Will Dupixent help my brother’s severe asthma and low FEV1?

Question

Hello doctor,

I am writing about my 26-year-old younger brother, who has struggled with severe, uncontrolled asthma for most of his life. Despite being on high-dose inhalers and other maintenance medications, his symptoms remain poorly controlled. He has already had multiple hospital admissions this year because of asthma flare-ups.

Recently, his pulmonologist said he may have an asthma-COPD overlap after spirometry showed his FEV1 was only 48 %, which feels very concerning for someone his age. His allergist has now suggested starting Dupixent, and our family is seriously considering it.

Before moving forward, I wanted to understand a few things:

Can Dupixent at age 26 still improve lung function after years of severe, uncontrolled asthma?
In patients with long-standing airway damage or asthma-COPD overlap, does it help improve FEV1, or does it mainly reduce flare-ups and hospitalizations?
His eosinophil count is elevated, and his FeNO level was 55, so I believe he fits the type 2 inflammatory profile. Does that make him more likely to respond well?
Is Dupixent generally safe to use alongside existing asthma and COPD medications, including high-dose inhalers?

We are hopeful, but also worried that years of uncontrolled disease may have caused permanent damage, so I would really appreciate some guidance on what kind of improvement is realistically possible.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

According to the history you provided, your younger brother appears to have asthma and COPD (chronic obstructive pulmonary disease) overlap syndrome, where both asthma and COPD features are present. However, in his case, the asthma component seems to be more predominant, especially considering his elevated eosinophil count and FeNO level (fractional exhaled nitric oxide level) of 55, which strongly suggests type 2 airway inflammation.

In such patients, Dupixent (Dupilumab) can be a very effective treatment option. It is a biologic therapy specifically used for severe allergic or eosinophilic asthma that remains uncontrolled despite high-dose inhalers and standard medications. Clinical experience and studies have shown that it can help reduce asthma attacks, hospital admissions, and steroid dependence and may also improve lung function, including FEV1 (forced expiratory volume in 1 second), over time.

However, it is important to understand that the improvement is usually gradual. Patients should not expect immediate changes within days or weeks. In severe long-standing asthma, especially when airway remodeling has already occurred, recovery of lung function may take several months, and the degree of improvement can vary from person to person. Still, younger patients with high FeNO (elevated fractional exhaled nitric oxide) and eosinophilic inflammation often respond quite well to Dupilumab.

Initially, he will likely need to continue his current asthma and COPD medications alongside Dupilumab. If his symptoms become better controlled over time, his treating doctor may gradually reduce some of the other medications depending on his response.

Before starting biologic therapy, I would also strongly recommend:

Reviewing his inhaler technique carefully, as incorrect usage is a very common reason for poor asthma control.
Ensuring good adherence to prescribed medications.
Avoiding smoking exposure, dust, and other known triggers.
Taking annual influenza vaccination.
Receiving pneumococcal vaccination, such as PCV20 or PCV21, if advised by his physician.

Overall, based on the details you shared, he does appear to fit the profile of someone who could benefit significantly from Dupilumab therapy.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.