{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:21:10Z","timestamp":1787667670959,"version":"build-2736575974"},"reference-count":19,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T00:00:00Z","timestamp":1708819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Severe adult-onset eosinophilic asthma and COPD with eosinophilic inflammation are two entities with a similar clinical course and are sometimes difficult to differentiate in clinical practice, especially in patients with a history of smoking. Anti-IL-5 or -IL-5R biological therapy has been shown to be highly effective in severe eosinophilic asthma but has not demonstrated significant benefit in patients with COPD with the eosinophilic phenotype. Our aim was to illustrate this issue in the form of a case report. Materials and Methods: We present the case of a 67-year-old patient who is a former smoker with late-onset severe uncontrolled asthma (ACT score &lt; 15) who experienced frequent exacerbations requiring treatment with systemic corticosteroids. The patient\u2019s lung function gradually worsened to a nadir FEV1 = 18%, despite a high dose of ICS in combination with a LABA and intermittent courses of OCS, with negative allergic skin-tests, but with high blood eosinophils level. Biological treatment with an anti-IL5R monoclonal antibody (benralizumab) was initiated, despite the difficulty in the differential diagnosis between asthma and COPD with eosinophilic inflammation. Results: The patient\u2019s evolution was favorable; clinical remission was effectively achieved with significant improvement in lung function (FEV1 &gt; 100%), but with persistence of residual mild fixed airway obstructive dysfunction (FEV1\/FVC &lt; 0.7). The therapeutic response has been maintained to date. Conclusions: Benralizumab was shown to be very effective in a patient with late-onset severe eosinophilic asthma presenting features of chronic obstructive disease\u2014habitual exposure to tobacco and inhaled noxious substances, and persistent airflow limitation on spirometry.<\/jats:p>","DOI":"10.3390\/medicina60030387","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T07:51:39Z","timestamp":1708933899000},"page":"387","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Severe Asthma or Chronic Obstructive Pulmonary Disease with Eosinophilic Inflammation? From Uncertainty to Remission under Anti IL-5R Therapy"],"prefix":"10.3390","volume":"60","author":[{"given":"Bianca","family":"Oprescu","sequence":"first","affiliation":[{"name":"Pulmonology Department, Infectious Diseases and Pulmonology Hospital \u201cVictor Babes\u201d Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Raduna","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Infectious Diseases and Pulmonology Hospital \u201cVictor Babes\u201d Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8897-8342","authenticated-orcid":false,"given":"Stefan","family":"Mihaicuta","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Infectious Diseases and Pulmonology Hospital \u201cVictor Babes\u201d Timisoara, 300310 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7469-6755","authenticated-orcid":false,"given":"Stefan","family":"Frent","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Infectious Diseases and Pulmonology Hospital \u201cVictor Babes\u201d Timisoara, 300310 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1164\/rccm.201611-2232PP","article-title":"Eosinophilic and Noneosinophilic Asthma","volume":"197","author":"Carr","year":"2018","journal-title":"Am. 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