Everything You Need to Know About Eosinophilic Asthma

Asthma is a condition that causes inflammation of the small airways in your lungs, causing you to cough, wheeze, experience chest tightness, making it hard to breathe. Your lungs may also produce excess mucus, contributing to breathing difficulties. 

There are many different scenarios, or pathways, that can lead to outwardly similar symptoms of an “asthma attack.” Some of these asthma sub-types are associated with specific components of the body’s immune system, and may also be associated with different environmental triggers, allergic profiles, and genetic signatures. 

One asthma subtype that has proven well-suited to targeted treatment is known as eosinophilic asthma. There are new treatments available which are especially effective in treating its symptoms, so determining whether your asthma is eosinophilic or non-eosinophilic can be a crucial step in finding the right treatment for you.

In this article, I’ll explain what makes eosinophilic asthma different from other types of asthma, with a focus on its specific symptoms. I’ll discuss how eosinophilic asthma is diagnosed, and the most effective approaches to treatment. Finally, I’ll discuss complications from eosinophilic asthma, and when to see your doctor about your asthma. 

What is Eosinophilic Asthma?

What sets eosinophilic asthma attacks apart from other forms of asthma starts with the presence of eosinophils, which are a type of white blood cell. Normally, eosinophils help fight off disease and infection as part of the body’s immune system response.

For people with eosinophilic asthma, however, certain asthmatic triggers can cause eosinophils to flood from the bone marrow to the lungs inappropriately. Once they’ve reached the lungs, eosinophil cells can touch off a chain of interactions that create the symptoms of a classic asthma attack.

Even among people who experience eosinophilic-type asthma attacks, the triggers that cause the eosinophil rush may vary. For some people, an allergic response is what drives their eosinophil cells toward the lungs.

For others, triggers such as environmental factors, air pollution, weather changes, and viral infections may be to blame. Severe eosinophilic asthma can arise in both childhood and adulthood.

Symptoms of Eosinophilic Asthma

The outward symptoms of an eosinophilic asthma attack resemble those of most non-eosinophilic asthma types. These symptoms include coughing, chest tightness or pain, shortness of breath, and wheezing.

During an asthma attack, your lungs may also produce excess mucus. Some of the muscle spasms experienced during an asthma attack are an attempt by the body to expel this mucus before it can block your airways. Some people with eosinophilic asthma experience only mild or moderate symptoms.

This means that symptoms are typically only experienced a few times per month or less, and come with lower levels of temporary lung impairment that get better quickly.

Other people experience more severe eosinophilic asthma attacks, which can strike multiple times a day and involve a more significant reduction of lung functioning.

Severe asthma can cause patients to miss out on many important work, school, and leisure moments, and significantly reduce quality of life. 

How symptoms vary from typical asthma

An eosinophilic asthma attack will look and feel similar to a non-eosinophilic asthma attack that’s of similar intensity. What sets eosinophilic asthma apart are the possible long-term effects that come with having frequently elevated levels of eosinophil cells in and around the lungs. 

In people with severe eosinophilic asthma, eosinophil cells can create reactive pathways that, in time, may lead to self-perpetuating asthma attacks. This means that over time, your asthma attacks would need less and less of an external trigger to start up. 

Inflammation caused by eosinophils can also lead to regular damage of the lung’s airways. And, what’s more, eosinophils may also cause these damaged areas to grow back thicker and irregularly.

This can reduce lung capacity in the long term, making breathing more difficult and recovery from asthma attacks more gradual.

How is Eosinophilic Asthma Diagnosed?

If you have mild to moderate asthma that’s responding well to common prescription treatments, your doctor may not even need to test to see if your asthma is eosinophilic. In more severe or treatment-resistant cases, an eosinophilic asthma diagnosis can be crucial to determining whether certain advanced therapies could be helpful.

