Severe Eosinophilic Asthma and Persistent Airflow Obstruction Treated with Biologic Therapies : A Case Report

Abstract

Severe asthma is characterized by persistent symptoms and recurrent exacerbations despite optimized treatment. Eosinophilic asthma represents a major Type-2 inflammatory phenotype associated with poor disease control and increased healthcare utilization. We report a case of severe eosinophilic asthma managed with biologic therapy. Clinical history, physical examination, laboratory findings, spirometry results, treatment, and therapeutic response were retrospectively reviewed from medical records. A patient with a history of asthma since childhood presented with worsening dyspnea, cough, and rhinorrhea. Symptoms occurred predominantly at night and were associated with recurrent exacerbations and previous hospitalization. Physical examination revealed bilateral wheezing. Peripheral eosinophilia was documented, with eosinophil counts ranging from 586 to 837 cells/μL. Spirometry demonstrated severe airflow obstruction with FEV1 49.3–53.2% predicted and FEV1/FVC 52.5–54.5%. Despite triple inhaled therapy, disease control remained suboptimal. Benralizumab 30 mg was initiated, resulting in a marked reduction of eosinophil count from 837 to 111 cells/μL. This case illustrates severe eosinophilic asthma with persistent airflow limitation despite optimized inhaled therapy. The significant reduction in eosinophil count following benralizumab supports the role of anti-IL-5 receptor therapy in suppressing eosinophilic inflammation and highlights the importance of phenotype-guided management in severe asthma.