Can biologic shots help asthma-COPD overlap at 55?

Question

Hello doctor,

I have had asthma for years, but now my pulmonologist says I might have COPD overlap, too. I am 55, smoked in my 20s but quit long ago. Still, I am short of breath after climbing stairs.

I am on inhaled steroids and a long-acting bronchodilator, but flare-ups still happen, and I ended up in ER twice this year.

I heard about biologic shots for severe asthma. Are those for people like me?
I am also wondering if I should use a nebulizer daily or just during attacks. It feels like I cannot breathe freely anymore, and it is scary, especially at night.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

From what you describe, it sounds like you may have what we call asthma-COPD overlap, which means your airways show features of both asthma and chronic obstruction from past smoking or long-standing inflammation. It is not rare, and with the right treatment, it can be controlled well.

First, make sure your inhaler technique is correct and that you never miss doses. Even small errors can make a big difference. Based on your history, I would recommend you use a triple drug inhaler having Budesonide, Formoterol, and Glycopyrronium bromide. This combination often brings much better control and reduces attacks.

If you are still having flare-ups despite using these regularly and correctly, there are now biologic injections (complex drugs derived from living organisms, such as vaccines, insulin, or therapeutic proteins) that target specific allergens.

These are given once every few weeks and can dramatically reduce severe attacks for patients who fit certain criteria.

To decide if you are a candidate, your doctor will check a few blood tests, such as eosinophil count (a blood test that measures the number of one type of white blood cell called eosinophils), total IgE (an antibody measurement in the blood used to detect allergic sensitivities, parasitic infections, or immune system disorders), and sometimes a breathing test that measures airway inflammation.

Regarding nebulizer use, it is not needed every day.
The inhalers you are already using are equally effective and safer for long-term use.
Keep your nebulizer for times when your breathing suddenly worsens, or you are too breathless to use your regular inhaler properly.
Using it daily without a clear need does not add benefit and can sometimes cause unwanted side effects.

Because you have breathlessness at night, we should also look for other possible triggers such as acid reflux (occurs when stomach acid flows back into the esophagus, causing burning chest pain (heartburn), regurgitation, and potential damage to the esophageal lining), nasal allergy (occur when the immune system overreacts to airborne triggers like pollen, dust mites, pet dander, or mold), or sleep apnea (a serious disorder where breathing repeatedly stops and starts during sleep, leading to poor oxygen supply and fragmented, nonrestorative rest).

Treating these often helps night symptoms. Try to avoid lying down soon after dinner, and keep your head slightly elevated during sleep.

It is also important to stay protected from infections. Make sure your flu and pneumonia vaccines are up to date. Try to keep your home smoke-free and well-ventilated. Regular physical activity helps a lot.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.