Neutrophilic Asthma

[BrittanyKat7]

Has anyone been diagnosed with Neutrophilic Asthma?

Basically at age 32 i went from being totally healthy to getting a bad bronchitis that left me with "asthhma". But my PFT's were showing fixed airway obstruction that matched more to COPD. ive never smoked in my life or been around it. i didnt buy that i suddently have copd. i have normal eosiniphils, no alpha 1 gene, normal ct scan, no heart issues, and NO allergies or acid reflux. well, looking at neutrophilic asthma- i resonate a lot with it. im sick a lot. i have incomplete airway reversibility. no amount of asthma meds help me that much either.

[HannahBenson]

BrittanyKat7...Hi, I know how frustrating this can be. I have eosinophilic asthma and I found that I had all of the markers for it but my dr. was not familiar with it so treated me with heavy steroids to lower my eosinophils count in my CBC... as soon as I stopped the steroids, the eosinophils would shoot back up. I imagine it can be similar for the netrophils...and the resulting inflammation will make asthma unmanageable. In my case the steroids stopped working and I could hardly breathe for months. I finally went to Mayo Clinic in the US and I was put on a daily biologic of Nucala (mapolizumab) which is a monoclonal antibody and I have been getting an injection once a month for the past two years...breathing just fine except for the scarring that occurred while I was not treated for EA but I have not had to use Prednisone for the last two years either. It is hard on your bone health so I have some osteopenia from prolonged Prednisone use. That is over now so I gladly get my Nucala once a month and have no asthma or need of steroids. You can see. what your neutrophils are doing in your bloodwork, and find out how this may affect your asthma. Good luck and breathe better. Hannah

[HannahBenson in reply to HannahBenson]

Hi...made a mistake in the text...I take a monthly Nucala shot...not a daily.

[Lysistrata Administrator Community Ambassador in reply to HannahBenson]

Hi, just to jump in here - blood eosinophil levels are generally a good reflection of airway eosinophils, and a good marker for eosinophilic asthma. The same isn't really true for neutrophilic asthma. Blood neutrophil levels are not typically a good reflection of what is going on in the airways.

They can also be raised by steroids and infection, so it can be hard to know how a raised neutrophil level is related to asthma. Someone on oral steroids could have raised blood neutrophils and normal eosinophils but have eosinophilic asthma not neutrophilic.

The precise relationship of neutrophils to asthma is also less well understood. Reducing blood neutrophil levels doesn't necessarily seem to improve asthma. And you can't target their production and circulation like you can with eosinophils - we need neutrophils for a functioning immune system!! Whereas I lived quite happily with a blood eosinophil level of 0 (and still had severe asthma attacks, so apparently that wasn't the cause in my case).

[Poobah]

I've held off replying, hoping fellow sufferers of NA would post. I have non-eosinophilic asthma and a bit like NA, research and treatment lags behind other phenotypes. I was given a 4 month course of Azithromycin as I don't respond well to steroids and I was very surprised at the positive outcome. I've had one additional course since then, a gap of almost 3 years so the first course really helped me recover from a bad patch that had rumbled on for at least 2 years.

I came across this article that includes a summary of available treatments and their efficacy in respect of NA. Azithromycin comes under Macrolides and has a positive write up in the article. I hope this helps you decide what to pursue in terms of more effective treatment. heraldopenaccess.us/openacc...

The article also details how NA is diagnosed. I was eventually diagnosed with a particular non-eosinophilic phenotype because of a research trial I took part in and fortunately the research team prescribed Azithromycin once they were satisfied it was an appropriate treatment.

Drilling down to a specific phenotype beyond eosinophilic and non-eosinophilic depends on the respiratory team and their specialities.

[BrittanyKat7]

Hi first of all, i want to thank you so much for sharing your information with me. It helps a lot and thats what this is all about. So, are you still on azithromycin as a maintenance medication for your asthma? Azithromycin has a lot of interesting immunomodulatory components that would assist in bringing down inflammation. All the inflammation and no cauSe like allergies or something makes me believe in chronic infection!

[Poobah in reply to BrittanyKat7]

I believe that Azithromycin is only used for up to 6 months at a time; 3 doses a week. I've had two lots of 4 month courses, about 3 years apart, which demonstrates how well it helped me - I didn't need it continously. My GP can't prescribe it and has to seek consultant's OK for me to have a course. Last Christmas I needed it and I spoke to my GP on a Thursday and my consultant rang me on the Monday to establish the facts direwith me, he authorised the prescription. So a pretty quick turnaround given the holiday period and the pandemic. Have a chat with your consultant, or get your GP to refer you for a telephone consultation with the consultant (quicker than waiting for a face to face appointment), in order to explore this medication. If you haven't taken it before they may want to run some blood tests first.

Good luck.

[Claire-Rose]

I have neutrophilic, eosinophilic and allergic asthma I take antibiotics 3 times a week for the neutrophils, injections every 6weeks for the eosinophils and antihistamine plus montelukast for the allergies hope this helps