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April 24, 2023 AsthmaBlogMedEvidence

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They say in stressful situations you should take a breath and calm down, but what if you literally can’t? Asthma is a common disease that affects around 25 million Americans. It results in several million ER visits and hundreds of thousands of hospitalizations yearly. It can also get worse over time. So what is asthma, how does it cause trouble, and what can we do about it? Take a deep breath as we dive in.

To start, asthma is a medley of several related conditions that can be divided in many ways. Into allergic and non-allergic, eosinophilic and neutrophilic, adult onset, asthma with persistent airflow, asthma with obesity, and severe asthma. Several of these categories overlap and make a big mess of everything. The common threads between all types of asthma are the symptoms. Asthma is defined by its symptoms:

  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Cough

A collection of symptoms are needed to diagnose asthma; a single symptom isn’t enough. Symptoms are also variable, getting worse at night, in the morning, or in response to a stimulus. Stimuli include irritants, allergens, exercise, infection, and weather. A pattern of symptoms in response to irritants may lead to an asthma diagnosis.

Our need to breathe makes this a dangerous disease. Asthma symptoms are variable, but they all involve the airway. The airway is affected in three ways: inflammation, bronchial hyperresponsiveness, and structural remodeling.

Inflammation is complicated. In allergic asthma, immune cells respond to dust, pollen, and other airborne items. These are detected by defense cells in our windpipe which mistake them as dangerous. Immune cells act quickly to try and kill the “invaders”. In asthma, the big guns are brought in. Eosinophils and neutrophils are like a bazooka: highly effective at killing invaders, but can cause area-of-effect damage when used improperly. Eosinophils cause bronchial hyperresponsiveness, impaired throat function, inflammation, phlegm, and long-term allergen sensitivity. Eosinophils can also occur in non-allergic asthma. They might get involved because of genetic predisposition, polyps, viruses, and fungi. Neutrophils are similar to eosinophils in causing inflammation, but cause more severe symptoms. They generally need more irritants to activate and can be triggered by tobacco smoke, pollutants, microbes, and obesity. You can have eosinophilic or neutrophilic asthma, or both at the same time. Whatever the flavor, inflammation is the result.

One of the effects of inflammation from eosinophils and neutrophils in the throat is bronchial hyperresponsiveness. Bronchial refers to the windpipe, hyper- means abnormally high, and responsiveness in this case refers to how narrow the throat gets. Bronchial hyperresponsiveness is an abnormally high constriction of the throat in response to stimuli, such as irritants. The responsiveness is temporary, leading to the characteristic variability in symptoms. Long term inflammation can cause persistent damage, called airway structural remodeling. This is when the cells of the airway grow in different ways. The walls of the airway are thickened, there is more muscle mass in the throat, the throat contracts harder, and the airway is reduced in size. This is a more permanent change in our throat, making this a long-term effect.

The symptoms are very constricting, is there relief? Yes! Eosinophils respond well to anti-inflammatory medicines known as corticosteroids, like cortisone. These are used for both long-term control and for asthma attacks. Unfortunately, these don’t work on neutrophils, and can actually prolong their lifespan, exacerbating symptoms. Bronchodilators open airways and reduce swelling. Allergy-induced asthma may also be alleviated using allergy shots, tablets, or medications. Newer medicines include monoclonal antibodies that target allergens or specific cells for destruction. Medicines that directly target eosinophils or neutrophils might provide a deeper relief from asthma. Don’t hold your breath, but keep an eye out for new research opportunities!

Written By Benton Lowey-Ball, BS Behavioral Neuroscience


Sources:

Cockcroft, D. W., & Davis, B. E. (2006). Mechanisms of airway hyperresponsiveness. Journal of allergy and clinical immunology, 118(3), 551-559. https://www.jacionline.org/article/S0091-6749(06)01511-9/fulltext

Global Initiative for Asthma. (2000). Global Strategy for Asthma Management and Prevention updated 2022. www.ginasthma.org.

