Asthma is a long-term lung condition that affects people of all ages. It happens when the airways become inflamed and the surrounding muscles tighten, making it difficult to breathe. Asthma encompasses various types, including allergic and non-allergic forms. Interestingly, eosinophilic asthma represents another subtype. This condition involves increased eosinophils in the airways. It typically affects adults and can be severe.
Currently, over 27 million people in the United States have asthma. Alarmingly, about 10% experience poorly controlled, severe asthma, possibly due to eosinophilic asthma. Recognizing this subtype is crucial, as it influences treatment options. Doctors now view asthma as a collection of conditions rather than a single disease. Understanding these differences can help develop more effective treatments for individuals.
What is Severe Eosinophilic Asthma?
Asthma is a disease that varies greatly among patients. It has a wide range of symptoms and treatment responses. Severe asthma, in particular, includes specific types known as phenotypes and endotypes. These types differ in how they present clinically and their underlying causes. They also respond differently to treatments.
Therefore, to determine asthma severity, doctors assess how well patients respond to controller therapies. These therapies include inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA). In other words, doctors evaluate how challenging it is to manage asthma symptoms and flare-ups.
Severe asthma poses a challenge because standard treatments often fail to control it. Standard treatment typically includes a medium to high dose of ICS combined with LABA or even oral corticosteroids.
Severe eosinophilic asthma (SEA) is a specific type of severe asthma, but it lacks a clear definition. It represents a recognized, yet not precisely defined, category of severe asthma. This condition arises from a unique process involving the abnormal production of eosinophils.
Sputum eosinophilia occurs in nearly half of all asthma patients. Both blood and sputum eosinophilia connect to more severe asthma, poor control, and worse outcomes. The effects of this ongoing airway inflammation include trapped air, worsened symptoms, frequent flare-ups, and a negative impact on quality of life.
Difference between Eosinophilic and Non-Eosinophilic Asthma?
The difference between Eosinophilic asthma and non-eosinophilic asthma is seen in their underlying causes and treatment responses.
Eosinophilic asthma is characterized by high levels of eosinophils, a type of white blood cell, causing persistent inflammation and severe symptoms, even without exposure to allergens. Furthermore, it typically affects adults and often requires advanced therapies for effective management.
On the other hand, non-eosinophilic asthma involves other inflammatory cells or occurs without significant inflammation, with symptoms usually triggered by allergens, infections, or irritants. Moreover, non-eosinophilic asthma often occurs in childhood and responds well to standard treatments like inhaled corticosteroids.
What Causes Eosinophilic Asthma?
Unfortunately, doctors do not yet understand the exact cause. There are no clear triggers, such as specific foods or exercise levels, that increase your risk.
Eosinophilic asthma typically develops in adults aged 35 to 50 who do not have allergies. Occasionally, older adults may experience it, and while it can affect children, this is less common. Interestingly, adult asthma usually impacts more women than men, but eosinophilic asthma affects both genders equally.
Living with Severe Eosinophilic Asthma
Managing severe eosinophilic asthma requires a proactive approach to ensure better control over symptoms and overall well-being.
Daily Management
Effective daily management of SEA revolves around consistent medication use, monitoring symptoms, and avoiding known triggers. Staying aware of asthma action plan is essential for handling flare-ups.
Lifestyle Adjustments
Living with SEA often calls for lifestyle adjustments. These may include avoiding allergens, pollutants, and irritants that could worsen symptoms. Also, maintaining a healthy diet, regular exercise, and creating an asthma-friendly environment at home can help too. Using air purifiers and keeping dust to a minimum can significantly improve quality of life.
Emotional and Mental Health
Severe eosinophilic asthma can take a toll on emotional and mental health due to the challenges it imposes. Anxiety, stress, and even depression can arise from managing symptoms or the fear of an asthma attack. Therefore, it’s important to seek support and engage in relaxation techniques like mindfulness or breathing exercises.
Monitoring and Regular Check-Ups
Consistent monitoring and regular check-ups are vital for managing SEA effectively. Moreover, regular visits to the healthcare provider can help assess the effectiveness of the treatment plan. Also, adjusting medications and monitoring lung functions can help too. Lastly, keeping track of the symptoms through asthma diaries or apps can help identify patterns and prevent exacerbations.
Diagnosis of Eosinophilic Asthma
Diagnosing severe eosinophilic asthma involves several tests to measure eosinophil levels and assess lung function. Below are the key procedures used for an accurate diagnosis:
Blood Test for Eosinophils
Doctors measure the number of eosinophils in your blood through a simple blood draw, often performed in a doctor’s office. High eosinophil levels—typically over 300 cells/µl—may indicate eosinophilic asthma. However, high eosinophils don’t always mean you have this type of asthma, as other diseases can also cause elevated eosinophil counts. Therefore, for an accurate diagnosis, your doctor will consider your medical history, symptoms, and a thorough clinical examination.
Sputum Sample Analysis
In this test, your doctor examines a sample of your sputum (mucus) under a microscope. The sample is obtained by coughing up mucus. If more than 2-3% of the cells in your sputum are eosinophils, this may point to eosinophilic asthma. Moreover, the procedure is non-invasive and is usually done in a doctor’s office.
Bronchial Biopsy or Fluid Examination
For a more in-depth analysis, a pulmonologist may perform a bronchoscopy to collect tissue or fluid samples from your lungs. Using a bronchoscope (a thin tube), they gather these samples by inserting it through your nose or mouth. This procedure helps assess the presence of eosinophils in your lung tissue. Although invasive, bronchoscopy is typically performed under local or general anesthesia and doesn’t usually require a hospital stay.
