Asthma is chronic inflammation of the airways. This inflammation causes the airways to narrow, which makes it difficult to breathe, and results in symptoms like wheezing, coughing and tightness in the chest. Eosinophilic asthma, or e-asthma, is a subtype of asthma associated with high levels of eosinophils. Eosinophils are a type of white blood cell. The symptoms of e-asthma are typically severe and can be difficult to control. Some patients with e-asthma are able to get control of their symptoms with standard asthma therapies (such as inhaled and/or oral corticosteroids), but others require biologic therapies (also called immunomodulators).
E-asthma is also associated with a number of other conditions. Below, we look at the nasal polyps, rhinosinusitis, ear infections and aspirin-exacerbated respiratory disease (AERD). Some of these conditions are associated with all types of asthma, and some have a strong association with e-asthma in particular.
Chronic rhinosinusitis
In addition to causing inflammation in the airways, asthma is also associated with rhinosinusitis, or sinusitis—inflammation in the linings in the nasal cavity and sinuses (the hollow sections inside the face). This is true for all forms of asthma, including e-asthma. Rhinosinusitis causes symptoms such as congestion, pressure or pain in the face, mucus that is yellow or green in color, and loss of sense of smell. When rhinosinusitis persists for twelve weeks or longer, even with treatment, it is called chronic rhinosinusitis. Some people can experience these symptoms for years.
Nasal polyps
Nasal polyps are non-cancerous abnormal growths that form on the inside of the nasal cavity or sinuses. Polyps can vary in size and may form clusters that are sometimes described as looking like bunches of grapes. When polyps are small and few, they may not cause symptoms. When polyps are larger, people may experience a range of symptoms related to blocked nasal passages, such as congestion, post-nasal drip, runny nose, headache, sinus infections and reduced sense of smell. There is also a clinical category for patients with chronic sinusitis who have nasal polyps—CRSwNP, for “chronic rhinosinusitis with nasal polyps.” Nasal polyps are associated with all types of asthma, including e-asthma.
Aspirin-exacerbated respiratory disease (AERD)
Aspirin and non-steroidal anti-inflammatory drugs (commonly called NSAIDs) are the go-to medication for headaches, pain and other minor ailments. But for some people, ingesting these medicines can worsen or trigger respiratory symptoms—such as congestion and stuffiness, wheezing breath, tightness in the chest and sinus pain. This condition is known as “aspirin-exacerbated respiratory disease” (AERD). It is associated with asthma, and e-asthma in particular.
Some people with AERD also experience gastrointestinal distress, edema (especially angioedema, swelling beneath the skin) and hives. It is also worth noting that many people with AERD also report that consuming alcohol triggers or worsens symptoms. AERD is called “Samter’s Triad” or “ASA Triad” (ASA stands for “Aspirin-Sensitive Asthma”) when it occurs as a trio of concurrent conditions—asthma, chronic sinusitis with nasal polyps, and sensitivity to aspirin and other NSAIDs.
Middle ear infections
Eosinophilic otitis media is a type of middle ear infection characterized by a buildup of thick, yellowish fluid that contains eosinophils. This type of infection can cause hearing loss and can be resistant to standard ear-infection treatments, and is strongly associated with e-asthma and nasal polyps.
