Treatments for eosinophilic asthma

Eosinophilic asthma, or "e-asthma," is a type of asthma associated with very high levels of eosinophils—a type of white blood cell that promotes inflammation.

Under normal circumstances, eosinophils play a key role in the immune response that fights bacteria, parasites, and other harmful invaders. When they occur in abnormally high levels, eosinophils can cause chronic inflammation—such as the airway inflammation seen in patients who have e-asthma.

Treatment for e-asthma (or any kind of asthma, for that matter) will depend on your specific symptoms and how difficult your asthma is to control. E-asthma is most often severe, and e-asthma is sometimes described as a type of severe asthma.

In terms of severity, asthma is categorized based on the treatments needed to get symptoms under control. Asthma that is severe requires treatment with one or more controller medications as well as a rescue medication. Below, we look at what these terms mean and how they relate to the treatment of e-asthma.

Rescue medications

Asthma patients with all levels of severity should be prescribed a rescue medication for emergencies. Also known as quick-relief medicines, rescue medications are used when a person is experiencing a worsening of symptoms or an attack. These medications are bronchodilators, medications that work by relaxing the muscles around the airways, which clench up during an asthma attack. Rescue medications are not intended for—and should not be used for—long-term asthma control.

Controller medications

Also called “maintenance medications” or “long-term controller medications,” these asthma treatments are used exactly for what the name implies—to keep asthma symptoms controlled. They are taken daily, even when symptoms are under control.

Controller medications include long-acting bronchodilators, high-dose corticosteroids, and other anti-inflammatory drugs. Some patients with e-asthma are able to control asthma symptoms with these treatments plus a rescue inhaler. Other patients are unable to get symptoms under control, even when taking more than one controller medication.

Biologic therapies

Biologic therapies or immunomodulators are a type of controller medication but are given their own category here because they are prescribed when other medications have failed to get asthma under control.

As with other treatments, the decision to use a biologic therapy will be one made by a patient and healthcare provider. Biologic therapies work by targeting the immunological processes that lead to airway inflammation—in the case of e-asthma, they work to reduce the levels of eosinophils. They may be taken in combination with a controller medication. Biologic therapies are typically taken with an injection that is given at a healthcare provider’s office.

Asthma action plan

Regardless of the type of asthma you have, you should have an asthma action plan. This is a written document that you create with the help of your healthcare provider that details the steps to managing your asthma.

An asthma action plan includes steps like monitoring your breathing on a daily basis, recognizing when your symptoms are getting worse and what triggers your asthma, learning how to use your different asthma medications, and knowing when and where to seek medical attention during an asthma emergency.

The Allergy and Asthma Foundation of America (AAFA) offers asthma action plans in English and Spanish. These are a free resource that can be filled out with your healthcare provider.

In addition to an asthma action plan, patients are advised to keep an asthma diary, which documents asthma symptoms and treatment on a daily basis. Diaries can be helpful in determining how well a treatment is working and identifying weak points in an asthma treatment plan.