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Treatments for Eosinophilic Asthma

Medically reviewed by Deborah Pedersen, M.D.
Posted on March 8, 2021

  • Treatment options for eosinophilic asthma are often aimed at reducing inflammation and lowering levels of inflammatory white blood cells known as eosinophils.
  • Corticosteroids, leukotriene modifiers, and biologics are three classes of medications used to treat eosinophilic asthma.
  • Participating in clinical trials may provide access to new therapies for eosinophilic asthma that are not yet widely available.

Several classes of medication may be used to treat eosinophilic asthma, a severe form of asthma. Because eosinophilic asthma is characterized by high levels of inflammatory white blood cells known as eosinophils, treatment options are often aimed at reducing eosinophils and inflammation in the body. By targeting inflammation pathways associated with eosinophilic asthma, your treatment team can help you manage the condition and improve quality of life.

Read more about the causes and diagnosis of eosinophilic asthma.

Corticosteroids

Corticosteroids are synthetic versions of the hormone cortisol, which is naturally produced by the body. Sometimes referred to simply as steroids, these drugs function mainly by reducing inflammation and suppressing immune system activity. When steroids are used for asthma, they can be delivered directly to the lungs through an inhaler or throughout the entire body via oral steroids. When it comes to eosinophilic asthma, some people respond to steroid treatment while others do not.

Inhaled Steroids

Inhaled corticosteroids act on the lungs to reduce inflammation in the airways. Inhaled steroids are safe and tend to have few side effects because they are inhaled directly into the lungs. Some people with eosinophilic asthma have symptoms that don’t respond to inhaled corticosteroids.

Oral Steroids

Individuals with more severe symptoms of eosinophilic asthma may need to use an oral steroid, such as prednisone. Researchers have observed a reduction in the number of eosinophils in people using oral and inhaled corticosteroids simultaneously.

While oral steroids can be useful for reducing inflammation and eosinophil numbers, long-term use of oral steroids is associated with several serious side effects. These include:

  • Weakening of the bones (osteoporosis)
  • High blood sugar and onset or worsening of diabetes
  • High blood pressure
  • Weight gain

To avoid these side effects, doctors often limit oral steroids to lower doses and short courses.

Leukotriene Modifiers

Leukotrienes are molecules involved in inflammation. They can contribute to asthma by increasing mucus production, contracting airway muscles, and recruiting eosinophils to the respiratory tract.

Leukotriene modifiers are medications that block the action of leukotrienes. These medications are usually in tablet form. Here are some examples of leukotriene inhibitors used to treat eosinophilic asthma:

  • Zyflo (zileuton)
  • Accolate (zafirlukast)
  • Singulair (montelukast sodium)

Side effects of leukotriene modifiers may include fatigue, diarrhea, nausea, and headache. Singulair has been associated with serious changes in behavior and mood.

Biologics

Biologic therapy is a relatively new approach toward asthma treatment. Eosinophilic asthma is thought to be due to the inflammation caused by eosinophils. Chemicals called cytokines help cells communicate. In people with eosinophilic asthma, cytokines lead to the production of more eosinophils — which causes more inflammation. Scientists have pinpointed the cytokines associated with eosinophilic asthma and have designed biologics to target, block, and destroy them.

Biologic therapies typically come in the form of monoclonal antibodies. Antibodies are immune proteins that can bind to and neutralize a very specific target. Monoclonal antibodies are bioengineered to target molecules involved in disease. Biologic therapies are administered via injection or intravenous (IV) infusion.

The cytokines associated with eosinophilic asthma are known as T helper 2 (Th2) cytokines. Th2 cytokines include chemical messengers known as interleukins (IL) IL-4, IL-5, and IL-13. By targeting these molecules, biologics may be able to prevent or reduce the inflammation in eosinophilic asthma.

There are several biologic therapies currently available for eosinophilic asthma.

Dupixent (Dupilumab)

Dupixent blocks the activity of the Th2 cytokines IL-4 and IL-13. It does this by binding to the receptor these cytokines use to signal.

Fasenra (Benralizumab)

Fasenra blocks IL-5 activity by binding to the IL-5 receptor on eosinophils. It also kills eosinophils by recruiting other immune cells to destroy them.

Nucala (Mepolizumab)

Nucala binds directly to IL-5 rather than the receptor for IL-5. The monoclonal antibody binding to IL-5 blocks cytokine activity, thus reducing inflammation and the activity of eosinophils.

Cinqair (Reslizumab)

Cinqair binds directly to IL-5 to block the activity of the cytokine and reduce the eosinophil count in your blood.

Side effects of biologic therapies may include injection-site reaction, muscle soreness, fatigue, sore throat, headaches, joint pain, and in rare cases, severe allergic reaction.

Know Your Options

Understanding which treatments for eosinophilic asthma are available, how they work, and their possible side effects can help you make decisions with your doctor. Living with severe eosinophilic asthma can be challenging, but finding the right treatment options can reduce eosinophilic asthma symptoms and improve your quality of life.

Read more about symptoms of eosinophilic asthma.

As researchers continue to learn more about the immune system, inflammation, and asthma, more targeted therapies are being developed. Participation in clinical trials for new eosinophilic asthma treatments may provide the opportunity to access therapies that are not yet widely available.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 3,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Are you living with eosinophilic asthma? Which treatments have worked for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on March 8, 2021
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Deborah Pedersen, M.D. has specialized in allergy and asthma care as well as pediatrics for over 16 years. Review provided by VeriMed Healthcare Network. Learn more about her here.
Amanda Agazio, Ph.D. completed her doctorate in immunology at the University of Colorado Anschutz Medical Campus. Her studies focused on the antibody response and autoimmunity. Learn more about her here.

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