Omalizumab therapy in a patient with severe asthma and co-existing chronic obstructive pulmonary disease

Exposure to tobacco smoke in asthmatics is one of the significant causes of severe asthma [1]. It is generally known that passive and active smoke exposure may induce asthma symptoms and bronchoconstriction in asthmatic patients [2]. Moreover, asthmatics who are regular smokers develop more severe asthma symptoms, have a lower quality of life and more often require emergency medical intervention and hospitalization due to exacerbations [3, 4]; their forced expiratory volume in 1 s (FEV1) decline over time is faster [5] and their response to inhaled corticosteroids (ICSs) [6], even to higher doses [7, 8], is poorer. Apart from an active struggle with addiction, the treatment of an asthmatic smoker requires medications that overcome steroid resistance (long-acting β2-adrenergic receptor agonists – LABA [9–11]) and have different mechanisms of action to corticosteroids (leukotriene receptor antagonist – LTRA [8, 12] and long-acting muscarinic receptor antagonists – LAMA [13]). Little is known of the efficacy of anti-IgE biologic therapy in these patients