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Eosinophilic asthma (e-asthma) is a rare form of the breathing disease that can be very hard to treat successfully. That can put you in a frustrating cycle of asthma attacks. People with e-asthma are less likely to have their asthma under control, and more likely to have serious attacks. 

Understanding what’s happening in your body and what you can do about it may help you break the cycle.

Why Is E-Asthma Different?

People with e-asthma have too many infection-fighting white blood cells called eosinophils in their lung tissue, blood, and mucus. These cells are ready to react to a threat. If the cells are overactive, they can cause inflammation. In the respiratory system, that means swelling that narrows breathing passages, and extra mucus in your lungs. 

Doctors don’t know why some people have high levels of eosinophils, but they can also cause problems in other parts of your body, like your stomach or bladder. 

E-asthma doesn’t always have the same triggers as more common forms of asthma. And it may not respond well to the asthma medications that are prescribed most often. So even if you avoid allergens like dust and pet dander and use a daily inhaler, you may keep getting flare-ups of your symptoms.

If you have asthma that’s severe or hard to treat, it may be eosinophilic asthma. Here are some signs:

  • Your symptoms are triggered by something other than allergens.
  • You’re often short of breath, especially after exercise or other physical effort. And your lungs don’t work as efficiently as they should, even when you take medicine to open up your airways.
  • You keep having attacks even though you’re using inhaled corticosteroids. Symptoms may stop when you take oral corticosteroids, but come back when you go off of them.
  • You get sinus infections often, and you have growths inside your nose or sinuses called nasal polyps.

It can take time to get to the right diagnosis. The symptoms are more likely to point to chronic obstructive pulmonary disease (COPD). The most reliable test for e-asthma involves coughing up mucus. But it can be hard to do and not every lab can process the results. 

What to Watch For

To avoid eosinophilic asthma flares, it’s important to stay on top of your symptoms. If you can spot an attack coming on, you may be able to prevent it. You may want to keep a symptom diary to make note of how you feel every day. Some people use a device called a peak flow meter that measures how hard you can blow air out of your lungs. 

Signs that lung inflammation is getting worse include: 

  • Your peak flow number is down.
  • Your chest feels tight.
  • You’re coughing. 
  • You’re unusually tired.

You and your doctor should come up with an asthma action plan. It tells you which symptoms to watch for and what to do when you have them.

How to Get Control

If you’re stuck in a cycle of flares, you and your doctor may need to rethink your treatment. The typical daily treatments – like inhaled corticosteroids and inhaled bronchodilators – don’t always work on eosinophilic asthma. It can help to add one of these more powerful treatments:

  • Oral corticosteroids: Many times, e-asthma can be brought under control with steroid medicines you take as a pill. These can have serious side effects, and when you take them for a long time, you’re more likely to get glaucoma, diabetes, and osteoporosis. But sometimes it may be worth the risk to prevent attacks.
  • Omalizumab (Xolair): This biologic drug targets your body’s reaction to allergens. Studies found it lowers the levels of eosinophils in your blood and in your airways, and cuts down on asthma attacks. It’s approved to use with moderate to severe asthma that’s triggered by allergies. If your doctor prescribes this for you, you get it as a shot once or twice a month. 
  • Other biologics: Drugs that are specifically approved to treat e-asthma are benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), reslizumab (Cinqair), and tezepelumab-ekko (Tezspire). These work against proteins in your blood that activate eosinophils. They can lower your number of serious attacks and the amount of oral steroids you have to take. You take them as shots or IVs.

You may be able to try a biologic drug if you've been taking standard asthma treatments but still have attacks often. You’ll need tests to measure your levels of eosinophils and your body’s reaction to allergens.   

What You Can Do

You play a big part in getting control of your e-asthma and preventing attacks.

  • Take your medications exactly the way your doctor tells you. Make sure you know how to use your inhaler. See your doctor every 3-6 months to check in on how well your treatment is working.
  • Figure out what things trigger your attacks, and do your best to stay away from them.
  • Watch for signs that an attack is coming on. 
  • Pay attention to your overall health. Exercise regularly, eat nutritious foods, and get to a healthy weight. Get vaccinated for the flu, pneumonia, and COVID-19. Respiratory viruses are one of the main causes of asthma flares.

Show Sources

Photo Credit: Catherine McQueen / Getty Images

SOURCES:

European Respiratory Journal Open Research: “Management of the patient with eosinophilic asthma: a new era begins.” 

Journal of Asthma and Allergy: “Diagnosis and management of eosinophilic asthma: a US perspective.”

Asthma and Allergy Foundation of America: “Understanding Eosinophilic Asthma,” “Preventing Asthma,” “Asthma Action Plan,” “Asthma Signs and Symptoms,” “Respiratory Infections.” 

American Partnership for Eosinophilic Disorders: “Eosinophilic Asthma,” “What is an Eosinophil-Associated Disease?”

American Lung Association: “Severe Asthma,” “Create an Asthma Action Plan.”

Global Initiative for Asthma: “Difficult-to-treat & severe asthma in adolescent and adult patients.”

Mayo Clinic: “Prednisone and other corticosteroids.”

Journal of Clinical Medicine: “Severe Eosinophilic Asthma.”

National Heart, Lung, and Blood Institute: “Managing Asthma.”

Frontiers in Immunology: “Involvement and Possible Role of Eosinophils in Asthma Exacerbation.”