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Practical Considerations in the Management of Eosinophilic Asthma

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Difficult To Treat Asthma

Part of the book series: Respiratory Medicine ((RM))

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Abstract

“Eosinophilic asthma” is a new terminology that has come to be used to describe an old concept of patients with asthma whose symptoms and severity are predominantly driven by the eosinophil. Quantitative sputum cytometry is the most validated and sensitive test for diagnosis of eosinophilic asthma. Other biomarkers, including blood eosinophils, immunoglobulin (Ig) E, fraction of exhaled nitric oxide (FeNO), and periostin, have also been used as surrogates for airway eosinophilia. Corticosteroids, inhaled and systemic, are mainstay of treatment and are most effective when they are titrated guided by sputum eosinophil percent. Recent approval of monoclonal antibodies directed against key mediators of type 2 inflammation, notably IgE, interleukin (IL)-5, IL-4, and IL-13, have added to the arsenal of treatment options available for patients with severe asthma. Anti-alarmin (including thymic stromal lymphopoietin (TSLP) and IL-33) and anti-chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTh2) therapies are currently under evaluation.

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Disclosure Statement

P. Nair is supported by the Frederick E. Hargreave Teva Innovation Chair in Airway Diseases. In the past 2 years, he has received consultancy and lecture fees from Astra-Zeneca, Sanofi, Teva, Novartis, Theravance, Knopp, Merck, GlaxoSmithKline, and Roche and research support from GlaxoSmithKline, AstraZeneca, and Novartis; and his institution has received research support from Roche, Teva, Sanofi, Boehringer Ingelheim, AstraZeneca, and Novartis. A. Bhalla does not have any conflicts to declare.

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  1. Division of Respirology, Firestone Institute for Respiratory Health, St Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada

    Anurag Bhalla & Parameswaran Nair

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  1. Mary Parkes Center for Asthma, Allergy & Pulmonary Care, University of Rochester School of Medicine, Rochester, NY, USA

    Sandhya Khurana

  2. Asthma Clinical & Research Programs Pulmonary Sciences and Critical Care, University of Colorado, Denver, CO, USA

    Fernando Holguin

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Bhalla, A., Nair, P. (2020). Practical Considerations in the Management of Eosinophilic Asthma. In: Khurana, S., Holguin, F. (eds) Difficult To Treat Asthma. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-20812-7_10

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