A 53-year-old woman with bronchial asthma comes to the allergy clinic for a checkup. She reports repeated exacerbations with nocturnal symptoms, frequent use of rescue medication and dyspnea on exertion when walking on level ground. Spirometry shows a pre-bronchodilator FEV1/FVC ratio of 60% and FEV1 of 55%. Skin tests are positive for mites and total IgE of 150 IU/ml. The patient is being treated with a combination of high-dose salmeterol/budesonide (50/500 mg: 2 puffs twice daily), maintenance oral prednisone (10 mg/day) and theophylline. Of the following options, which is the most advisable therapeutic approach?
The indication of omalizumab in a patient such as the one referred to is a correct indication, although in severe asthma that is difficult to control, there are other prior measures that are not contemplated and that must always be taken into account before resorting to this treatment. It is mandatory to ensure firstly that it is truly asthma and not another disease that simulates asthma, secondly that there are no complications that worsen the evolution as could be the presence of gastroesophageal reflux, bronchiectasis, presence of opportunistic germs given the chronic treatment with steroids, etc; and thirdly, it is necessary to confirm that the patient complies with the treatments correctly, especially the inhaled treatment, etc. Once all of the above has been checked, it would be time to start a trial treatment with omalizumab.
Add magnesium sulfate.
Increase the dose of prednisone to 30 mg/day.
Add omalizumab.
Nebulized treatment at home.
Switch to a combination with high doses of budesonide and formoterol.
The indication of omalizumab in a patient such as the one referred to is a correct indication,