My father has an asthma-COPD overlap. Can biologics help him?

Question

Hello doctor,

My father is 65 and has been told he has an overlap of asthma and COPD. His latest PFT showed FEV1 54 % predicted and eosinophils 620.

He uses inhalers regularly but still gets breathless when walking. So, my concerns are:

Would adding biologic injections like Mepolizumab or Benralizumab help in his case?
Are they safe for long-term use?
Also, can nebulizers be used daily, or do they reduce inhaler effectiveness?
His oxygen level sometimes dips to 91 % at night. Should we consider home oxygen therapy?
Lastly, are there breathing exercises that can help strengthen lungs in the asthma-COPD overlap, or is the damage mostly irreversible now?

Please give your suggestions.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

What your father has is an asthma-COPD (chronic obstructive pulmonary disorder) overlap, which means both conditions are playing a role in his breathlessness.

His FEV1 (forced expiratory volume in 1 second) shows moderate obstruction, and an eosinophil count suggests that inflammation from the asthma side is still active. The first thing is to make sure his inhaler regimen is fully optimized.

Many patients in this situation do best on triple therapy, that is, one inhaler combining an inhaled steroid, a long-acting bronchodilator, and a long-acting muscarinic blocker.

If he is not already on that, that would be the next logical step before moving to injections.

Also, make sure his technique and timing are right by performing the technique in front of the doctor and watching reliable videos; a lot of benefit can be lost if the inhaler isn’t used correctly. Now, about the biologic injections.

In someone who keeps having symptoms or flare-ups despite using high-dose inhalers correctly, these injections can help reduce attacks and steroid use. They are given once a month or every few months, depending on the drug, and long-term safety data so far have been very good.

They do not cure the disease, but they can make the asthma component much quieter and improve quality of life.

Nebulizers can be used if he has trouble coordinating his inhaler breathing or needs relief during a flare, but they don’t add extra benefit if he’s already using his inhalers properly.

They will not make the inhalers “less effective.” For daily use, the inhaler with a spacer is usually enough and more convenient.

If his oxygen level sometimes drops to 91 % at night, that is worth checking in detail. We usually arrange an overnight oximetry or sleep study to see how long and how low the oxygen dips go.

Continuous home oxygen is considered only if his oxygen stays below about 88 % for a significant time, either at rest or during sleep. Brief dips do not always need oxygen but do need investigation, especially if there’s snoring or daytime sleepiness suggesting sleep apnea.

Even though some of the lung damage in COPD is permanent, there is a lot he can do to feel better. Pulmonary rehabilitation and regular breathing exercises help him breathe more efficiently and reduce the sensation of breathlessness.

Staying active, eating well, and getting his flu and pneumonia vaccines are just as important as the medicines.

Best wishes, and speedy recovery to your father.

Thank you.