Does Tezepelumab help manage severe asthma in teen swimmers?

Hello,

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I have read your query and can understand your concern.

Tezspire (Tezepelumab) is a monoclonal antibody that targets TSLP (thymic stromal lymphopoietin), a key player in the initiation of asthma inflammation. It has proven effective in both T2-high and T2-low asthma phenotypes, making it a viable option for your patient, even in the absence of classic T2 inflammation markers (for example, eosinophils, IgE, and FeNO not markedly elevated).

Suitability for non-T2 asthma:

While T2-high asthma typically shows elevated eosinophils, IgE, and FeNO, T2-low asthma can still present with severe symptoms and exercise-induced issues, without clear markers of T2 inflammation. Tezspire works by targeting a broader inflammatory pathway that is independent of eosinophilic or IgE-mediated mechanisms. This makes it potentially effective even in cases where traditional T2 markers are not prominent. Given your patient's persistent symptoms despite maximal inhaler therapy, Tezspire could be a valuable option, especially since it has been shown to reduce exacerbations and improve asthma control in both T2-driven and non-T2 asthma.

Expected impact on exercise tolerance:

Tezspire may improve exercise tolerance by reducing exercise-induced bronchoconstriction (EIB). Addressing the underlying airway inflammation could lessen the severity and frequency of asthma symptoms during exercise, leading to better performance and less limitation in training. Clinical studies have shown improvements in lung function and a reduction in exacerbations, which are likely to translate into better exercise capacity. However, it may take several weeks to months to see full benefits, and the improvement in exercise performance will depend on how the patient responds.

Considerations for adolescent athletes:

1. Growth monitoring: Since your patient is an adolescent, monitoring growth during treatment is important, although Tezspire generally has a favorable safety profile.

2. Exercise performance: Tezspire may improve exercise-induced symptoms, enabling more consistent and effective training. However, starting Tezspire could require adjustments to other asthma therapies, such as bronchodilators. Close monitoring of physical performance is recommended to gauge how the medication affects his training.

3. Psychosocial impact: Asthma can be especially frustrating for competitive athletes. Tezspire’s potential to improve asthma control could not only enhance physical performance but also positively impact his mental well-being and confidence, which is important in the context of adolescent sports.

Pre-exercise bronchodilator routine:

Your patient should continue using pre-exercise short-acting beta-agonists (SABA) like Albuterol, 15-20 minutes before exercise, as needed, to prevent symptoms. While Tezspire may reduce the frequency of symptoms and the need for SABA over time, it is best to maintain the current routine initially. Adjustments can be made as the effects of Tezspire on exercise tolerance become clearer. If the patient achieves more consistent symptom control, the reliance on pre-exercise SABA may decrease.

Tezspire appears to be a reasonable next step for your patient, particularly given his ongoing symptoms despite intensive therapy. It has the potential to improve asthma control, reduce exacerbations, and enhance exercise tolerance. Regular monitoring of asthma symptoms, lung function, and exercise performance will be critical, and adjustments to his asthma management plan, including pre-exercise medications, can be made based on his response to therapy.

Collaboration with a sports physician and pulmonologist may also be beneficial to ensure a comprehensive approach to both asthma management and athletic performance.

I hope this answers your query.

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Thank you.