Asthma Subgroups: Treatment Options For Neutrophilic Asthma

If you are among the 10-15% of asthmatics with severe asthma, or asthma that responds poorly to corticosteroids, a simple blood or sputum test may confirm a diagnosis of neutrophilic asthma. Now that you have a proper diagnosis, here are some treatment options your doctor might recommend.

Before reading this post, you may also be interested in clicking on over and reading other posts I've written on this subject: "The basics of neutrophilic asthma," and "What causes neutrophilic asthma."

Control of environmental triggers

Other than medicines to help control asthma, most asthma treatment programs involve controlling any environmental factors that might play a role in worsening asthma. Neutrophilic asthma is usually not allergic, and therefore not triggered by allergens such as dust mites, pollen, mold spores, animal dander, etc. Suspected triggers are thought to be viral respiratory infections and inhaling air pollution. So, preventing and controlling these environmental factors may help improve asthma control in those diagnosed with neutrophilic asthma.

That said, I will now discuss some treatment options. Keep in mind that neutrophilic asthma remains poorly defined, so, at the present time, there are no approved treatments for it. However, there are some treatments worth trying.

Traditional asthma treatments

These are medicines generally considered top-line treatments for asthma. They include.

  • Rescue medicine. You probably already have a prescription for albuterol (Ventolin, Proventil) and levalbuterol (Xopenex). Most asthma experts recommend that all asthmatics have access to one of these at all times.
  • Corticosteroids. These help a majority of asthmatics obtain ideal asthma control. However, in those diagnosed with severe asthma, they do not work as well. Most are on the highest doses to obtain minimal control. Some are not responsive to them at all.  I think it’s fair to say that researchers are still not sure how to use corticosteroids in treating neutrophilic asthma. This typically inspires a quest to by physician and patient to trials using alternative asthma treatments.
  • Alternative asthma treatments. These are treatments generally not considered to line asthma treatments, although they may help some asthmatics obtain better asthma control. They include medicines that used to be commonly prescribed for asthma, such as theophylline and ipratropium bromide (Atrovent). They may include medicines traditionally prescribed for COPD, such as tiotropium bromide (Spiriva). The following are alternative treatments that may prove useful for neutrophilic asthma.
  • Macrolides. These are antibiotics that appear to have anti-inflammatory effects. They include erythromycin and azithromycin. Trials of low doses of these medicines have shown inconclusive results in the general asthma population, although they may prove useful in those with severe neutrophilic asthma.1,2,3
  • Formoterol. This is a long-acting beta-adrenergic (LABA), or a bronchodilator that lasts up to 12 hours. Clinical trials show that it may reduce neutrophil levels, and may be a viable option for treating neutrophilic asthma.4 Other studies show formoterol to be more effective than salmeterol (another LABA) at reducing neutrophils.5 This means that asthma controller medicines that contain formoterol may be a top-line treatment for neutrophilic asthma. The medicine is available under the brand name Foradil. It is also available as one of the active ingredients in Symbicort and Dulera.
  • Biologics.6 These are medical products made from “natural sources,” such as humans, animals, or microorganismsFDA They are generally not considered drugs but as biologics. They are also referred to as monoclonal antibodies. These block the effects of the biological pathways responsible for neutrophilic asthma. For instance, if you look at my post on “what causes neutrophilic asthma,” you will learn that mediators such as LTB4, TNF-α, IL1, IL6, IL8 and IL17 are thought to be responsible for inflammation and/or elevated neutrophil levels. Biologics might block their effects resulting in better asthma control. They have been studied with inconclusive results. However, current of future biologics may show promise and might be worth trying. There appears to be quite a few of these types of treatments in the pipeline. Of course, a potential problem here is they might diminish the immune response necessary for fighting off infections.7,8
  • Treatments to block effects of neutrophils.Researchers have looked into this option with inconclusive results. Likewise, as is the case with biologics,  there are fears that this type of treatment might cause neutropenia, which is an abnormally low neutrophil level. This might make it so the immune system is incapable of fighting off infections, which wouldn’t be good. So, further studies will be needed in this area as well.6

Future therapies

Of course, there are a number of possible doors that are open or will be open, thanks to genetic research. Efforts are ongoing to better understand this asthma subgroup, and as more is learned, this should lead to more treatment options to help neutrophilic asthmatics obtain ideal asthma control. As more is learned, we will be sure to keep you posted. 

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