Warning! Not for the faint-hearted (or Time-Strapped). The 'Material / Content' on the links that follow are 'quite' (some might say 'very') Technical - BUT - contain probably the most impressive info / details I've ever read on the topic of 'Eosinophils' (including their 'good' as well as their 'bad' points). There's also some very interesting (but again 'technical') material on Asthma, IgE, Inflammation etc. (As you may know, it's believed around 50% of Asthmatics may fall into the Eosinophilic Phenotype but, interestingly, 'close-reading' of the 'first' article linked-to below, touches on the grey area / overlap and 'interconnectivity' of Eosinophils, IgE, Mast Cells etc).
These Articles are on the 'long' side. The 1st one impressed me the most (though both are very informative and reasonably up-to-date). If you want to 'skim' them for a keyword / term that interests you (for example, the expression 'IgE') don't forget - once you've opened the Article and clicked onto it - you can hold-down the Control & F Keys Simultaneously, to bring up a 'search box' then enter a 'word' in order to search inside the Article, thereby saving yourself some time.
Once gain, these Articles are 'Technical', so - please - no moan-backs / complaints if you struggle with them!
Could you please explain very briefly the difference between the asthma types regarding eosinophilic and non eosinophilic asthma? Trying to work out what I have!
Asthma Type wont be apparent without Tests. However your Surgery may have already classified you (so you could ask them) though it would be preferable to have been classified by an NHS or Private Consultant who has not only looked at your Spirometry Test results but also blood tests, FeNO Test and questioned you closely on your symptoms.
Like yourself I try to keep abreast of the science behind asthma and it’s treatments.. (being a chemist myself..)
I have recently been offered ( but not as yet accepted) a biological for treatment of my asthma but I have to say I am wary of the long term side effects... which are possibly yet to come to light..
The first article ( I haven’t read the second yet) just reiterates my concern about knocking out all of my eosinophils to dampen my asthma on the one hand but maybe leaving other areas of my body and immune system open to attack on the other...it is a difficult one!
Very good ‘food for thought’! You haven’t made my decision any easier...!!
I have been taking prophylactic azithromycin for about 7yrs now.
In the beginning it was great and drastically cut down on my infections. However in the past 2yrs or so it has become less effective sadly.. so I alternate between prophylactic antibiotics depending on my symptoms.
I am not sure that the azithromycin has ever had much effect on my eiosinophil levels though... hence the offer of mepo.
I hope that gives you a little bit of helpful info so that you can make an informed decision.
Mepo’s a better fit for Eosinophils, but I too don’t like the idea of totally exterminating them (still, that’s already what Oral Steroids seem to do). Problem with Mepo is that - although it’s been around for about 10 Years (if you include the original clinical trials) it’s only been in wide public use for a couple, so the number of users is insufficient to fooly dismiss risk (as far as it’s reasonable to do so). Dupilumab looks like a good one to watch but - again - once available in the UK, it will have little USA Public Use track record.
A Doc I Private Message on this Site has a near identical symptom set to me, but is a lot younger. He’s doing well on Omalizumab, started about 3 Months ago.
I’d take 7 Years relief via Azithromycin though, assuming it helped a lot. Was it 3 Times a week?
Don’t think there is any direct benefit for Azithromycin as far as Eosinophils are concerned. But - if (like many) upper airways issues (nasal / sinus etc) are a major contributor to your Asthma - and bacteria rather than the more typical viruses are the problem - some possible improvement in that biome might indirectly reduce eosinophil arrival. (Vaguely possible, but maybe somewhat unlikely I guess). There’s a book on Amazon called something like Cure For Asthma, by an American Doc, who recons that - not infrequently - asthma is triggered by Clamidia-Pneumonia (or something that sounds like that anyway) and he’s therefore dead keen on Azithromycin. European Medical Journal plus a Clinical Trial last year (I think) seemed to support the case for trying it too.
