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Eosinophils and asthma

bluecar15 profile image
6 Replies

I've been reading posts on here and I'm learning so much about asthma! Never occurred to me how little I know about the first condition I was ever diagnosed with vs ones I found out about later.

I've noticed a few talking about eosinophils, I have slightly high eosinophils and I have asthma, I was unaware the two could be linked. If someone has asthma but they also have say eczema, how do you know what's causing the eosinophils?

Are high eosinophils particularly concerning? My drs don't seem to have ever noticed them, I just know from seeing my blood tests over the years that I tend to be a few points above the reference values, well or otherwise.

6 Replies
Josephone profile image
Josephone

Morning, I had high eosinophils and my asthma was very bad but thankfully my consultant put me on the monthly injection mepolizumbab and I’m a new person with no asthma symptoms for years, hope that this helpful

Kekememe1 profile image
Kekememe1

High eosinphils used to send me to the ER constantly due to it irritating my asthma. The ER doctor told me that high eosinophils indicate allergies. I have severe allergic asthma and a daily dose of prednisone is what helps me. My pulmonoligist and I agreed on this. The nasal sprays does nothing. Zyrtec D helps, but only for a day or 2, plus it makes me super dehydrated. So yes, eosinophils, indicate high allergies.

Lysistrata profile image
LysistrataAdministrator

High eosinophil levels are connected with one type of asthma (eosinophilic asthma - a fairly common type but not the only type). They won't necessarily be high in allergic asthma though, unless someone has both allergic and eosinophilic asthma. These types of asthma are closely related but not quite the same thing, and it's entirely possible to have both; however, if someone qualifies for a biologic that targets eosinophils, it may not address the allergic side, so they might still have problems with allergic triggers.

It's worth noting that a 'high' eosinophil count in terms of asthma is actually within the normal lab range - the normal range is usually below about 500 cells/microliter (also written as 0.5 x 10^9/L), but the level to qualify for an asthma biologic targeting eosinophils is usually 300-400 (0.3-0.4), and trials have shown some of these drugs can have a positive effect on asthma with eosinophil counts above 150/mL (0.15 x 10^9/L). Eosinophils higher than the normal lab range are actually higher than they look in the context of asthma.

Increased eosinophils are associated with a higher risk of serious asthma attacks (but they're definitely not the only risk factor). They're not necessarily linked to symptoms - you can have eosinophil-driven inflammation in your airways but not necessarily notice.

Steroids (inhaled or oral, but for most asthmatics just inhaled outside an asthma flare) are the basic preventer treatment for everyone with asthma, but can be particularly effective for people with higher eosinophil counts, who may need a higher dose. Because you may not always notice if you have high levels of inflammation in your airways, it's important to keep taking the inhaled steroids regularly - that should minimise your risk of attacks. Though in general it's important for anyone to keep taking their inhaled steroids and any other preventer in fact, to reduce the risk of attacks.

If you have a lot of serious flares (needing oral steroids and/or hospital several times a year), as well as raised eosinophils, you might be eligible for one of the biologic treatments I mentioned, which specifically target the production of eosinophils.

bluecar15 profile image
bluecar15 in reply to Lysistrata

Thanks for all the info! I think where my confusion lies is honestly my asthma is pretty badly controlled but I don't really see any drs for it. It honestly wouldn't occur to me to go see a Dr when my asthma gets bad, I just see it through and take my inhalers (so presumably it isn't that bad as I'm alive?! That's been my thought process anyway!)

I haven't been to hospital with my asthma since I was a small child and it was my parents choice rather than mine! My asthma doesn't really present typically (peak flows don't tend to be affected even when I'm really unwell and my biggest symptom is a cough and chest tightness, I don't really wheeze). Until very recently I didn't realise I was getting asthma attacks and hitting the 'red zone' of most peoples plans, I just thought getting very breathless and needing to take your ventolin every minute or so Until you can get to sleep so it'll pass was a normal asthma symptom that everyone got every few months or so. I've had asthma so long that using breathing exercises to get my breathing under control when I need to and sometimes needing to sleep off bad asthma symptoms has become the norm to me.

I only ask out of interest because whenever I get a bloodtest my eosinophils come back between 0.6-0.8 ill or not, as my drs never mentioned it I never really saw it as a problem and assumed it was being caused by my allergies and was common for eczema and other allergic disorder patients . I tend to forget asthma is an allergic disorder to be honest even though mine is triggered by some allergens and so it hadn't occurred to me that eosinophils and asthma would be linked.

