LOOKING INSIDE: TEST YOUR KNOWLEDGE OF TYPE 2 INFLAMMATION IN ASTHMA
The Next Breath Editorial Team
September 2020
UNDERSTANDING SEVERE ASTHMA
Explore these facts about type 2 inflammation – a contributor to asthma – and then test your knowledge. What score will you get?
Asthma is a disease that affects the lungs and causes breathing difficulties. The symptoms of this common disease are widely recognized, but their underlying causes have not always been so well understood. Fortunately, advances in science are revealing more about asthma than we’ve ever known before, such as the role of a specific type of overactive immune response called type 2 inflammation.
In people with asthma, excessive inflammation can cause airways to narrow, making it harder to breathe.1 Things in the environment, such as pollen, smoke or even exercise can trigger this excessive inflammation, causing asthma symptoms to appear or worsen.2
For 50%-70% of people with asthma, the excessive inflammation in their airways is a specific type called type 2 inflammation.3,4 People who have asthma with underlying type 2 inflammation are more likely to have poor asthma control, more frequent asthma attacks and symptoms that have a bigger impact on their quality of life.1,2,5
Type 2 inflammation is linked to other diseases such as atopic dermatitis (AD) and chronic rhinosinusitis with nasal polyposis (CRSwNP).6 When a person has asthma and another related disease with similar type 2 inflammation, we refer to them as being coexisting because they occur together at the same time. While they may not be obviously connected through the symptoms they cause, it is important to be aware that coexisting diseases with similar type 2 inflammation can increase the severity of symptoms and have a greater impact on quality of life.7
So how does a doctor test for type 2 inflammation? Tests that help generate a picture of the type of inflammation that is driving asthma include:2
- A blood or sputum (a mucus produced by the lungs) test to look at levels of eosinophils. These are a type of white blood cell that indicate inflammation.8
- A FeNO (fractional concentration of exhaled nitric oxide) test, which indicates inflammation in the lungs. FeNO is measured by blowing slowly and steadily into a portable device, which measures a gas called nitric oxide within exhaled air.2,9
- A blood test that measures levels of immunoglobulin E (IgE), an allergic marker that can shed more light on the inflammation.
Now that you’ve learned more about asthma and its different causes, it’s time to test your knowledge! Read the question on each card below, think of your answer and then flip the card to reveal if you’re correct.
Which factors can contribute to an asthma attack?
See the answerWhich factors can contribute to an asthma attack?
The causes of an asthma attack are complex and can include internal factors, such as excessive type 2 inflammation, and external triggers, such as pollen, smoke or exercise.
What percentage of people with asthma have underlying excessive type 2 inflammation?
See the answerWhat percentage of people with asthma have underlying excessive type 2 inflammation?
We now understand that between 50%-70% of people with asthma have excessive type 2 inflammation.
What is a coexisting disease?
See the answerWhat is a coexisting disease?
A coexisting disease is the presence of more than one long-term disease at the same time; however, with type 2 inflammation, these often share an underlying connection. One example is asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP), which can both be linked by the presence of similar type 2 inflammation.
Can you name any diseases other than asthma that may have underlying excessive type 2 inflammation?
See the answerCan you name any diseases other than asthma that may have underlying excessive type 2 inflammation?
Excessive type 2 inflammation is present in some people with chronic rhinosinusitis with nasal polyposis (CRSwNP) and those with atopic dermatitis (AD). But as the science of type 2 inflammation advances, we are continuing to discover new connections with other allergic or atopic diseases.
What types of tests can doctors use to help detect whether people with asthma have excessive type 2 inflammation?
See the answerWhat types of tests can doctors use to help detect whether people with asthma have excessive type 2 inflammation?
Doctors can use different biomarker tests to look for specific characteristics of excessive type 2 inflammation in people with asthma. These include testing blood and sputum for levels of eosinophils, testing levels of exhaled nitric oxide (known as a FeNO test), or testing blood for levels of a marker called immunoglobulin E (IgE).
Know Your Asthma Type by checking out our brochure and learn more about the different types of severe asthma.
References:
- 1. Dunican EM, Fahy JV. The role of type 2 inflammation in the pathogenesis of asthma exacerbations. Ann Am Thorac Soc. 2015;12(suppl 2): S144-S149.
- 2. GINA 2020 Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2020. Available at: https://ginasthma.org/gina-reports/. Accessed: July 2020.
- 3. Fahy JV. Type 2 inflammation in asthma — present in most, absent in many. Nat Rev lmmunol. 2015;15(1):57-65.
- 4. Peters MC, Mekonnen ZK, Yuan S, et al. Measure of gene expression in sputum cells can identify TH2-high and TH2-low subtypes of asthma. J Allergy Clin Immunol. 2014;133(2):388-394.
- 5. Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Resp J. 2007;30(3):452-456.
- 6. Gandhi NA, Bennett BL, Graham NM, et al. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50.
- 7. Staikuniene J, et al. Association of chronic rhinosinusitis with nasal polyps and asthma: clinical and radiological features, allergy and inflammation markers. Medicina (Kaunas) 2008; 44(4):257-265.
- 8. Healthline. Eosinophil Count: What It Is and What It Means. Available at: https://www.healthline.com/health/eosinophil-count-absolute. Accessed: July 2020.
- 9. AAAAI. WHAT IS A FENO TEST? Available at: https://www.aaaai.org/conditions-and-treatments/library/asthma-library/feno-test. Accessed: July 2020.
Date of Approval: August 2020 | MAT-GLB-2001249
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