I worry about the long term effects for which there is not enough data as of yet. Also some of the really new biologicals too - as you say have the same problem.
When I take azithromycin I take 250mg once a day for 6days then one day off. This is a weird regime but arrived at by my cons and myself to best avoid stomach upset. Usually it is taken x3 weekly.
That said ... I would massively recommend it.. it is amazing especially if you have sinus and chest infections. It has anti bacterial and anti inflammatory properties and worked wonders for me. When not taking this I use Septrin daily and then swap between the two when needed.
I think I have also seen reference to the research that you mention about azithromycin.
I would definitely give azith a try first it’s a lot less hassle than monthly injections too..!
Thanks for your replies.. it’s good to know that others have reservations about bios too..
Sorry to bother you, but I omitted to ask you about one important point on Azithromycin that could really help in my decision as to whether to try it rather than a Biological.
With my condition I get daily Chest Sputum (which I realise may be triggered by a tendency to pick-up and hold onto virus that antibiotics (ABs) can’t change much. Or, in maybe that I have constant low level bacteria in my lungs which long term ABs ‘would’ help with it.
Just wonder if - prior to ‘you’ taking Azithromycin - Chest Sputum was also a daily issue for you too and, if so, whether you attribute any degree of ‘significant’ Daily Sputum Reduction ‘relief’ to your use of Azithromycin?
I guess it could also be that Eosinophils themselves directly give rise to my Chest Sputum, and that tackling those eosinophils head on with a Biological might work better than Azithromycin.
Appreciate I also need to get more sense out of my Consultant on this, but any insight into any experience you might have (if Sputum was a daily issue for you) could help.
There is a risk of resistance of course but I have been taking it for nearly 8yrs now and there is no sign that I have become resistant at all. I still have a lot fewer infections than before I began taking it too.
Also I ( and I think others using azith) are encouraged to take antibiotic free periods eg. a few months per year during ‘well’ times. I also rotate it with other antibiotics to help alleviate this as potential problem.
Very interesting. I doubt they would do it with me as I am allergic to so many antibiotics and that’s one of them that I’m not lol.
Having said that, my MRSA is resistant to azithromycin and many other things. The only sensitivities it came up with are sulfa, vancomycin and rifampicin. The first two didn’t eradicate it and they say there’s not much chance of ever getting fully rid of it so I guess I have a little guest here to stay.
But other bugs I’ve had do respond to azithromycin so we use it sparingly to preserve its efficacy.
Incidentally, I have been told by doctors that erythromycin and azithromycin both have a positive effect on gastrointestinal motility. I have esophageal dysmotility amongst other things and we considered antibiotics but decided against it for aforementioned reasons.
I understand you not overusing azith in your situation.. it makes sense.
I have certain antibs that are my ‘go to’ drugs as well so I don’t overuse these either.
I am afraid that I don’t know anything about azith and gastrointestinal motility..! Sorry! However I do get a bad stomach with azith sometimes.. another reason why I rotate my antibs.
Very interesting to hear other people’s experiences... asthma has a lot to answer for!!!
Thank you for suggesting these articles. I found them interesting and informative. I have been on Mepolizumab for 18 months now with fantastic results. I am well aware that there may be side effects of long term use of this drug but considering where I was I am willing to accept this. I had no quality of life before Mepo and could not work. I am now back at work, regularly exercising and my life has returned to normal (well almost 😂). I do have constant headaches which is being investigated but apart from this I am great 😄🙏
Thanks for that. Glad things are going well. I am tempted by Mepo, but have read mixed Comments on this Forum concerning it and (as already stated) by the fact that it has only got a couple of years history.
Guess that - even when added together - the number of this Forum’s Members who Comment, won’t necessarily give ‘as clear an impression’ as the ‘bigger picture’ based on ‘the many more’ Patients using Mepo who are not members of the Forum.
