Can newer treatments help manage my asthma-COPD overlap?

Question

Hello doctor,

I am a 52-year-old, and I smoked for about ten years in my twenties. I was diagnosed with asthma years ago, but now they say it is more like “overlap” with chronic obstructive pulmonary disease. I am on triple therapy inhaler (inhaled corticosteroid, long-acting beta agonist, long-acting muscarinic antagonist), but still have flare-ups if I catch a cold or if the weather changes. I also get short of breath walking up stairs. I have read about Dupilumab and Tezepelumab, and I am trying to quit vaping completely, but it is tough. I am scared this might keep getting worse, no matter what I do.

Are there newer biologic treatments that help people like me?
Would Dupilumab and Tezepelumab apply here?
Does pulmonary rehabilitation really help breathing or only exercise tolerance?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You are describing the typical asthma-COPD (chronic obstructive pulmonary disease) overlap picture I see often. First, let us confirm the overlap and your current control. I would recommend you do spirometry with a bronchodilator and get your inhaler technique reviewed. Then get blood eosinophils, fractional exhaled nitric oxide, total immunoglobulin E, and allergy testing. These numbers tell us if there is an allergic component, and if so, which one. Also, if total immunoglobulin E is high and if symptoms suggest those like yours, then you should also get a serum Aspergillus-specific immunoglobulin E test done to rule out allergic bronchopulmonary aspergillosis (ABPA).

Biologic treatments can help people with asthma-chronic obstructive pulmonary disease overlap when the asthma biology is active despite high-dose inhaled corticosteroid, long-acting beta agonist, and long-acting muscarinic antagonist. Depending upon your test results, the best-suited biological treatment is prescribed.

Before or alongside biologic treatments, I make sure the foundations are flawless. We meticulously correct inhaler technique and confirm you are truly on high-dose inhaled corticosteroid as part of triple therapy. Some patients benefit from switching their reliever (as needed) to Budesonide-Formoterol to treat the flare at the first cough.

Vaccines such as influenza, pneumococcal, and coronavirus disease boosters, and aggressive treatment of sinus disease, gastroesophageal reflux disease, and obstructive sleep apnea are significant game changers because they remove common flare triggers.

Pulmonary rehabilitation helps more than just exercise tolerance. Done well, it can be life-changing, and one can benefit a lot.

For vaping cessation, the most effective path is a combined plan: set a quit date, remove triggers, and use medication support. Try nicotine replacement such as a patch or short-acting gum, or lozenge, and if still no help, there are some drugs from which you may benefit, such as Varenicline. Smoking or vaping cessation can benefit extremely well.

Consider a low-dose computed tomography if exacerbations continue to rule out bronchiectasis or other contributors.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.