Saturday, May 14, 2016

Science behind my asthma

I just found an article that seems to describe my type of asthma. It is Jantina C. de Groot, Anneke ten Brinke and Elisabeht H,.D Bel: Management of the patient with eosinophilic asthma: a new era begins.

I learned from the ASC conference that I have adult-onset eosinophilic asthma. According to the article, this is an uncommon but well-defined asthma phenotype. This asthma phenotype can be identified by "typical symptoms (few allergies and dyspnoea on exertion), typical lung function abnormalities fixed airflow obstruction, reduced forced vital capacity and increased residual volume),typical comorbidities (nasal polyposis) and a good response to systemic corticosteroids." This is me! 

This is the part that convinced me this article was very relevant for me: "Another characteristic feature of late-onset eosinophilic asthma is chronic rhinosinusitis with nasal polyposis[76]. The association between peripheral blood eosinophilia, nasal polyposis and asthma has been recognised for many decades, in particular in combination with aspirin sensitivity [30, 77, 81]. This association has been confirmed in a study in adults with difficult-to-control asthma, showing that severe sinus disease was a strong independent predictor of persistent eosinophilia in blood or sputum [54]. Mucosal inflammation in these patients might extend even to the middle ears. In 2011, a newly recognised middle ear disease, eosinophilic otitis media, was described, characterised by a highly viscous, eosinophil-predominant middle ear effusion causing progressive deterioration of hearing. This otitis is associated with asthma and nasalpolyps, and responds to prednisone, whereas other treatments for otitis media failed [82, 83] Again this is me - my damn effusions that only go away with prednisone - because they are eosinophilic otitis media.

The article then goes on to recommend that patients with this phenotype can benefit from various monoclonal including "Omalizumab (Xolair) is a monoclonal antibody that binds IgE and is, to date, the only biologic therapy approved for asthma." which I already take. However, there are others that show promise. "Lebrikizumab and tralokinumab are both humanised monoclonal IgG4 antibodies to IL-13 and potent inhibitors of its function."

OK - I have to admit, it's all a bit over my head and I need to read it more carefully and discuss it with Mike to figure out what it means. But I think it is a good start to understanding the scientific approach to my severe asthma.

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