CRA105 A BREATH OF RELIEF: MEASURABLE GAINS WITH DUPILUMAB IN AN ELDERLY SEVERE ASTHMA PATIENT

Deepa Priya Naidu Subramaniam¹, Jaya Muneswarao Ramadoo², Lalitha Pereirasamy¹, Irfhan Ali Hyder Ali¹

¹ Respiratory Department, Hospital Pulau Pinang, Pulau Pinang, Malaysia
² Pharmacy Department, Hospital Pulau Pinang, Pulau Pinang, Malaysia

INTRODUCTION
Severe asthma significantly affects quality of life and increases healthcare burden. Despite maximum inhaled therapy, some patients remain symptomatic.The introduction of biologics has transformed treatment, especially for patients with Type 2 inflammation. This case highlights the real-world effectiveness of dupilumab in an elderly patient with severe allergic eosinophilic asthma, managed at a tertiary hospital.

CASE SUMMARY
A 69-year-old non-smoking woman with allergic rhinitis presented with late-onset nocturnal wheeze and exertional dyspnea triggered by environmental factors. Spirometry showed obstructive features and expiratory airflow variability. She had frequent exacerbations and an Asthma Control Test (ACT) score between 14–17, despite good adherence to high-dose ICS/LABA. Her FeNO was elevated (199 ppb), FEV₁ was 1.08L(48%), and improvement with triple therapy was minimal. A further exacerbation revealed persistently raised FeNO and declining lung function. Investigations showed high total IgE (1006 IU/mL), specific IgE to house dust mite (87 kU/L), and eosinophilia (0.4–0.6 x10⁹/L). HRCT showed minimal atelectasis. A multidisciplinary team (MDT) diagnosed severe allergic eosinophilic asthma, and she was started on subcutaneous Dupilumab 600mg followed by 300mg every two weeks. She tolerated the treatment well. Post-treatment, ACT improved to 22–23, FeNO normalised (21 ppb), FEV₁ improved, and no further exacerbations or systemic steroid were needed. Inhaler therapy was stepped down to medium-dose triple therapy.

DISCUSSION
Dupilumab targets the IL-4 receptor alpha, inhibiting IL-4 and IL-13, which are key in Type 2 inflammation. While RCT’s showed benefit, data in elderly patients are limited. Early multidisciplinary input and proper phenotyping are essential.

CONCLUSION
Biologics can offer sustained symptom control, reduce exacerbations, and better outcomes in elderly severe asthma when introduced early in tertiary