Those of you who have non-eosinophilic asthma do you have sore/painful lungs 24/7?
Do you feel that there is ongoing inflammation in the lungs (poor response to steroids)?
Does your lungs limit the amount of exercise you can do? For example the amount of walking or cycling you can do per day.
Hi,
Non-eosinophilic/eosinophilic asthma is more about what biological process is driving the asthma, whereas issues with exercise or lung pain etc are more general: they could be due to poorly controlled asthma, or due to something else entirely ie not asthma.
In general the driver behind asthma doesn't necessarily make a difference to asthma 'basics' ie whatever is driving it, asthma generally is associated with reversibility and response to reliever drugs which open the airways, plus features such as usually being worse at night and variability in measures of the airways such as peak flow and spirometry.
The inflammation point is a complex one, as there are different types of inflammation in asthma and this can be associated with different triggers - but your airways narrowing, and what the immediate solution to that is (ie reliever medication), is pretty much the same across different types of asthma.
The difference is more in how you try to make the airways less twitchy and likely to constrict, and that does depend to some extent on the underlying driver, though inhaled steroids do seem to work for the majority of asthmatics. At the more severe end, however, very specific drugs are being developed with particular targets, and that's where things like allergic and eosinophilic asthma really matter right now - there's no point in a drug that reduces eosinophils or IgE (a marker of allergy) if that isn't what's causing your symptoms.
Non-eosinophilic, non-allergic asthma is associated with poor or no response to steroids, but this is a complicated area as some people with more severe eosinophilic or allergic asthma are also steroid-resistant. It is also possible to have asthma that isn't driven by classic 'inflammation' at all, though this is rare and not well understood. As per the above, this type of asthma would still present similarly to other types (similar symptoms, response to reliever, but there are fewer treatment options for this type).
Hope this helps and you get some relief as it does sound frustrating!
Thanks Lysistrata!
Asthma really is a complicated disease. So there isn't a distinct symptoms that occurs typically in non-eosinophilic asthma? For example persistent bronchial tube irritation (pain?) caused by neutrophilic inflammation (that can't be controlled with ICS)
No, not really. You might get some difference in triggers for different kinds of asthma (for example someone with allergic asthma is more likely to react to things like cats, dogs, or dust mites), but even with triggers there's a LOT of overlap, and people can easily have the same triggers and the same response to them with different kinds of underlying asthma.
In terms of asthma symptoms, ultimately they tend to be the same whatever underlying process is driving them - eosinophilic, allergic, neutrophilic, or something else that we don't yet understand fully.
Think of asthma like a car (not my analogy but it's a good one. credit to EmmaF91). A car remains the same whoever is driving it: your VW Golf (or whatever car you like) is the same car whether it has an 18-year-old learner, a granny with bad eyesight, or someone with advanced police driving skills behind the wheel. Some drivers might increase or decrease the likelihood of that car getting into an accident, and where you drive it might make a difference too (no VW Golf is going to be in Formula 1, even if Lewis Hamilton drives it). But the car itself (asthma) doesn't change, even if the driver (IgE, eosinophils, neutrophils, both, neither etc) is different.
It's also worth noting that a base level of inhaled steroids seems to work fairly well for most asthma types at the mild level; if this isn't controlling things then thinking about type may be helpful for what you add on after that, but studies have suggested that generally everyone should be given ICS as a first line preventer, whatever their eosinophil levels, because it seems to help with asthma. (You might see things suggesting a different approach in COPD, but that's a different illness).
Bronchial irritation and pain aren't necessarily related - it's not actually possible to feel pain in your bronchial tubes, you don't really process pain from there. Some people do feel muscular pain in their chest/round their ribs if they've been having trouble breathing, or the cartilage between their ribs can become irritated (costochondritis) which causes pain - but that's not the airways. You can also have pain referred from somewhere else that might feel like it's in your lungs/airways.
Love the car analogy - especially this bit...."Some drivers might increase or decrease the likelihood of that car getting into an accident". Some people are more likely to cause an accident with their asthma too, eg not taking their preventer inhalers all the time, or not taking other meds as prescribed!
Also covers the fact that even the best drivers can get into accidents, even ones that aren’t their fault! (Sudden unexpected triggers anyone 😉)
Like that you like my car analogy tho Lysistrata!
Also don’t forget other conditions! If asthma is a VW Golf than COPD is a fiat punto, etc etc (I have little/no knowledge of cars 😅). All resp conditions can have their own cars!
Loving the analogy! I feel like my lungs would be a bit of an old banger 😂 or a very unreliable make!
I think I'd be spending a lot of money in garage fees and crossing my fingers at passing the MOT!
Great analogy! I thought that there is no sensation in the air sacks but there is nerves in the bronchial tubes that can sense the irritation... Well it's been a while since this has been gone through in the elementary school.
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