Did you know there are different types of asthma? One type you may not have heard of is called eosinophilic [EE-oh-sin-oh-FILL-ick] asthma. It is sometimes called e-asthma or eos asthma for short. It is a type of asthma that has increased inflammatory cells called eosinophils [EE-oh-sin-oh-FILLS] in the airway. An estimated 25 million people in the United States have a diagnosis of asthma and about 10% of them have poorly controlled, severe asthma. Many of these patients could have e-asthma.
What Is Eosinophilic Asthma?
Eosinophilic asthma is a type of asthma that is caused by high levels of white blood cells called eosinophils in the airways of the lungs. The purpose of these white blood cells is to help you fight infections. Sometimes these immune cells are over-reactive and cause inflammation in the body, including in the lungs. People who have high levels of eosinophils can have swelling in the airways which can lead to asthma symptoms.
Eosinophilic asthma is a type of severe asthma. It usually starts in adulthood and may not respond to treatment with a common asthma medicine called a corticosteroid. In addition, this type of asthma can be associated with increased allergies.
If you have eosinophilic asthma, you can have allergic or non-allergic asthma triggers. Other types of asthma, such as allergic asthma, are more often triggered by specific allergens such as animal dander, mold spores, dust mites, and environmental allergens in the air.
How Do You Treat Eosinophilic Asthma?
Your doctor may do several tests to confirm your type of asthma. This may include checking your mucus or saliva for eosinophils, checking your blood eosinophil count, or doing a test that checks your breath for a nitric oxide gas. Your doctor will also ask you about your current and past symptoms, as well as any current and/or history of allergies If your doctor diagnoses you with e-asthma, understanding this unique type of asthma is important to help you manage symptoms and have better quality of life.
Current management of e-asthma begins with standard guideline-based therapy. For example, most people with asthma are prescribed two medicines:
- A controller medicine that treats airway swelling – usually an inhaled corticosteroid
- A quick-relief medicine to help relieve symptoms when they occur by relaxing bronchospasms [brahn-ko-spaz-uhmz] – when muscles tighten and squeeze around the airways
Depending on how often and how severe your symptoms are, you may take these medicines every day or as needed. Your health care provider should develop a clear, written, and understandable action plan for effective management of asthma symptoms.
For some people with e-asthma, the common controller medicines may not work well enough on their own to control asthma symptoms. Once your doctor looks at your tests, medical history, and current symptoms, the next step is making a plan for your treatment. Shared-decision making can be undertaken with your health care provider to see if you need to add a targeted therapy. This type of asthma treatment is known as a biologic, or monoclonal antibody therapy.
Biologics target specific cells (pathways that are part of your immune system) to block swelling and reduce symptoms. You get these therapies as a shot or by IV every few weeks or two months, depending on the treatment.
Current biologic options for e-asthma include:
How Does Eosinophilic Asthma Affect Quality of Life?
If you have uncontrolled asthma, no matter the type, you are at higher risk for emergency room visits, hospital stays, or death. If you have severe asthma, you may have symptoms every day and go to the emergency room more often than people with well-controlled asthma. Severe asthma can limit your ability to do even simple tasks, can be debilitating, and can decrease your overall quality of life. Identification of severe subtypes of asthma (like e-asthma) may be very important for treatment of your uncontrolled asthma.
A study by the Asthma and Allergy Foundation of America (AAFA) in 2017 found that people with severe, uncontrolled asthma have greater emotional, social, and financial burden of disease. But not all people with severe, uncontrolled asthma are aware of what type of asthma they may have or that biologic treatments exist that may control their asthma better and improve their quality of life. This is an issue that you should be aware of and discuss with your health care provider.
If you have asthma, talk with your doctors specifically about how asthma negatively affects your day-to-day life. Let them know what you hope to achieve with treatment. Ask them if you are a potential candidate for biologic asthma treatments.
We also encourage health care professionals to work closely with their patients to understand the many ways severe asthma is affecting quality of life. Together, people with asthma and their support teams can develop a shared understanding of asthma management and treatment goals.
Medical Review: May 2022 by John M. James, MD
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