Hi There was just wondering if anyone knows what it means to have a high lymphocyte count in asthma? Mines always high apparently despite long term steroids. I have been told that steroid treatment should bring it down but mine hasn't which has lead to being asked about compliance (I have been taking them) so why's mine still high.
SW
Hi there,
As you probably know, lymphocytes are one type of white blood cell, the inflammatory/immune cells in the body. The processes which cause inflammation in asthma are not fully understood, and vary from person to person. Several types of white cells can be seen to be high in asthma, including lymphocytes, eosinophils and neutrophils, although it's not clear whether this is a cause or a consequence of the inflammation.
Steroids certainly would be expected to bring the lymphocyte count down in most asthmatics with a high count - however this doesn't happen in everyone. Excess lymphocyte production has been postulated as one mechanism of steroid resistance in asthma. To put it very simplistically, you may simply have the type of lymphocytes that don't respond to steroids. True steroid resistance is quite rare, but it does happen.
Some references - some quite complex immunology here I'm afraid - qjmed.oxfordjournals.org/cg...
erj.ersjournals.com/cgi/rep...
The other issue which it is important to consider in people who have been on long term high dose steroids and aren't showing a clinical response is whether the steroid is being absorbed properly from the gut. Do you have other features of long term steroid use - ie, the weight gain, rounded face, and so on? Have you had an absorption study, where you take a dose of steroid in the morning and then have blood tests every hour to see if your blood levels are increasing appropriately? This test is not done in very many hospitals, but it may be worth considering, especially if you don't show the usual features of steroid use. If you do have an absorption problem, this can be dealt with by giving soluable steroids or regular depot steroid injections such as Kenalog.
Hope this helps a bit - sorry I can't give you a better explanation of why your lymphocytes are still high, the immunology is a bit beyond me!
Take care
Em H
Thankyou thats made it clearer. I always thought it was eosonophils that were high in asthma. Thankyou Sw
I'm glad it made it a little clearer! You're right that it is more usually eosinophils which are high, at least in allergic asthma, but asthma is such a heterogeneous condition, and it seems that in at least some people, neutrophils or lymphocytes can be implicated. In particular, the balance between two different types of lymphocyte, CD4 T helper type 1 and type 2 cells, seems to be important in allergy and asthma - a predominance of Th2 cells may be responsible for allergy and asthma in some people. As I said, it's not fully understood (and certainly not by me!) and there are likely to be many different forms of asthma and allergic disease out there mediated by different cells and inflammatory mediators. Hopefully in the future, when more research has been done, asthma will be defined not as one disease but as many, and we will talk about having 'lymphocyte mediated asthma', or 'leukotriene mediated asthma' or 'IgE mediated asthma' and will be on appropriate targetted treatments. That may be a little simplistic, because of course all of these inflammatory cells and mediators interact, but you get the idea.
I have always had fairly high eosinophils (and I am atopic) but have also always had high neutrophils, and in the past this has always been attributed to oral steroids +/- infection. In fact, when my notes were re-examined, my neutrophils have always been high even when I wasn't on oral steroids a few years back (although admittedly was on very high doses of inhaled steroid, which could possibly have the same effect). My consultant has theorised that my high neutrophils are actually part of what's driving my asthma, rather than as a result of the steroids. Unfortunately at the moment it's only of academic interest, as there's very little that can be done about it!
I believe the Brompton were doing a study a while back about neutrophil-driven asthma as opposed to eosinophil-driven asthma? or am I imagining that? If anyone does know anything about it, I'd be interested to hear.
Well this has turned into rather a late night ramble so I'll sign off!
Take care all
Em H
Im a little confused.... are lymphocytes and eosinophils the same. Iv been on steriods for yrs and my con did a blood test which showed my eosinphils are within normal range but he wanted and expects me to ahve none? think it is something to do with absorption because just after having a course of iv methyl pred there were hardly any.
Just got a little confused between lymphocytes and eosinphils and wahst the difference between them??
Olive
Eosinophils and lymhocytes are not the same, although they are both white blood cells and both part of the immune system and inflammtory response.
Lymphocytes come in several different types (natural killer cells, T cells, B cells) and are involved in several parts of the immune response, including the production of antibodies and the direct killing of foreign material such as bacteria and viruses.
Eosinophils are involved in the killing of parasites, which are of course much less common in the Western world than they used to be. One of the theories that attempts to explain the rise in asthma over the last two decades points to the lack of parasites leaving eosinophils and IgE with 'nothing to do', so to speak - leading to a rise in allergy and asthma.
As I said before, asthma is a heterogeneous condition, and the root cause of it will differ from person to person. It is possible that some people have lymphocyte-driven asthma and others have eosinophil-driven asthma.
Hope this helps
Em H
thanks emh for explaining. i iunderstand bit more now!!!
olive
I always have a higher white cell count and on numerous occasions had to say no to antibiotics when in hospital unless I have a really high count and coughing up gunk!
Regards eosinophils - perhaps we should all get a pet tape worm? Give the enos something to bash instead of our lungs, though there has been research on using intestinal worms to control asthma!
Kate
Indeed there has, there is a big worm trial ongoing in Nottingham at the moment, I did enquire about it, but as usual severe/brittle asthma is one of the exclusion criteria (I can't say I blame them!). On the converse side, when drugs like Xolair have been used in countries where parasitic infection is endemic, they have been shown to slightly increase the incidence.
Em
steroid inhaler and cataracts
severe asthma , adrenal insufficiency 
Update on my unicorn journey 
Main symptom asthma cough
Bruising from high dose steroid inhaler 
