Evidence-Based Approach of Biologic Therapy in Bronchial Asthma.

The emergence of biologic agents in the treatment of bronchial asthma has a wide impact on improving quality of life, reducing morbidity, and overall health care utilization. These therapies usually work by targeting specific inflammatory pathways involving type 2 inflammation and are particularly effective in severe eosinophilic asthma. Various randomized controlled trials have shown their effectiveness by reducing exacerbation rates and decreasing required glucocorticoid dosages. One of the relatively newer agents, tezepelumab, targets thymic stromal lymphoprotein and has proven its efficacy in patients independent of asthma phenotype and serum biomarker levels. This article reviews the pathophysiologic mechanism behind biologic therapy and offers an evidence-based discussion related to the indication, benefits, and adverse effects of such therapies.

Central Vein Thrombosis in Pulmonary Neuroendocrine Neoplasm: A Novel Presentation.

Internal jugular vein (IJV) thrombosis is a rare finding and is usually associated with central venous catheterization, neck infections, or local trauma. Neuroendocrine tumors (NETs) rarely predispose to central vein thrombosis. The usual presentation of pulmonary NET depends on tumor location and is usually non-specific. It ranges from asymptomatic to cough, hemoptysis, dyspnea, etc. Here we present the case of a 52-year-old male with right-sided neck swelling. Ultrasound imaging of the neck revealed right IJV and right subclavian vein thrombosis. Further imaging with computed tomography (CT) scan of the chest showed mediastinal mass. Histopathology findings were consistent with NET of pulmonary origin. Patient was started immediately on anti-coagulation and radiology oncology was consulted for tumor-specific treatment. This case highlights an association of central vein thrombosis with underlying mediastinal and lung malignancies.

A Case of Persistent Asthma Resistant to Available Treatment Options: Management Dilemma.

Asthma affects nearly 300 million people worldwide, with 250,000 associated deaths annually. An estimated 5%-10% of patients have severe asthma, while only 1%-2% presented with treatment-resistant or refractory asthma. Currently, the endotype of asthma is divided into T-helper type 2 (Th2) high and Th2-low inflammation endotypes. The Th2-high endotype is characterized by eosinophilic asthma, while the Th2-low endotype is associated with neutrophilia and a pauci-granulocytic profile. The Th2-low endotype carries a high resistance to corticosteroid and bronchodilator therapy, and these patients typically have a severe and acute-onset of symptoms. We present a 57-year-old nonsmoking female with recurrent intensive care unit (ICU) admissions for severe acute asthma exacerbations, resistant to bronchodilator and steroid treatment, requiring mechanical ventilation. Currently, the guidelines for treating neutrophil-predominant Th2-low inflammation asthma have not been established. This creates a management dilemma when encountered with such a patient in clinical practice. We aim to propose targeted treatment options for these severe and potentially fatal asthma patients, with reference to current literature.