Consequently, these diagnostic tests allow doctors to confirm whether severe eosinophilic asthma is the cause of your symptoms and help guide appropriate treatment.
Treatments for Eosinophilic Asthma
Diagnosing eosinophilic asthma can take time because it is a rare condition. Once doctors identify it, they focus on treatments specifically designed for this type of asthma.
Eosinophilic asthma occurs when you have an unusually high number of eosinophils, which are white blood cells that help fight diseases. These cells can be found in your blood, lung tissue, and mucus from your respiratory tract. The main goal of treatment is to improve your asthma symptoms and help you breathe better.
Depending on your specific needs, your doctor may recommend one of the following severe eosinophilic asthma treatments to prevent asthma attacks:
Corticosteroids
Corticosteroids are maintenance medications. They help you breathe normally and prevent asthma symptoms from worsening. These drugs work by stopping certain cells in your lungs from releasing chemicals that trigger asthma attacks.
You typically use inhaled corticosteroids daily, and they are safe for most people. You can combine them with long-acting beta-agonists (LABAs) or anticholinergics. While the amount of corticosteroids absorbed into your bloodstream is minimal, it’s essential to rinse your mouth after using them. This practice helps prevent thrush, a fungal infection in the mouth.
Sometimes inhaled corticosteroids may not work well for eosinophilic asthma, so your doctor might prescribe corticosteroid pills. However, these pills can have more side effects.
Bronchial Thermoplasty
Bronchial thermoplasty is a procedure being researched to treat eosinophilic asthma. Your doctor may suggest it if other treatments haven’t controlled your symptoms. During the procedure, a lung specialist uses a specialized probe and thermal energy to reduce the smooth muscle in the airways. This helps prevent the muscles from tightening during an asthma attack. To achieve the best results, bronchial thermoplasty often requires multiple sessions over several weeks.
Fast-Acting Inhalers
Fast-acting inhalers, also known as bronchodilators, provide quick relief. They open swollen airways and can be used alongside inhaled corticosteroids. However, depending on the type prescribed, side effects may include dry mouth, heart palpitations, or nervousness.
Biologics
Biologics are laboratory-made medications that act like human antibodies. Unlike inhalers or pills, you receive them through injections or IV infusion. Their purpose is to block the chemicals that cause inflammation in your lungs. Side effects may include soreness at the injection site, and although rare, some people could have a severe allergic reaction known as anaphylaxis.
Leukotriene Modifiers
Leukotrienes are chemicals in your immune system that contribute to asthma symptoms. Eosinophils work with leukotrienes to cause inflammation in your airways.
Leukotriene modifiers help reduce the effects of leukotrienes and ease asthma symptoms. Some individuals may feel anxious or agitated when taking these medications, so it’s important to notify your doctor if this occurs.
How to Manage SEA at Home?
Managing severe eosinophilic asthma (SEA) at home requires minimizing flare-ups and maintaining symptomatic management. Furthermore, you can also opt for the following tips:
Medication Adherence
It is essential to follow the prescribed medications consistently to manage severe eosinophilic asthma symptoms. Moreover, it is essential to remember that missing doses can worsen symptoms or lead to life-threatening flare-ups.
Home Environment
You might not know it but many factors that trigger asthma may be present in our home. Therefore, it is important to create a safe environment that reduces potential asthma triggers. Even if your SEA isn’t linked to allergies, environmental irritants can exacerbate symptoms.
Monitoring Symptoms
An efficient way to manage SEA at home is tracking your symptoms and identifying patterns that lead to flare-ups. Moreover, you can also maintain an asthma action plan tailored to your condition, symptoms, and triggers to detect the onset of a flare-up.
Trigger Avoidance
While severe eosinophilic asthma doesn’t always have identifiable triggers, some environmental factors can still make symptoms worse. These triggers may include air pollution, viral infections, temperature changes, or emotional distress. Hence, keeping an eye on such triggers can help you prevent flare-ups.
Conclusion:
In conclusion, managing severe eosinophilic asthma requires a comprehensive understanding of the condition. Patients can achieve better symptom control by recognizing its unique characteristics and treatment options. Regular monitoring of eosinophil levels and adherence to prescribed therapies can lead to improved outcomes. Moreover, exploring innovative severe eosinophilic asthma treatments, such as biologics and bronchial thermoplasty, can provide additional relief. Overall, proactive management and informed decision-making empower individuals to navigate their asthma journey successfully. Stay informed, engage in open communication with your doctor, and take charge of your health for a better quality of life.
Frequently Asked Questions
1. Is Severe Eosinophilic Asthma Hereditary?
While there is no established genetic link to SEA, genetic factors may leads to its onset as a family history of asthma or immune-related conditions can make individuals more susceptible.
2. What Are the Common Triggers for Severe Eosinophilic Asthma?
Common triggers for SEA include environmental triggers such as pollen or smoke, respiratory infections, air pollutants, cold air, and stress.
3. Are There Any Diet Recommendations for Severe Eosinophilic Asthma?
According to research, a high-fat and low-fibre diet (or a diet rich in red meat or processed foods) can worsen asthma flareups. However, an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids may help reduce inflammation.
4. Can Severe Eosinophilic Asthma Cause Long-Term Lung Damage?
Yes, if poorly managed, severe eosinophilic asthma can lead to long-term lung damage. Therefore, early diagnosis and consistent treatment is essential to prevent complications and improve quality of life.
