Sequential Use of Tezepelumab and Bronchoscopic Lung Volume Reduction With Endobronchial Valves in a Patient With Severe Asthma-COPD Overlap and Heterogeneous Emphysema: A Case Report.

Asthma-COPD overlap (ACO) carries greater symptom burden, frequent exacerbations and impaired quality of life compared with asthma or COPD alone. Evidence-based advanced therapies are lacking, and management is typically extrapolated from existing guidelines. Tezepelumab, an anti-thymic stromal lymphopoietin antibody, reduces exacerbations and improves lung function in severe asthma. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves benefits selected patients with advanced emphysema and hyperinflation despite optimal therapy. A 71-year-old woman with severe ACO, frequent exacerbations and hyperinflation despite triple inhaled therapy was treated sequentially with tezepelumab and BLVR. Tezepelumab improved airway control and reduced exacerbations; BLVR subsequently addressed persistent hyperinflation. Over 2 years, the patient achieved sustained improvements in lung function, St. George's Respiratory Questionnaire score and annual exacerbation rate. This case highlights the potential benefit of a combined anti-inflammatory and interventional approach in difficult-to-treat ACO, a population for whom evidence-based advanced therapies remain limited.