Omalizumab in middle-aged or older patients with severe allergic asthma-COPD overlap

Introduction: Biological therapies used for severe asthma may be useful even for middle-aged or older patients who have a history of severe allergic asthma with a chronic obstructive pulmonary disease (COPD) overlap phenotype. Aim: To show omalizumab efficacy in severe allergic asthma-COPD overlap disease.Material and methods: We report our data of a retrospective study on 11 patients (mean age: 67.18 years) with a positive history of severe allergic asthma treated with omalizumab. They all presented limited reversibility of airway obstruction and signs of chronic bronchitis at radiological examinations, as in asthma-COPD overlap. Omalizumab improved conditions in terms of reduced exacerbations as well as asthma control test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) scores. Results: Clinical improvement was seen already in the first year with significantly increased ACT scores (p < 0.0001) and a significantly decreased number of exacerbations (p < 0.001). Furthermore, our data showed a significant inverse correlation over time between the number of exacerbations and ACT (r = -0.83, p < 0.0001), AQLQ symptoms (r = -0.87, p < 0.0001), forced expiratory volume in 1 s (FEV1) (r = -0.71, p < 0.001) and FEV1/forced vital capacity (FVC) (r = -0.43, p = 0.04). There also was a positive correlation between ACT and FEV1 (r = 0.74, p < 0.0001), ACT and AQLQ symptoms (r = 0.93, p < 0.0001), FEV1 and AQLQ symptoms (r = 0.67, p < 0.001). All parameters continued to improve during the second year of treatment. Conclusions: Omalizumab may be relevant as a therapeutic option even in middle-aged and older patients with severe asthma.