non eosinophilic inflamation

Can anyone help me understand how my son is still having asthma probs with sore/tight chest yet less than 1% eoosinophils and eNO of <20?

I felt a bit foolish at our last o/p appointment as my son had lung function of 37%, was obviously finding it quite hard to breathe and was having probs putting sentances together but had an eNO reading of 16 suggesting normal amount of oesinophilic inflamation, he also has very little wheeze (which prompted our local to suggest it was stress related or perhaps minimal effort on PF) but resp rate quite high.

He has had 3 months of 80mg Triamcinolone under RBH difficult asthma protocol to see if he can stay well - obviously not worked from a symptom point of view but clinically has done it's job as eosinophils dropped from 20% to 1%. So if it isn't eosinophilic inflammation what other type is there? I am concerned he is still becoming unwell even though the steroids are doing their job. I came away thinking that perhaps this is a subconscious response to avoiding some stressful situation as all tests are showing a good response to steroids. I was feeling so confused by it all and worrying that my son looked terrible yet I had not taken him to A&E but gone to appointment (he wasn't too bad when we left home it was the walk from the station that knocked him for six then having to hold off taking inhaler until after lung function and seeing doc). I felt like a really bad mother who had not done the right thing so sat really quietly nodding my head and asking nothing! He is now trying Azithromycin to see if this helps as it has some anti-inflammatory effects but I know nothing else as was too busy impersonating a nodding dog in the back of someones car to ask anything sensible.

Any help greatly appreciated.


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