From what you and others have said I'm thinking that the esomophils may or may not be linked to asthma but aren't really a concern in itself but my uncontrolled asthma is a concern (which to be honest I already knew) I just got a bit tired of going to the asthma nurse all the time to be honest when she didn't really seem to have a clue about what was going on and would just keep changing my inhaler. Once I got on one that wasn't awkward to get hold of or had to be kept in the fridge or something and which kept my cough away most of the time when I took it I just stuck with it to be honest and let my gp surgery do phone appointments as they wanted to. I always answer their questions honestly and am quite open about my asthma control not being great but it seems to be a bit of a tick box exercise, they don't put my answers down in the notes, rather whatever gives me a 'pass'. They have always seemed quite happy to give me antibiotics for my chest infections and have never linked them to my asthma, if I mention my asthma symptoms are worse because of the illness they offer to prescribe me a steroid inhaler and when I say I've already got one go, OK take that then. My asthma runs in the family and in the past we'd all be given steroids with the antibiotics but they stopped that a few years ago and said that steroid tablets weren't given to asthmatics anymore? (I spoke to other family members to see if it was just me, but seems to be the case for all of us, though we do go to the same drs) Which obviously isn't the case. Most of the time for a chest infection they'll do a phone appointment rather than a in person one so they aren't checking o2 or anything.

Anyway I guess it's different whatever Dr you go to. I haven't died or anything so it can't be that bad but I guess I'll go to the asthma nurse at some point soon. My Dr says there's a new one so maybe she'll be able to help me a bit more

Lysistrata profile image
LysistrataAdministrator in reply to bluecar15

Your surgery sounds completely terrible, can you switch?? Or see if there's a dr you haven't seen who might be better? Phone appointments for asthma can be helpful, they don't have to see you for a routine review necessarily, but they should be paying FAR more attention to you saying you're not controlled and not just shrugging it off!! And potentially seeing you or at least doing *something* about your lack of asthma control.

It honestly wouldn't occur to me to go see a Dr when my asthma gets bad, I just see it through and take my inhalers (so presumably it isn't that bad as I'm alive?! That's been my thought process anyway!). Nope - not how it works, sorry to be blunt here! You're literally playing with fire here, and trying to manage your symptoms by yourself is not a good idea even if it hasn't *yet* given you a serious attack - I get that help is not easy to come by, but even so. 'Sleeping off' symptoms is a particularly terrible idea, please don't ignore night time symptoms, or indeed any. I used to be told oh if it were asthma you'd wake up or not be able to sleep - nope, that isn't true and you don't always notice at the time. Asthma UK have a page on sleep: asthma.org.uk/advice/living...

Peak flow is useful for some people, not so much for others. But atypical presentation/lack of wheeze isn't less of a problem - it sounds like you're aware of this at least, though some drs are not. This post on peak flow may be helpful: healthunlocked.com/asthmauk...

I give you that these particular GPs probably won't do much if you do go to them as they don't seem to take asthma seriously or understand how to treat it. 'No one gives asthmatics steroid tablets anymore???' That's total nonsense - and if they ignore that your preventers aren't helping then you're more likely to need oral steroids! However, it doesn't mean you should be sitting at home when you're struggling. This advice may help you on asthma attacks: asthma.org.uk/advice/asthma...

This post may also be helpful - about when to get help with asthma: healthunlocked.com/asthmauk...

This post is about things your GP could add on, but apparently isn't bothering to consider: healthunlocked.com/asthmauk...

Also From what you and others have said I'm thinking that the esomophils may or may not be linked to asthma but aren't really a concern in itself but my uncontrolled asthma is a concern (which to be honest I already knew) - no, the eosinophils are almost certainly linked in your case. They're definitely linked to poorly controlled asthma and exacerbations; they are a marker of uncontrolled inflammation, which drives the process leading to airway narrowing in eosinophilic asthma. Yours are pretty high, especially for asthma. Asthma as a whole has various different underlying mechanisms; it is not always an allergic disorder nor is it always eosinophilic. BUT if it is driven by eosinophils there are ways to address that with treatment, and as above you do need to address it as they are driving the disease process along with your allergies.

Given your GP and asthma nurse are so unhelpful, I'd strongly advise you call the Asthma UK nurses before the Easter break and chat things through - they're lovely and knowledgeable and can give you a lot more time and generally a lot more help than your GP can: AUK helpline - 0300 222 5800 M-F 9-5 (option 3 for nurses, it will give you a menu). AUK WhatsApp - 07378 606728.

I appreciate you're not a newbie to asthma, but since your GPs are unhelpful and not very knowledgeable, you may find parts of this helpful: healthunlocked.com/asthmauk...

bluecar15 profile image
bluecar15 in reply to Lysistrata

Thank you so much for all the info you've given. I'm going to get an appointment and see if I can't get this sorted out. Honestly they aren't that bad! They definitely are all pretty strapped for time there tho and have way too many patients subscribed which leads to 10 minute appointments that absolutely can't overrun and as soon as there is a specialist nurse, the doctors pretty much refuse to speak to you as we have a specialist for that! Because of that they do take a lot of managing and encouraging from the patient to actually get anything done and honestly I wasn't doing that at all because I didn't see my asthma as a priority. I'm crossing my fingers that the new nurse knows a bit more about more atypically presenting asthma and I'll take along some print outs as well.

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