What is Eosinophilic Asthma? Questions About E-Asthma Answered

Eosinophilic asthma is a subtype of asthma that is typically more severe and associated with more exacerbations. While only 5% of adults with asthma have eosinophilic asthma, up to 50-60% with severe asthma have eosinophilic asthma. Here’s what you need to know about eosinophilic asthma.

Asthma affects approximately 27 million people in the United States. It is a chronic disease caused by airway inflammation, leading to shortness of breath, coughing, and wheezing. While asthma can be severe, it can be effectively controlled through lifestyle management – avoiding dust, smoke, pollutants, and other triggers – and medications.

However, for a small population of asthma sufferers, commonly used treatments are not effective.

Eosinophilic asthma, or e-asthma, is a more severe form of asthma characterized by an increased number of eosinophils, a type of white blood cell, in the airways. Eosinophils play a crucial role in the immune response, and their presence in the lining of the airways can trigger inflammation and asthma symptoms.

Knowing how to address and manage eosinophilic asthma is critical. If your asthma is worsening or becoming less responsive to previously effective treatments, please discuss your symptoms with an allergy and asthma specialist to determine the best course of action.

What are the symptoms of eosinophilic asthma?

Typically, asthma causes airway inflammation, inhibiting airflow and causing breathing difficulties. E-asthma, however, is often associated with inflammation of the whole respiratory system, meaning that the swelling isn’t confined to airways but can be experienced in the nasal passages and sinuses.

Commonly seen e-asthma symptoms include the following:

• Wheezing
• Coughing
• Chest tightness
• Shortness of breath
• Difficulty breathing during physical activity
• Chronic sinusitis with nasal polyps
• Inflamed lining of the nose
• Restricted airways

People with e-asthma also find that inhaled corticosteroid medications are not effective in symptom reduction, though corticosteroids taken in pill form tend to be more successful. People with e-asthma are more prone to asthma attacks and

Symptoms can vary depending on the severity of the asthma and the individual’s unique response to triggers.

What triggers eosinophilic asthma?

It isn’t yet known exactly what causes e-asthma. The condition is largely first identified in adults between the ages of 35 and 50 with no history of allergies, though it can also appear in children.

E-asthma symptoms aren’t necessarily brought about by the same environmental irritants that often precede a standard asthma flare-up; e-asthma has unique and, often, non-allergic triggers. These triggers may include smoke, pollution, certain medications (such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and beta-blockers beta or infections. Stress, anxiety, and strong emotions can trigger asthma symptoms in some individuals. Emotional factors may exacerbate asthma by increasing airway inflammation and hypersensitivity. Identifying and avoiding these triggers can help manage the symptoms of e-asthma and reduce the risk of flare-ups.

What is the difference between asthma and eosinophilic asthma?

Eosinophilic asthma (e-asthma) is a specific subtype of asthma characterized by high levels of eosinophils, a type of white blood cell, in the airways. While e-asthma shares many similarities with other types of asthma, there are some key differences:

Underlying Inflammation:

• Asthma: Asthma can be triggered by various factors, including allergens, irritants, respiratory infections, exercise, and emotions. The underlying inflammation in asthma may involve multiple immune cells and mediators, not exclusively eosinophils.
• Eosinophilic Asthma: Eosinophilic asthma is characterized by predominant eosinophilic inflammation in the airways. Eosinophils release inflammatory mediators that contribute to airway hyperresponsiveness and asthma symptoms.

Triggers:

• Asthma: Triggers for asthma exacerbations can vary widely and may include allergens, irritants, infections, exercise, stress, and medications.
• Eosinophilic Asthma: While e-asthma can be triggered by similar factors as asthma, it may be particularly responsive to allergens and other stimuli that elicit eosinophilic inflammation.

Response to Treatment:

• Asthma: Treatment for asthma typically involves bronchodilators (e.g., beta-agonists) to relax the airway muscles and anti-inflammatory medications (e.g., corticosteroids) to reduce airway inflammation.
• Eosinophilic Asthma: Eosinophilic asthma may respond well to anti-inflammatory treatments that specifically target eosinophils or eosinophil-related pathways. Biologic therapies, such as monoclonal antibodies targeting interleukin-5 (IL-5) or its receptor, are often used for severe eosinophilic asthma.

