Abstract
This article presents a clinical case of a 56-year-old female patient with severe uncontrolled persistent asthma of mixed phenotype, characterized by poor disease control despite optimized background therapy and biologic treatment. The patient had a long history of asthma with progressive respiratory symptoms, frequent exacerbations, dependence on systemic corticosteroids, and development of mild respiratory failure (grade I). Particular attention is given to the use of omalizumab, an anti-IgE monoclonal antibody, administered according to the patient’s total IgE level and body weight. Although initial improvement in clinical symptoms and asthma control questionnaire scores was observed, the therapeutic response was not sustained, and disease control subsequently deteriorated. The report summarizes objective findings, including pulmonary function test results, laboratory markers of allergic and eosinophilic inflammation, bronchoscopy findings, sputum cytology, and chest computed tomography demonstrating chronic airway inflammation and progressive fibrotic remodeling of lung tissue. This case highlights the heterogeneity of severe asthma and illustrates the limitations of anti-IgE therapy in patients with mixed inflammatory phenotypes or non-IgE-mediated mechanisms of disease. The findings emphasize the importance of individualized treatment strategies, continuous monitoring, and consideration of alternative biologic therapies in patients with severe uncontrolled asthma.