Also, that this Forum Membership is made up (predominantly) of those who’s Asthma remains unresolved, with the consequence that most Comments encounter will be from folk who’s treatment is ‘not’ going particularly well. (I’m guessing those that get a lot better will have less need / time for this Forum, so won’t be around to leave Comments).
A clearer impression of Mepo Results (and ‘other’ Treatments for that matter) would, I imagine, emerge, if more Comments were available from Patients with improving / resolving symptoms.
Yes the big picture is hard to see on this forum. Personally xolair and mepo aren’t the right drugs for me (xolair didn’t really work and I had an allergic reaction to it, mepo worked brilliantly but the side effects were too much to live with long term) however I do know of lots of people on them, who have no side effects and are now basically symptom free!
Mepo basically ‘cured’ my asthma when I was on it so I’m hoping the next in line for me (benralizumab) will be ‘my’ cure with no real side effects!
For me putting up with the unknown long term side effects is worth it cause without I have to basically live in the hospital...
It’s always a personal choice/decision but I think if you’re severe enough to be offered a biological and your asthma is really impacting quality of life it’s worth a try. I know that for some mepo/xolair can be the ‘cure’ that lets life restart again.
Take your point. Xolair/Mepo have not, I believe, provided Users with any Lung Function Improvements but, for some Patients, have reduced exacerbations (though have seen it mentioned that oral steroids were being taken by a number of it’s Users, which made me wonder whether it was the Biological or the Steroids helping). Believe some of the indications from the newer Biologicals now available (or beginning to become accessible) include potential Lung Function benefits too. Hope the benralizumab works out for you. Be interesting to hear how you get on with it.
I started mepo 3 months ago and I have had a very significant reduction in asthma symptoms and my fev1 today at the hospital outpatients clinic was 31% which is 10% higher than it was 2 months ago. I have also been able to greatly lower my oral steroid and space my nebs out longer apart.
There are other factors involved like me being put on a cpap machine 24/7 for tracheobronchomalacia and I now use a pep mask to help me cough stuff up better than I could before but I have to say I am very impressed with mepo so far.
I haven’t noticed any terrible side effects but I have so much going on with my body I may not realise what they are. I have not read the side effects literature.
I didn’t make the decision to take biologics lightly. My life was terrible before. I was on Xolair from I think 2009 until last year and it saved my life but I still had residual symptoms from the eosinophilic stuff. So I took the advice of my doctors and switched to mepo. I was very anxious about it but glad I did.
It is a little difficult to say if the azithromycin had a major effect on my sputum production because I also nebulise hypertonic saline to alleviate this problem. The saline really helps to cough up and thin sputum - maybe this could be helpful for you too? Sometimes this can cause my asthma to be a bit twitchy but I am advised to take salb before nebbing if I need which solves any problems. So I am sorry I can’t be specific with that but the saline is great......
However azithromycin really helped me with the infections... obviously from it’s antibac properties and so this did prevent some mucous production too. There is also talk of a poss anti-viral link with azithromycin but not sure about this!! More info needed!!
Macrolide antibs also have anti-inflammatory properties. Azith has definitely helped with my inflammation levels.. lwr FeNO but still higher than ideal. I wonder if this is because some asthmatics (myself included) have problems with both neutrophilic and eisinophilic inflammation.. and the azithromycin is great for neutrophilic inflammation but not so good for eosinophilic? Maybe suppressing one but not the other?I have read that it is supposed to be particularly useful in people with purely neutrophilic asthma... without high eosinophil levels.
Maybe you could suggest a bronchoscopy to your cons If you are concerned about underlying infection. They can be really specific with what bugs you do/don’t have then before you commence any new treatment?
I still personally think that azith is one of my best meds and would recommend it although with the caveat that none of these meds are a miracle cure!! Sadly.....😜
Sorry for the long and rambling reply.. hope it’s helpful in some way?
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Husband still suffering eosinophilic asthma mentioned but not yet diagnosed.
Eosinophilic asthma 
Eosinophilic Asthma?