How do you know if asthma is eosinophilic?

Diagnosis of eosinophilic asthma involves taking a thorough medical history review, physical examination, lung function tests, and eosinophil tests. Allergists-Immunologist specialiise in the diagnosis, treatment and management of asthma, including e-asthma.

The evaluation will typically begin with a discussion of your health history and symptoms, triggers, and any previous treatments. A physical exam will be performed where the physician checks for nasal inflammation, polyps, or infections in the middle ear.

Your doctor will also administer a lung function test, known as a spirometry test. Allergy testing may be performed to assess for allergic triggers of asthma. A spirometry test measures the amount of air inhaled and exhaled. Eosinophil tests will also be administered to determine the concentration of eosinophils within the airways. These tests include the following:

• Blood Test: Your doctor might have blood tests performed to measure the overall level of eosinophils in your blood supply.
• Breath Test: A breath test measures the amount of nitric oxide being exhaled, which is an indication of eosinophil-related inflammation.

Is eosinophilic asthma dangerous?

E-asthma is a serious and potentially life-threatening respiratory condition. When left untreated, it can lead to long-term complications, including permanent lung damage and reduced lung function.

Patients with e-asthma experience more frequent and severe asthma attacks, leading to more frequent hospitalizations and emergency room visits. Identifying and managing this condition correctly is essential for reducing the risk of severe asthma attacks and improving the overall well-being of people affected by this condition.

How is eosinophilic asthma treated?

There are several types of drugs that are commonly used to help manage e-asthma symptoms and improve lung function. These medications work in different ways to address the different aspects of the condition. The most commonly prescribed treatments include the following:

• Anti-Inflammatory Medications: In some cases, anti-inflammatory medications can play a crucial role in reducing and preventing lung inflammation in e-asthma. These include fluticasone, budesonide, and mometasone.
• Bronchodilators: Bronchodilators relax and open the airways to relieve asthma symptoms. They are often used as a first-line treatment for asthma and are available in both oral and inhaled forms. By opening the airways, bronchodilators improve airflow and make breathing easier.
• Combination Medications: Combination medications are a combination of a bronchodilator and an anti-inflammatory medication in a single device. These medications provide the benefits of both drugs in one inhaler, making it easier for patients to manage their asthma.
• Leukotriene Modifiers: Leukotriene modifiers are a class of medications that block the action of leukotrienes, which are chemicals involved in immune system responses. Leukotrienes are thought to contribute to the development of inflammation and airway hyperresponsiveness in asthma.
• Corticosteroids: Corticosteroid pills are generally considered the most effective treatment for eosinophilic asthma. Research has shown that corticosteroids can significantly improve lung function and reduce asthma symptoms in patients with e-asthma. However, repeated courses or long-term use of systemic steroids cause significant long-term side effects. Avoiding the use of systemic steroids is a key treatment goal for e-asthma.
• Biologics: Biologics work by blocking or neutralizing specific proteins involved in airway inflammation. They are typically reserved for patients with severe asthma who have not responded to other treatments or who require frequent or chronic systemic corticosteroids.

In addition to managing e-asthma symptoms with medications, there are lifestyle modifications that help keep symptoms at bay. The Asthma Impairment Risk Questionnaire (AIRQ) is a valuable tool for understanding the impact and management of e-asthma.

The AIRQ consists of a series of questions about your asthma symptoms, daily activities, and quality of life. By completing this questionnaire, you provide valuable information about your asthma and its impact on your daily life. Your responses are used to assess the severity of the condition and guide your medical team in developing a personalized action plan.

The caring team at Allergy Partners offers consistent, compassionate support that delivers exceptional outcomes for diverse patients struggling with e-asthma. With our expertise and dedication to patient care,  we can help you optimize your asthma control and enjoy a better quality of life.