Introduction: According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome.
Case report: A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage.
Discussion: Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.
