My brother has asthma. Can an allergy test reveal triggers?

Question

Hello doctor,

My brother, 28, has moderate persistent asthma. His latest spirometry shows FEV1 at 55 %, and eosinophils are elevated at 650/µL.

He has been using a Budesonide-Formoterol inhaler regularly, but still gets nighttime wheezing and chest tightness. Kindly provide your opinion on the following -

Should we consider stepping up to a higher inhaler dose or try biologics like Dupilumab?
Would doing an allergy panel help identify specific triggers worsening his symptoms?
Also, can long-term steroid inhaler use cause bone thinning or other serious side effects?
Are pulmonary rehabilitation programs or breathing exercises scientifically proven to improve lung function and reduce the frequency of flare-ups?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your brother has moderate persistent asthma with reduced lung function (FEV1 (forced expiratory volume) 55 %) and raised eosinophil count, which suggests an eosinophilic phenotype. Despite regular use of Budesonide–Formoterol, his symptoms are not fully controlled, especially at night.

In such cases, the next steps usually include:

Increasing the inhaled corticosteroid dose or considering a triple inhaler.
Since eosinophils are elevated, biologics such as Dupilumab, Mepolizumab, or Benralizumab may be beneficial in patients who remain symptomatic despite high-dose inhaled therapy.
An allergy panel can be helpful to identify environmental triggers (dust mites, pollen, pets) and guide avoidance strategies.

Regarding the concerns about long-term inhaled steroids, at recommended doses, inhaled corticosteroids are generally safe. Rarely, with high cumulative doses, they may cause systemic effects such as bone thinning, but this is uncommon compared to oral steroids. Regular monitoring and using the lowest effective dose minimize risks.

Pulmonary rehabilitation, breathing exercises, and structured physical activity programs have evidence for improving quality of life, exercise tolerance, and reducing exacerbations, though they do not reverse the underlying asthma.

He should review treatment with his pulmonologist to discuss either dose escalation or eligibility for biologic therapy. Avoiding triggers, adhering strictly to the inhaler technique, and considering allergy testing are important supportive measures.

I hope this helps.

Thank you and take care.

Regards.