Pate, C. A., Zahran, H. S., Qin, X., Johnson, C., Hummelman, E., & Malilay, J. (2021). Asthma surveillance—United States, 2006–2018. MMWR Surveillance Summaries, 70(5), 1. https://www.cdc.gov/mmwr/volumes/70/ss/ss7005a1.htm?s_cid=ss7005a1_w 

Pelaia, G., Vatrella, A., Busceti, M. T., Gallelli, L., Calabrese, C., Terracciano, R., & Maselli, R. (2015). Cellular mechanisms underlying eosinophilic and neutrophilic airway inflammation in asthma. Mediators of inflammation, 2015. https://www.hindawi.com/journals/mi/2015/879783/


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Eosinophilic asthma is a type of asthma that is characterized by high levels of eosinophils in the airways. Eosinophils are a type of white blood cell that are involved in the body’s immune response to allergens and other triggers. When eosinophils are activated, they release inflammatory chemicals that can cause damage to the airways, leading to asthma symptoms.

Symptoms of eosinophilic asthma include wheezing, coughing, shortness of breath, and chest tightness. These symptoms may be more severe than those of other types of asthma and may not respond as well to traditional asthma treatments like inhaled corticosteroids.

Diagnosis of eosinophilic asthma involves a blood test to measure eosinophil levels and a sputum test to look for eosinophils in mucus from the lungs. Treatment may involve targeted biologic medications that specifically target eosinophils, such as mepolizumab, reslizumab, and benralizumab. These medications work by reducing the number of eosinophils in the airways, which can help to reduce asthma symptoms and improve lung function.

If you or someone you know has severe asthma, clinical trials may be an option for you. Clinical trials are an important way to test new medications and treatments for asthma and other conditions. They allow researchers to gather important data on the safety and effectiveness of new treatments, and they provide patients with access to cutting-edge therapies that may not be available through traditional channels. By participating in a clinical trial, you can play an important role in advancing medical research and helping to improve the lives of people with eosinophilic asthma and other conditions.

Clinical trials for this condition are currently available at ENCORE Research Group’s Jacksonville Center for Clinical Research, University Blvd. location.  To learn more, you can contact us by phone, or sign up on our website. Our knowledgeable staff can guide you through the process and help you determine if a clinical trial is a good option for you.






Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 3, Prevention, The Evil Eosinophils. In this episode, Dr. Michael Koren and Dr. Sunil Joshi explore allergy shots vs. allergy drops for managing allergic rhinitis. For people with allergic rhinitis, allergy shots, and drops are two treatment options. The doctors explain the difference between the two treatments and their effectiveness in reducing allergic rhinitis symptoms. They also discuss the pros and cons of each option and how to decide which one is best for you.

This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.

Common medications:

  • The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair).
  • The anti-IL4/IL13 product is dupilumab (Dupixent)
  • The anti-IgE agent is omalizumab (Xolair)
  • The anti-TSLP agent is Tezepelumab. (Teszpire)

Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.

Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.

He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association.


Prefer to listen to the podcast without video? You can do that below!








Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 2, Prevention, Testing, and Treatment.  In this episode, Dr. Michael Koren and Dr. Sunil Joshi explore the importance of prevention before treatment and the different testing and treatment options available for pollen allergies. They also cover clinical treatments, such as immunotherapy, and how they can help manage symptoms.

This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.

Common medications:

  • The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair).
  • The anti-IL4/IL13 product is dupilumab (Dupixent)
  • The anti-IgE agent is omalizumab (Xolair)
  • The anti-TSLP agent is Tezepelumab. (Teszpire)

Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.

Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.

He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association.


Prefer to listen to the podcast without video? You can do that below!








Welcome to MedEvidence: Two Docs Talk Allergies and Asthma. In this part 4 series, Dr. Michael Koren and Dr. Sunil Joshi bring expert insights and valuable knowledge on allergies and asthma. Today’s Part 1- Pollen Season and Symptoms Associated with Pollen Allergies: As pollen season approaches, many people experience a range of symptoms associated with pollen allergies. The doctors discuss the common symptoms of pollen allergies, such as itchy eyes, runny nose, and congestion. They also cover the types of pollen that cause allergies and ways to avoid exposure.

This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.

Common medications:

  • The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair).
  • The anti-IL4/IL13 product is dupilumab (Dupixent)
  • The anti-IgE agent is omalizumab (Xolair)
  • The anti-TSLP agent is Tezepelumab. (Teszpire)

Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.

Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.

He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association.


Prefer to listen to the podcast without video? You can do that below!





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