Hemodynamic improvement but worsening hypoxemia after balloon pulmonary angioplasty: severe eosinophilic asthma unmasked in CTEPH

We report a patient with peripheral-type chronic thromboembolic pulmonary hypertension (CTEPH) in whom exertional hypoxemia and dyspnea worsened despite substantial hemodynamic improvement after repeated balloon pulmonary angioplasty (BPA), prompting reassessment for a competing ventilatory limitation. Optimization of concomitant severe eosinophilic asthma with benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, and sinus surgery improved airflow obstruction and oxygenation and was accompanied over time by a further reduction in pulmonary arterial pressure. These changes suggest that a superimposed hypoxia-related pulmonary vascular component, compatible with group 3 physiology, may have been attenuated.