To report on the continued experience with the use of omalizumab in patients with obstructive lung disease who may also have a comorbid asthmatic component mediated by IgE antibody.
All patients were drawn from the original pool of 250 patients in a pulmonary practice who had asthma or chronic bronchitis and qualifying levels of IgE (>30 IU/ml). Seventeen patients have been studied. Eleven completed 12 months of therapy (4 completed 4 to 9 months of therapy). Age range was 48 to 82 years. Nine were females. Fifteen have heavy primary or secondary cigarette exposure. Sixteen had positive skin tests to relevant indoor allergens. Baseline FEV1 was below 60% predicted in 11 patients. IgE ranged from 32 to 496 IU/ml. End points were reduction in number of acute exacerbations requiring hospitalizations or unscheduled office visits, reduction in inhaler use and improvement in dyspnea or cough indices. A 12 month baseline period was compared was compared with treatment intervals after the first month of omalizumab therapy.
Comparing the year before therapy to the treatment period, the average monthly exacerbation rate decreased from 0.20 to 0.11. Comparing the month before therapy with the final treatment month, the average daily number of inhalations of asthma inhalers decreased from 13.5 to 7.4. The average daily Fletcher dyspnea score decreased from 1.35 to 0.53. The average daily cough severity scale decreased from 1.12 to 0.59. Of the six patients that were prednisone dependent at baseline the average daily prednisone requirement decreased from 37 to 10 mg.
Continued experience with the use of omalizumab in patients with severe chronic obstructive lund disease confirms the initial impression of effectiveness. The role of IgE in these patients may be significant in disease severity. This pilot study suggests that further controlled studies in this group of patients would be warranted.
A patient population with chronic obstructive lung disease should be screened for the use of omalizumab therapy. Skin test reactivity to indoor allergens was common.
Clifford Risk, None.