The most common way to test for and diagnose eosinophilic asthma is a procedure called induced sputum cell count. This involves inhaling a liquid that forces you to cough out mucus, saliva and other secretions from your lungs and airways.

This discharge, or sputum, is then analyzed to calculate an estimated level of eosinophil white blood cells in your airways. Researchers are also developing alternative ways to diagnose it. These involve less invasive methods that rely on secondary indicators like exhaled nitric oxide levels, or certain mRNA signatures. 

Treating Eosinophilic Asthma

There is no cure for eosinophilic asthma–or for any type of asthma–but there are effective strategies for managing the condition with prescription medications. Your treatment plan will first depend on whether your asthma is mild, moderate, or severe. 

Expect your doctor to first see how well you are responding to the more common, cost-effective corticosteroid and inhaler treatments. You may then be deemed a candidate for newer, more costly biologic treatments that are geared toward severe eosinophilic asthma.

Corticosteroids

Oral corticosteroids are sometimes prescribed for short-term relief from asthma attacks. The medications reduce swelling in your airways by dampening your body’s overall immune response, so you can breathe more easily. Examples are prednisolone (Pediapred) and prednisone (Deltasone).

Inhaled corticosteroids are used on a more long-term, preventive basis to prevent swelling and reduce mucus in your lungs. Examples of inhaled corticosteroids are beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, or mometasone. Because they come with significant side effects, they are only prescribed long-term in cases of more severe asthma. 

Fast-acting inhalers

Medications called beta agonists are inhaled through a face mask or mouthpiece, attached to an inhaler or a nebulizer misting machine. Within minutes, these fact-acting inhalers can relax tightened airways and lessen the symptoms of an asthma attack.

Severe asthmatics need higher doses of these inhalers, which, in the long run, might not be sufficient to treat the most intense forms of eosinophilic asthma.

Leukotriene modifiers

Leukotriene modifiers work to relax the smooth muscles around your airways and ease swelling. They are available in pill or liquid form, and are sometimes prescribed if other chronic preventive and chronic treatments have failed.

Biologic therapies

Biologic therapies are a newer form of asthma treatment that targets certain kinds of cells, chemical messengers, and proteins in your body. In the case of eosinophilic asthma, the targets are those associated with inflammation caused by eosinophil cells.

Biologics can be taken as a shot or an infusion that you get every few weeks. Since they have significant risks and are very costly, your doctor will likely only prescribe these if your eosinophilic asthma is severe, and other medications have not worked for you.

Examples include the monoclonal antibody therapeutics omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab. In the lungs of patients with severe eosinophilic asthma, these biologic treatments can significantly lower your airways’ reactivity to triggers, reducing the amount and severity of asthma attacks you experience. They may allow you to cut back on, or even suspend, use of oral steroids.

Eosinophilic Asthma Complications

Without proper treatment, severe eosinophilic asthma can contribute to worse lung functioning as the airway walls change shape and muscles around the airways tighten. 

White blood cells like eosinophils are good at fighting viruses or mutating cells. But for people with this asthma, they inappropriately flood the lungs and attack its airways. After an asthma attack is through, these cells usually don’t return to the bone marrow from which they came.

Instead, they die and break down within the respiratory system. In the process, they can release toxins that permanently harm the body.

Left untreated, eosinophilic asthma can also lead to worsening asthma attacks of increasing frequency. These attacks can, in some cases, prove life-threatening.

When to See a Doctor for Asthma

Maintain regular contact with your doctor about your asthma, and report any changes so your treatment can be adjusted accordingly.

Tell your doctor if you’re having serious trouble breathing during what feels like an asthma attack, and see your doctor if: 

• You find yourself using your rapid-relief inhalers more often than usual
• Your medications become less effective
• Your symptoms change

Watch out for signs of an asthma emergency, which include:

• Breathing not improving after using a quick-relief inhaler
• Shortness of breath even when you aren’t doing anything particularly strenuous
• Wheezing or shortness of breath that worsens

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