What's Your [Pheno]Type?

Last updated: March 2021

My asthmadoctor—known here as Dr. Smartypants—is always on her A-game. She’s basically a superstar (and super smart, too). I’ll be honest, when I made her give me this, very brief, “Are you kidding me, it’s not even 10 AM,” sort of look during my last, first-of-the-day appointment, it was kind of fun.

The question? “Okay, so my friend honestly wants to know what my phenotype is.” I couldn’t help myself from laughing a bit as I asked the question—and saw her expression. “I know, that’s not really a before-10 AM type question."

What are the different asthma phenotypes?

A phenotype is defined as “a cluster of characteristics that define a disease and its subsets,”—or subgroups.1 A phenotype is the “clinical presentation” of asthma.2Tests may help get the big picture, but are not always necessary to determine what a person’s asthma phenotype is—essentially, what their asthma “looks like”. For example, so far, there is no blood test that can “define a given phenotype”.2 Some phenotypes are allergic (atopic) or non-allergic, and severity classifications, as well as other more technical things like whether a person’s asthma is eosinophilic or neutrophillic (inflammation biomarkers). Severity—intermittent, mild, moderate, or severe—are also “phenotypes” in a clinical setting.

After her brief pause, Dr. Smartypants laughed too, and contemplated for a moment—taking into account my pulmonary function tests (which I ROCKED this appointment, by the way—104% FEV1 and 93% FEF25-75. BOOM!), meds, and clicking around my record a couple times. “Are your skin tests positive?"

“Only for dust mites last time,” I told her. (She wasn’t my doctor then—probably why she couldn’t find my old allergy tests in her computer!)

“So, you’re only slightly atopic. Your PFTs are good, you don’t have frequent or really bad exacerbations, but based on your medication, I’d say you have moderate-to-severe asthma with a mild atopic component."

Well, that puts it into words for me! I always have trouble describing my asthma to people for this reason—I don’t exactly fit into boxes. Unfortunately, where I live, we don’t have the resources to check things like eosinophils or neutrophils (at least not outside of clinical trials), so I can’t currently get much more specific than moderate-to-severe asthma with mild atopy! But at least it’s a better answer than I had yesterday. (Although, like when I was told I have severe ADHD, the word severe just feels weird to me.)

Then for good measure I asked if she would be interested in joining the scientific committee of one of the organizations I’m involved with. I mean, hey, if I’m going to throw a curve ball at her, I might as well throw two while I’m at it. She agreed quickly, and we talked scientific committees momentarily.

All in all, a win-win with my inquisitiveness—although she did catch on that I haven’t been taking my Nasonex and faxed a prescription off to the pharmacy for me. Touché, Dr. Smartypants. Touché.

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