Understanding the Key Symptoms and Treatments for Eosinophilic Asthma

Understanding Eosinophilic Asthma

Eosinophilic asthma is a type of asthma characterized by higher than normal levels of eosinophils, a type of white blood cell, in the body. Eosinophils play an important role in the immune system, particularly in defending the body against parasites and infections. However, in some people with asthma, eosinophils can trigger inflammation and make asthma symptoms worse.

What Causes Eosinophilic Asthma?

Researchers are still working to understand what exactly causes some people to develop eosinophilic asthma. It's likely a combination of genetic and environmental factors. Potential triggers may include:

• Exposure to allergens like dust mites, pet dander, pollen, or mold
• Respiratory infections
• Environmental pollutants or irritants
• Medications like aspirin or NSAIDs

When exposed to these triggers, eosinophils can release inflammatory proteins that cause swelling and mucus production in the airways. This leads to common asthma symptoms like coughing, wheezing, shortness of breath, and chest tightness.

Key Symptoms of Eosinophilic Asthma

The symptoms of eosinophilic asthma often mirror those of other asthma types. However, there are some characteristic signs that can help identify if someone may have this more severe, inflammation-driven form of asthma. Key symptoms to look for include:

Difficult-to-Control Asthma

One of the most telling signs is asthma that is difficult to control with the usual medications like inhaled corticosteroids. If asthma symptoms persist even after taking control medicines consistently and correctly, it may be a sign of underlying eosinophilic inflammation.

Frequent Asthma Flare-Ups

People with eosinophilic asthma often experience frequent severe flare-ups known as exacerbations. These are episodes where asthma symptoms like wheezing, chest tightness, and shortness of breath suddenly worsen and make it very difficult to breathe.

Eosinophilic asthma exacerbations may be triggered by exposures to allergens, irritants, weather changes, or respiratory infections. However, sometimes a clear trigger isnt identified. Frequent, severe attackseven when taking daily controller medsis a hallmark of poorly controlled eosinophilic asthma.

Nighttime Asthma Symptoms

Waking up with asthma symptoms like coughing, breathlessness, or chest tightness is also common. This happens because circulating eosinophil levels tend to rise at night, driving increased airway inflammation and narrowing while sleeping. Suffering from disturbing nighttime symptoms can also take a toll on quality of life.

Lung Function Declines Over Time

Progressive loss of lung function is characteristic of long-standing eosinophilic airway inflammation. Spirometry is a simple breathing test that measures how much air you can exhale after taking a deep breath. Repeated testing over months and years can detect irreversible lung damage.

When to See a Doctor

If any of the above symptoms sound familiar, it's important to talk to your doctor. Getting tested can help determine if eosinophils are indeed driving your asthma. Common diagnostic tests include:

• Sputum analysis - Coughing up mucus for examination under a microscope. An eosinophil percentage higher than 3% indicates eosinophilic asthma.
• Blood tests - A complete blood count can detect high eosinophil levels. Over 300-400 eosinophils per microliter of blood is considered elevated.
• Lung function tests - Spirometry and other pulmonary function assessments to evaluate airway obstruction and diagnose asthma.
• Allergy testing - Skin or blood tests to pinpoint triggers like pet dander, pollen, mold, or dust mites.

Identifying eosinophilic asthma is key, as treatment approaches can vary from typical asthma.

Treating Eosinophilic Asthma

The main goal when treating eosinophilic asthma is reducing excessive airway eosinophilic inflammation. This helps prevent symptoms, improve lung function, and minimize future exacerbations. Common treatment approaches include:

Inhaled & Oral Corticosteroids

Corticosteroids like fluticasone and budesonide work by blocking inflammatory pathways that activate eosinophils. High-dose inhaled steroids are usually the first-line treatment. For more severe cases, oral steroids like prednisone may be needed in the short-term.

Biologics & Monoclonal Antibodies

Newer injectable biologics target specific eosinophil-driven inflammation processes. Monoclonal antibodies like mepolizumab (Nucala) and benralizumab (Fasenra) work by either depleting eosinophils or inhibiting their activity. These can improve symptoms for those with uncontrolled, eosinophilic asthma.

Avoiding Triggers

Identifying and limiting exposure asthma triggers can also help prevent eosinophilic flare-ups. This may involve avoiding known allergens, irritants like cigarette smoke, respiratory infections, and even controlling stress levels with relaxation techniques.

Omalizumab (Xolair)

Omalizumab is a targeted therapy that blocks immunoglobulin E (IgE), an antibody that plays a central role in allergic reactions. Reducing IgE dampens the allergic response that can activate eosinophils. Omalizumab is mainly used for those with overlapping eosinophilic and allergic asthma.

In summary, eosinophilic asthma often causes asthma symptoms that are difficult to control with standard treatments. Identifying key markers like frequent exacerbations, nighttime symptoms, and lung function decline can prompt further testing for underlying eosinophilic airway inflammation. Diagnosis then enables more personalized treatment to minimize symptoms long-term.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.