Of the approximately 25 million Americans living with asthma, up to 10 percent have severe asthma, according to the Asthma and Allergy Foundation of America. One subtype of asthma that’s often severe is Eosinophilic Asthma — or e-asthma — which is marked by high levels of inflammation-causing white blood cells, called eosinophils, in the lungs.
Some people who have eosinophilic asthma may be able to manage their symptoms with standard asthma treatments. But those who struggle to control their symptoms or experience frequent asthma attacks despite following their treatment plan may benefit from the addition of newer treatments called biologics, which target eosinophils directly.
Given that researchers are still learning about e-asthma and its treatment, those newly diagnosed with the condition may have questions of their own. Here are some frequently asked questions regarding eosinophilic asthma, along with answers to guide you if you have just been diagnosed and are beginning treatment:
1. How is eosinophilic asthma treated?
The goal of e-asthma treatment is to reduce the number of eosinophils in your airways to help you breathe easier. This may involve the use of standard asthma therapies like long-term controller and rescue medications. Controller medications, which include inhaled or oral corticosteroids, inhaled long-acting beta agonists, and oral leukotriene modifiers, are typically taken daily to help reduce inflammation in your airways and prevent attacks. Rescue — or quick-relief — medications help alleviate symptoms during an asthma attack by relaxing tightened muscles in your airways to allow air to flow through. These may include inhaled short-acting beta agonists and oral steroids. If your symptoms are severe or not well controlled, relatively new options called biologics may help, according to the American Partnership for Eosinophilic Disorders (APFED). Biologics target specific cells or proteins in your body to help prevent airway inflammation.
2. How do I know if my treatment plan needs to be adjusted? What are my treatment options if my rescue inhaler and long-term controller medication aren’t enough to manage my symptoms?
APFED explains that many patients with eosinophilic asthma can control their symptoms with inhaled or oral steroids. Those whose asthma is resistant to these treatments, though, may still experience attacks that disrupt daily routines and affect quality of life. If your symptoms interfere with daily activities, you use your rescue medication frequently, or you experience side effects of corticosteroids, be sure to talk to your doctor about adjusting your treatment plan, as you may benefit from the addition of a biologic. Those with severe, persistent asthma should expect to receive ongoing medical care in order to maintain overall health.
3. How do biologics treat eosinophilic asthma?
Biologic therapies typically target proteins involved in the production and activation of eosinophils. David Rosenstreich, MD, chief of the division of allergy and immunology at the Montefiore Medical Center in the Bronx, New York, says different biologics have different targets. Most block the activity of interleukin-5, a protein involved in the immune system, he says. Others work against the so-called allergy antibody, IgE, to reduce your body’s allergic response, or interleukin-4, which has been shown to play a role in the development of inflammation.
“Asthma is fundamentally an inflammation problem in the airway,” Dr. Rosenstreich explains. “This inflammation occurs after cytokine-activated cells infiltrate the bronchial airway and act on the tissue there. Biologics are essentially designed to block the action of these cytokines.”
4. How do I know if biologics are the right option for me?
Your doctor will work with you to decide whether your asthma symptoms may benefit from biologic therapy. As most biologics are designed to address the production of eosinophils in the body, they will likely only benefit those with e-asthma. The first step, therefore, is to get tested for eosinophilic asthma. Your doctor can perform a simple blood test to measure the level of eosinophils in your blood. To confirm a diagnosis, your doctor may order additional tests, such as a sputum eosinophil count, a bronchial biopsy, or an exhaled nitric oxide test.
5. How are biologics administered?
Most biologic therapies are given by injections or shots under the skin. The frequency of injections depends on the specific medication you’re prescribed, Rosenstreich notes. However, most are administered in your doctor’s office or an infusion center, every four weeks or so.
6. What follow-up tests are needed to see how well treatment is working?
Rosenstreich says that people taking biologic therapy for e-asthma will typically undergo routine blood tests to measure the level of eosinophils in the blood. Your doctor may also collect a sample of your sputum to check for the presence of eosinophils. If biologics along with any other asthma treatments you’re taking are working, tests should show a reduction in eosinophils, according to APFED.
Your doctor will also ask about your asthma symptoms. If you’re still experiencing attacks and symptoms like cough, wheezing, shortness of breath, or chest tightness, your treatment may need to be adjusted, APFED says.
