Neutrophilic Asthma

Has anyone being diagnosed with this asthma type? Just wondering what treatment you have as I’m on maximum treatment and not eligible for biologics - however the last time I had my bloods tested I was on 40mg of prednisolone so would this affect the eosinophil levels

[Poobah]

Has your consultant tried long term macrolide? I fall partly into this group and definitely respond better to macrolides than steroids, which only have a limited impact (I think it's because we have low eosinophil counts). I've just finished a four month course of Azithromycin and it's got me through the winter months. It works by decreasing the neutrophils, similar to how steroids reduce eosinophils.

Research is ongoing as there are limited treatments for this phenotype and I've taken part in a couple of research projects. Currently there is ongoing research into the impact on lung MAIT cells by Azithromycin plus the possibility of a VitB2 inhaler which may have similar results.

There's also a group of medicines called long-acting PDE 4 inhibitors, but I don't know much about them, but they are considered a novel treatment for neutrophilic asthma.

Your consultant should be able to prescribe a suitable novel treatment if they have established that your asthma is definitely neutrophilic.

[Hidden in reply to Poobah]

I’m on Azithromycin permanently, on 250mg daily - not had a face to face for 18 months now, and due a review anytime soon, so hopefully we can come up with a new plan

[Poobah in reply to Hidden]

If you Google new treatments for neutrophilic asthma there are a few articles drawing on various research but stating, almost universally, that more research is required, as are new treatments. Macrolides are the current available treatment, but as Lysistrata has mentioned, a possible biologic treatment is being developed that may be beneficial.

I read what I can, but I have to admit that alot of the detail goes over my head, but there are nuggets in such published info, for example, from 2020: ncbi.nlm.nih.gov/pmc/articl...

One of the research nurses did tell me that they study sputum and the dead cells within it in order to measure the neutrophils (in addition to bloods). I had to have sputum tests before I could be prescribed Azithromycin and also had post treatment tests.

You say that your eosinophils were low but you were on 40mg of Pred at the time. It is possible to have high eosinophils as well as high neutrophils, but the steroids would suppress the eosinophils. Maybe something to discuss when you get to see your consultant.

And there is always the option to join research as a volunteer patient. I know that covid hasn't postponed research at my respiratory clinic.

[Lysistrata Administrator Community Ambassador]

HI, I might have this type but not sure - I'm non-eosinophilic anyway (or the portion that's uncontrolled is non-eos; I think i probably have some inflammation that's under control.

My consultant claims I don't have neutrophilic asthma because my blood tests are normal for neutrophils, but I know from reading the literature for work that blood neutrophil levels are *not* a good reflection of what's going on in the airways, and there aren't currently very helpful markers for neutrophilic asthma, beyond measurement in sputum which can be hard to do (and which I haven't done). It's also confusing because pred can raise blood and sputum neutrophil levels by prolonging the neutrophil lifespan (so you don't produce more but you have more in the bloodstream and airways at once).

This is in contrast to eosinophilic asthma, where the blood eos level is a good marker of airway inflammation and a good predictor of response to biologics (and steroids); however, steroids suppress eosinophil levels. I don't have raised eosinophils - but that's on *no* pred; mine were zero on pred and normal off it. So I feel like they should perhaps be trying a bit harder to see if you have eos when you have lower pred, if possible.

As Poobah says, there are possibilities if you don't in fact have eosinophilic asthma, such as macrolides. They are an odd one though! There are studies saying they work better for non-eos and others saying they work well for all types, but realistically most people with eos asthma and exacerbations on max treatment will be steered towards biologics, not macrolides.

tbh I have kind of given up on seriously looking for anything because my cons is fixated on eos asthma and doesn't want to listen or believe anything else is really an issue, especially with the blood results. I don't want steroids that don't help (I am very glad to be off pred!), but his refusal to believe I can have real issues or exacerbations without eosinophilic inflammation is depressing.

However, for your information if you *do* turn out to be non-eosinophilic, there is a bio on the horizon (in the next couple of years) I've been following which seems to work on a broader range of asthma: europeanpharmaceuticalrevie...

[twinkly29]

I don't know the technical ins and outs like Lysistrata and others do but I do know that being on pred long term can cause results (eg slightly raised white cells for example) that make people think there's an issue or mask other issues. So I imagine it would be difficult while on pred to say definitely if it is something like neutrophilic asthma. It may be but difficult to know.

[Tigerpaws]

I've never heard of it; what are the symptoms?