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Symptoms of E-asthma, also called eosinophilic asthma, can include chronic rhinosinusitis, asthma attacks, nasal polyps, wheezing, and more.

Unlike other types of asthma, E-asthma, also called eosinophilic asthma, can affect both the upper and the lower respiratory system rather than just the lungs. Asthma that starts in adulthood (35 to 50 years old) is often E-asthma.

People with eosinophilic asthma may experience the following symptoms:

• Chronic sinus issues
• Nasal polyps
• Shortness of breath
• Wheezing
• Severe or intermittent episodes of cough
• Chest tightness

Other symptoms of E-asthma can include:

• Chronic rhinosinusitis: Sinusitis is an inflammatory condition that affects the sinuses and is distinguished by facial pain and pressure, a loss of smell, clogged nasal passages, and a runny nose.
• Asthma attacks: The airways in the lungs become swollen, mucus production increases, and muscles surrounding the airway may contract, causing the narrowing of the airway.
• Changes in lung function: The changes in lung function seen in eosinophilic asthma are similar to those seen in chronic obstructive pulmonary disease (COPD). Hence, eosinophilic asthma is sometimes confused with COPD.
• Hypereosinophilic syndrome: This may cause fatigue, rashes, mouth sores, and cognitive symptoms, such as confusion and memory loss.

Knowing the symptoms of eosinophilic asthma can help determine the severity of this kind of asthma.

Doctors make a diagnosis, which usually entails testing for eosinophil content in the blood or, in rare cases, in the lung sputum. In severe cases, the doctor may perform a bronchial biopsy or extract bronchial fluid from the lungs for testing.

What is eosinophilic asthma?

Eosinophilic asthma (e-asthma) is a type of asthma caused by inflammation of the respiratory system.

Eosinophils are responsible for this swelling, which usually aids the body in fighting off illness. However, an excess of eosinophils in the bloodstream can cause excessive swelling, obstructing the body's airways with mucus.

• Eosinophilic asthma is uncommon and experts do not know the exact prevalence of it, but it is estimated that about five percent of asthma patients have it.
• Unfortunately, the exact cause of E-asthma is unknown.
• Many clinical trials are currently underway to investigate the potential causes of eosinophilic asthma.

Possible risk factors

• Doctors believe that eosinophilic asthma is much more common in people who develop asthma as adults (late-onset or adult-onset asthma).
• Environmental exposure and family history may play a role in its development.
• E-asthma often responds poorly to standard treatments, such as inhaled corticosteroids and bronchodilators.

What are the treatment options available for eosinophilic asthma?

There is no cure for eosinophilic asthma. However, because the effects of it can be severe, it is critical to work with the doctor to find a treatment plan that works for the patient.

The various types of treatment for E-asthma include:

• Corticosteroids:
  • These treatments may be in the form of inhalers or pills.
  • They are typically taken daily to control asthma.
  • Because eosinophilic asthma can be resistant to inhaler treatments, corticosteroid pills are more likely to be prescribed for this condition.
• Bronchodilators:
  • These are quick-acting inhalers that will open the airways if they are swollen and if there is difficulty breathing.
• Leukotriene modifiers:
  • Leukotrienes are chemicals found in the body that promote inflammation.
  • To prevent asthma attacks and manage symptoms, leukotriene modifiers reduce the effects of leukotrienes and reduce leukotriene production.
  • These medications, like corticosteroids, are for asthma maintenance, not for immediate relief during an asthma attack.
• Biologic therapies:
  • These drugs have been chemically engineered to mimic the behavior of human antibodies.
  • They are usually used in conjunction with other asthma medications and are administered via injection intravenously.
  • Biologics used to treat eosinophilic asthma inhibit the immune system protein interleukin-5 and reduce the body's eosinophil production.
  • The following biologics are currently approved for use in the United States:
    • Benralizumab is an anti-interleukin-5 receptor antibody. 
      • Recommended for those aged 12 years and older.
    • Dupilumab is a monoclonal antibody against interleukin-4 receptor subunit alpha, and interleukin-13 inhibitor binds to the interleukin-4 alpha receptor.
      • Recommended for those aged 12 years and older.
    • Mepolizumab is an antibody that binds to and inhibits interleukin-5. 
      • Patients aged six years and older are advised to use this product.
    • Reslizumab is an antibody that binds to and inhibits interleukin-5. 
      • Recommended for people aged older than 18 years.
    • Omalizumab is a drug that is directed against the immunoglobulin E, popularly called allergy antibody. It can often relieve symptoms by curbing the eosinophil levels.
      • Approved for use in the United States for the treatment of moderate to severe persistent allergic asthma in those aged six years or older.

Eosinophils can contribute to a condition called airway remodeling.

When airway inflammation persists for an extended period, it can cause scarring and tissue damage. This decreases lung function and elasticity, which can exacerbate asthma symptoms and make treatments less effective.

Even though it is a severe form of asthma, advances in treatment have made it possible to manage eosinophilic asthma. If a person has symptoms of this type of asthma, they must consult their doctor and keep a record of what they believe their asthma triggers are, so a treatment plan that works for them can be developed.