dose Tezepelumab, a novel TLSP-inhibitor, and otherwise unchanged therapy we documented a significant reduction in intrinsic PEEP measured via a naso-gastric balloon catheter and a narrowing in the expiratory flow curve of the ventilator within 24 hours. The consecutive ventilatory improvement allowed the successful weaning from veno-venous ECMO therapy and invasive ventilation.

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