Asthma Phenotypes

[Matman]

The following (very recent - Summer 2018) short article on Asthma Phenotytes caught my eye.

It highlights increased medication needs for overlapping asthma phenotypes.

Interestingly, it talks of low Eosinophils and also low FeNO as distinct phenotypes separate from high Eosinophils and high FeNO. It also singles out Obesity as a significant phenotype.

Thanks ‘in advance’ for any comments, as I’m pretty tied-up at present and may therefore not have time to respond to individual replies.

contemporaryclinic.pharmacy...

[Lysistrata Administrator Community Ambassador]

Thanks! This is very interesting. I have tracked down the full paper which thankfully is open access, if anyone wants it:

ncbi.nlm.nih.gov/pmc/articl...

I am still confused about myself lol. I thought I would be eos low FENO low but actually as.my clinic is so into measuring FENO I know it has been anything from 16 to 55, with pretty much zero correlation to asthma control at the time except for the 55 which was before an attack. Low eos yes (had that measured a lot too) but maybe not low FENO. I also still have attacks and significant poor control even with that low FENO.so it clearly isn't everything. I wonder if I have another phenotype as well like they suggest? I do need my Fostair Nexthaler and get worse off it so clearly respond to some extent to inhaled steroids, but pred only helps me sometimes so may be somewhat steroid resistant. Also on various non steroid stuff eg Spiriva and Phyllocontin which work well.

[Lysistrata Administrator Community Ambassador]

I'm bumping this up because I want to see if there are other phenotypic freaks lurking on here...

[Pipsqueak77]

Hi

I too have found this very interesting.. thanks.

I did read a similar paper a while ago but can’t remember any details I’m afraid.

I fall into the high eosinophil/FeNO category to the point where I can virtually predict my FeNO value on how much my chest hurts. It has been in the hundreds and as low as 21.

I am I’m afraid overweight too ( thanks pred!!!🤣) but this has never been mentioned by my docs so it is very interesting to see it as a phenotype in its own right.

The problem with having high eosinophils is that they generally respond quite well to steroids... (as in my case) so it’s difficult to meet the criteria for mepo and you are therefore left in limbo..☹️

Good talking point....! Thanks

[Lysistrata Administrator Community Ambassador in reply to Pipsqueak77]

The joys of limbo! I just can't muster any

...Is there any chance you can get your clinic to jump in there with a blood test before giving you pred, if you're not on it continually? Just one over 300 in the last year will be enough as I'm guessing the exacerbation part will be OK (4 or more needing pred in past year or 6 months continuous).

My clinic is very good with trying to find some eosinophils but I'm worried that because pred doesn't really work for me a lot of the time I wouldn't meet the criteria for that if they get a drug I can have! My flares without pred are not less severe, it just is unlikely to work and we're all in agreement that pred isn't worth it unless it's doing something useful!

[Pipsqueak77 in reply to Lysistrata]

Hi

Yes...! You are right! A blood test would be the way forward but my cons is not at my local so when I am admitted they don’t know the situation so don’t do one..! And I’m afaid I haven’t really been that well to ask!!😜

I have had one test with raised eos and my present cons has referred me to tertiary to see if I can have mepo.... trouble is that was a few months ago and have not heard anything.

Am planning on writing something down for next admission so hopefully they will test!

Am off and on pred like a yo-yo so that is not a problem as you suspected!

Thanks for your help and advice 😊

[Lysistrata Administrator Community Ambassador in reply to Pipsqueak77]

Ahh even the locals tend to.remove blood the moment I get there - I wouldn't think to ask either! And probably you have been on pred at least some.of the time before you even get to hospital! I admit I am spoiled living in easy reach of mine (tertiary) though doesn't mean they get anything useful lol other than lots of FENO readings!!

I would chase up the tertiary centre when you feel up to it - I heard nothing for ages due to admin problems but then got an appt in a few weeks when I rang in July and said I'd been referred in April... Admin is very much not an NHS strong point. Hopefully that eos test will be enough and if not, the tertiary centre may be more diligent in collecting it! I find them very keen to try and get people on things if they think it would help - even for freaks like me.

[Pipsqueak77 in reply to Pipsqueak77]

Ps..

I am sorry to hijack your post Matman ..

Also Lysistrata - I am sorry for you ... you are in a difficult position.. I don’t have any sensible options to add..

It is so hard to get your head around.. chasing test results. People think I am mad..😝😝

[Lysistrata Administrator Community Ambassador in reply to Pipsqueak77]

Thanks - you are too, the criteria csn be difficult but crossing fingers! The admin does my head in really, especially when not feeling so good.

I don't think anyone has any sensible options for me atm but I have my eye on some stuff I hope will get approved in a few years that is a bit broader.

[Pipsqueak77 in reply to Pipsqueak77]

Sorry I think we crossed posts...

Yes I think chasing might not be a bad idea but I don’t really want to cause any trouble..😞

Thanks

[Lysistrata Administrator Community Ambassador in reply to Pipsqueak77]

Oops yes! I don't think you'll be causing trouble - I think the NHS is inclined to forget about people unless they push a bit. I just found a number and said hello I have been referred but not heard anything can you please let me.know what's going on?

[Pipsqueak77]

Yes.. I guess you are right.

I was referred in May so maybe will chase if I don’t hear by the end of July?

Many thanks😊