5 terms that e-asthma patients should understand

Roughly 25 million people in the U.S. have asthma, a chronic condition of the respiratory system that makes it difficult to breath. A person having an asthma attack usually experiences coughing, wheezing and a sense of breathlessness, and in severe cases, will have severe difficulty breathing. There are several different subtypes of asthma, one of which is eosinophilic asthma, or e-asthma. This type of asthma is related to high levels of a white blood cell called eosinophils. The following slides look at several important terms related to e-asthma, as well as a rare disease that is associated to asthma symptoms and very high levels of eosinophils.

Eosinophils are a type of white blood cell that play an important role in the body’s immunological response, helping to fight things like infectious bacteria and parasites. Abnormally high levels of eosinophils are associated with a number of disorders and health conditions, including most cases of asthma. In people who have e-asthma, eosinophils levels are high, and lead to inflammation and narrowed airways. Your healthcare provider will determine your eosinophil levels using a blood test, but may also examine a sputum sample as well. In some instances, a healthcare provider may order a bronchial biopsy, where a tissue sample is taken from the airways, which will then be tested in a lab for the presence of eosinophils. Because this test is more invasive, it is not typically used during an initial diagnosis.

You may hear a healthcare provider describe your asthma as “difficult-to-control,” “difficult-to-treat,” “therapy-resistant” or simply “difficult asthma.” These terms are used to describe asthma that is not well controlled, even when using high-dose controller medications. When a person has difficult-to-control asthma, they will work with their healthcare provider to identify weak points in their treatment plan that may be preventing the asthma from being controlled. This can include everything from correcting inhaler technique, to finding and eliminating asthma triggers, to making lifestyle changes that can improve asthma control, such as quitting smoking and losing weight. A healthcare provider will also look for other health conditions that may be causing the symptoms, such as gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease (COPD) or vocal cord dysfunction.

Some people with difficult-to-control asthma have severe asthma. E-asthma is a type of often severe asthma. There are a few ways of categorizing asthma severity. One is based on the frequency of symptoms, lung function, how much asthma interferes with normal activities and how often asthma interferes with sleep. Another is based on the type of treatment required to control the asthma. Severe asthma requires treatment with high-dose corticosteroids and long-acting bronchodilators. However, some people with severe asthma are unable to get symptoms under control, even with these treatments.

As mentioned at the end of the previous slide, some patients are unable to achieve control over severe asthma symptoms, even when treating with traditional types of controller medications. If this is the case, your healthcare provider may recommend treating asthma with what is called a biologic therapy. Biologic therapies are also called immunomodulators, a term that gives more insight into what these medications do—modulate (control or modify) how the immune system works in order to reduce symptoms. In the case of e-asthma, an immunomodulator would reduce the amount of eosinophils causing inflammation. There are several varieties of immunomodulators that are used to treat asthma. Some are specifically used for eosinophilic asthma, while others are used for non-eosinophilic severe asthma. These medicines are usually taken by injection—some can be self-administered after training by a healthcare provider. These medications are not used to treat asthma attacks, and are typically used as add-on therapies with other forms of asthma treatments.

EGPA stands for “eosinophilic granulomatosis with polyangiitis.” It is formerly known as “Churg Strauss syndrome” and that term still appears in some of the literature around eosinophilic diseases. If you’re researching eosinophilic asthma, you may come across a mention of this rare autoimmune disease that is also related to very high levels of eosinophils. EGPA causes inflammation of the blood vessels throughout the body including the lungs, nerves, skin and GI tract. When these vessels become inflamed, it can hamper blood flow to the organs and tissue. Some people some experience only a mild case, while others have full-blown symptoms and complications. Most people with EGPA first develop symptoms between the ages of 30 and 50. Asthma, allergies, sinusitis and pneumonia, or a worsening of existing symptoms, are usually the first signs of the disease. As the disease progresses, it can affects the lungs, gastrointestinal tract, nerves and cardiovascular system, and damage many different areas of the body.