Changing Your Eosinophilic Asthma Treatment Plan

If you have eosinophilic asthma, you already may have tried several different treatments. This is because it’s a complicated disease. Maybe common asthma therapies like inhaled corticosteroids haven’t helped you.

The good news is that some new treatments may work well for your eosinophilic asthma. But it can be tricky to figure out when you need them and how to make the switch.

If You’re Not Getting Relief From Your Current Treatment

When you are first diagnosed with asthma, your doctor usually will put you on a treatment plan that includes a rescue, or quick-relief, medication. This is an inhaler that works fast to control asthma symptoms. You also will take drugs every day to control the inflammation in your airways that causes your symptoms. The first choice for it is inhaled corticosteroids. They help ease swelling and tightness in your airways.

But if your asthma isn’t well-controlled with these therapies, tell your doctor. Signs that your condition isn’t well-managed include using your rescue inhaler more than twice a week, waking up with asthma symptoms more than twice a month, and having trouble doing your daily activities.

Look at Second-Line Treatments

If your eosinophilic asthma’s isn’t well-controlled, your doctor may add other medications, such as a long-acting bronchodilator. It quickly opens up your airways so air can move in and out of your lungs more easily.

Another option is using an inhaler while taking corticosteroid pills, but that may not work very well for eosinophilic asthma. And taking corticosteroids by mouth for a long time can cause more serious side effects. They include high blood pressure, high blood sugar, glaucoma, and osteoporosis. If you need to resort to oral corticosteroids more than twice a year, it could be a sign that you need to update your treatments.

Ask About Biologics

These are newer drugs that rely on living organisms to help block the chemicals that inflame your lungs. You may be a candidate for biologics if your level of a type of white blood cells called eosinophils are high enough. Your doctor can check it with a blood test.  

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Even then, the FDA has approved biologics only if you’ve tried other treatments without success. You can combine biologic drugs with your other asthma medications.

The FDA has approved these four biologics. Which one you may take depends on the level of eosinophils in your blood. They are:

  • Mepolizumab (Nucala). For an eosinophil count above 150 cells/microliter
  • Dupilumab (Dupixent). For an eosinophil count above 150 cells/microliter
  • Benralizumab (Fasenra). For a high eosinophil count, above 300 cells/microliter
  • Reslizumab (Cinqair). For a very high eosinophil count, above 400 cells/microliter

There’s no way to know if one biologic may work better for you than another. No studies have compared their effectiveness. Doctors usually base their decisions simply on your eosinophil count. Your preference may come into play, too. You can take some biologic drugs at home, while others require a monthly trip to your doctor for an IV infusion.

Monitor Your Condition

You should start to feel better within 3 months of starting on a biologic therapy. Sometimes, it takes longer. If you haven’t see big improvements in 6 months, talk to your doctor.

The American College of Allergy, Asthma and Immunology has a shared decision-making tool you can use with your doctor to help determine if you are on the best treatment. (Go to https://asthmarelief.acaai.org/) You may still have asthma flares, for example, but notice that you’re not coughing in between them. If that’s the case, you may want to stay on the medication for longer.  

If not, you can always switch to another biologic you qualify for. You also might try nondrug therapies like bronchial thermoplasty if your asthma is severe and constant. It uses thermal energy to shrink the muscles that cause airway constriction in asthma. But it can worsen your symptoms temporarily, sometimes seriously.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on February 03, 2020

Sources

SOURCES:

American Partnership for Eosinophilic Disorders: “Eosinophilic Asthma.”

American College of Allergy, Asthma and Immunology: “Asthma Treatments.”

Mayo Clinic: “Asthma Treatment: 3 Steps to Better Control.”

Asthma & Allergy Foundation of America: “Oral Corticosteroid Stewardship Statement.”

UpToDate: “Treatment of Severe Asthma in Adolescents & Adults.”

J. Allen Meadows, MD, president, American College of Allergy, Asthma and Immunology.

Rachel Taliercio, DO, pulmonologist, Cleveland Clinic.

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