When all else failed, organics helped her breathe again
Last summer, Marlena McCree went for a kayak ride. It was a monumental milestone for the 57-year-old – and confirmation that she had finally found the right treatment for her severe asthma.
The treatment, drugs known as biologics, would take years to reach McCree, who credits University of Michigan pulmonologist Njira Lugogo, MD, for giving her a chance to finally breathe.
âBiologics are a new class of drugs that attack asthma at the cellular level compared to just treating a patient’s symptoms,â Lugogo said. “They have shown promising results for patients with severe asthma.”
An unknown diagnosis
The 13-year-old grandmother from Detroit was diagnosed with asthma at the age of 23 and spent the next three decades going back and forth between doctor’s appointments, trying new ones. inhalers, steroids and other drugs. At the height of her illness, McCree was intubated three times – unsure if she would live to see another day.
McCree’s severe symptoms also saw her in and out of hospitals, including three times in 2017. But she was never able to find relief until she met Lugogo in 2018.
“Dr. Lugogo diagnosed me with eosinophilic asthma, something I had never heard of before,” said McCree. “I was happy to hear that there were treatments that might help.”
Eosinophilic asthma, or e-asthma, is a serious type of lung disease most commonly seen in adult patients, although it also occurs in younger individuals. A diagnosis of e-asthma is considered if a patient often uses a rescue inhaler to control asthma symptoms, has asthma attacks requiring emergency care, or takes oral steroids to treat the condition.
âI suspected e-asthma because the patient was very sensitive to oral steroids,â Lugogo said. “She has also had frequent exacerbations, as well as a history of allergies and excessive nasal congestion, which are symptoms of the disease.”
Finally, the right treatment
To confirm his suspicions, Lugogo relied on biomarkers, measurable characteristics of the body that can help diagnose certain conditions.
Different biomarker tests can help identify specific types of asthma. These include a blood test to measure a patient’s eosinophils, a type of white blood cell that contributes to inflammation in the lungs.
âEosinophils are a useful and powerful biomarker for diagnosing patients,â Lugogo said. âThe number of eosinophils in a patient’s blood can predict their responsiveness to corticosteroid therapy and certain biological therapies. “
Asthma patients like McCree are usually treated with a combination of oral steroids and biologics, which are man-made proteins that prevent inflammation by acting on specific substances in the body’s immune system.
âWe also test for increased levels of exhaled nitric oxide and allergies to determine if a patient is sensitive to the environment. These biomarkers help us understand the type of inflammation in a patient and allow us to treat them more effectively.
There are currently four biologics – Dupixent, Nucala, Fasenra, and Cinqair – that target pathways affecting eosinophils. A fifth biologic, Xolair, targets immunoglobulin E which is essential in the treatment of allergic reactions.
But, Lugogo cautions, “It’s not a cure – it’s seen as a cure. And some patients are super responders while others may not respond at all.”
For those with asthma, Lugogo stresses that good asthma control is an achievable goal and that there are many new treatment options available.
âIf you have asthma, don’t just give in to it and let it rule your life,â Lugogo said. âMany patients adjust their activities around their breathing by doing less and less. If organic products aren’t the answer for you, advocate for a better way to treat your asthma so you can enjoy a better quality of life.
For McCree, biological therapy finally meant getting his life back on track.
“I depended on my three children to do so much for me over the years and I missed a lot of things from their childhood.” But she makes up for lost time with regular bowling outings, summer kayaking and benefits from her 13 grandchildren, aged 4 to 19.
âPlaying with them is a fun activity,â she said. One that she’s always grateful to be a part of.