Neutrophilic asthma is a type of asthma in which there is a high neutrophil count in your sputum (mixture of saliva and mucus from your respiratory tract). Neutrophils are white blood cells that help fight off infections and play a role in healing injured tissues.
Neutrophilic asthma is the most common type of severe asthma in adults and usually starts after age 12, affecting approximately 1 in 5 adults with asthma. These patients tend to be older, are found to have disease-causing bacteria in their respiratory tract, and do not respond well to traditional therapies.
What are signs and symptoms of neutrophilic asthma?
Neutrophilic asthma is characterized by severe persistent asthma, with more frequent attacks each week. Patients with the condition need frequent emergency treatment, hospitalization, and artificial breathing support. This type of asthma is found to result in life-threatening sudden onset asthma in about 23% of the patients.
The attacks of neutrophilic asthma are more frequent and worsen at night. The condition typically results in a worse quality of life and reduced chances of survival. Many individuals with neutrophilic asthma may be susceptible to severe occupational asthma as well in later life.
How is neutrophilic asthma treated?
Your doctor will make a treatment plan according to your asthma type. Neutrophilic asthma is treated like severe asthma.
Basic treatment for persistent asthma includes:
- Corticosteroid inhalation
- Long-term controller medicines such as montelukast or theophylline
Special personalized treatment includes:
- Macrolide antibiotics. These medicines help control the number of white blood cells in the airways. Patients should use these medicines under their doctor's guidance and only for the recommended period, as long-term use may cause antibiotic resistance.
- Oral corticosteroids. Used to decrease inflammation, these are usually recommended for short-term use. But if asthma flare-ups are frequent, your doctor may prescribe them for the long term. Oral corticosteroids can interfere with the function of other body organs and result in side effects such as osteoporosis (brittle and thin bones), increased risk of type 2 diabetes, and more.
- Personalized medications. Also known as "precision medicines," these medicines are based on your genes, lifestyle, and environment.
- Monoclonal antibodies. Also known as "biologics," these medicines help block the response to triggers that cause inflammation, specifically cells of the immune system. These are given in the form of intravenous infusion.
- Bronchial thermoplasty. This is an outpatient procedure in which radiofrequency energy is used to apply mild heat to smooth muscles of the airways. This procedure helps decrease smooth muscle tissue mass, causing less airway contraction and fewer flare-ups.
- Lifestyle changes. Changes that can help restore the proinflammatory states in the body to normal include:
- Quitting smoking and limiting passive smoke exposure
- Eating a healthy diet
- Reducing exposure to environmental triggers
- Weight management
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Crisford H, Sapey E, Rogers GB, et al. Neutrophils in asthma: the good, the bad and the bacteria. Thorax. 2021; 1-10.
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