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Management of the patient with eosinophilic asthma: a new era begins

Jantina C. de Groot, Anneke ten Brinke, Elisabeth H.D. Bel
ERJ Open Research 2015 1: 00024-2015; DOI: 10.1183/23120541.00024-2015
Jantina C. de Groot
1Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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  • For correspondence: Christa_de_groot@yahoo.com
Anneke ten Brinke
1Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Elisabeth H.D. Bel
2Department of Respiratory Medicine, Amsterdam Medical Centre, Amsterdam, The Netherlands
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    FIGURE 1

    Two different pathways lead to eosinophilic airway inflammation in asthma. In allergic asthma, dendritic cells present allergens to CD4+ T-cells, inducing T-helper (Th)2 cells, which produce interleukin (IL)-4, IL-5 and IL-13, and leading to IgE switching in B-cells, airway eosinophilia and mucous hypersecretion. In nonallergic eosinophilic asthma, air pollutants, microbes and glycolipids induce the release of epithelium-derived cytokines, including IL-33, IL-25 and thymic stromal lymphopoietin (TSLP), which activate innate lymphoid cells (ILCs) in an antigen-independent manner via their respective receptors (IL-17 receptor B (IL-17RB), ST2 and TSLP receptor (TSLPR)). Activated ILC2s produce high amounts of IL-5 and IL-13, leading to eosinophilia, mucus hypersecretion and airway hyperreactivity. CRTH2: chemoattractant receptor homologous molecule expressed on Th2 cells; ALX/FPR2: receptor for lipoxin A4; FcεRI: high-affinity receptor for IgE; GATA3: GATA-binding protein 3; PG: prostaglandin; ROR: retinoic acid receptor-related orphan receptor; NK: natural killer; MHC: major histocompatibility complex; TCR: T-cell receptor. Reproduced from [51] with permission from the publisher.

  • FIGURE 2
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    FIGURE 2

    Effect of high dose triamcinolone on sputum eosinophils. Effect of treatment with intramuscular triamcinolone or placebo on sputum eosinophil percentages in 22 patients with eosinophilic asthma. Horizontal lines represent median values. Reproduced and modified from [87] with permission from the publisher.

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  • TABLE 1

    Clinical profile of late-onset eosinophilic asthma patients

    Adult onset of asthma
    Equal distribution between sexes
    Few or no allergies to common allergens
    Elevated eosinophils in peripheral blood
    At risk of severe exacerbations
    Normal or moderately elevated IgE level
    Low FEV1 and often persistent airflow limitation
    Air trapping and dynamic hyperinflation
    Chronic rhinosinusitis with nasal polyposis
    Aspirin sensitivity
    Good response to systemic corticosteroids
    Good response to anti IL-5 treatment
    • FEV1: forced expiratory volume in 1 s; IL: interleukin.

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Vol 1 Issue 1 Table of Contents
ERJ Open Research: 1 (1)
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Management of the patient with eosinophilic asthma: a new era begins
Jantina C. de Groot, Anneke ten Brinke, Elisabeth H.D. Bel
ERJ Open Research May 2015, 1 (1) 00024-2015; DOI: 10.1183/23120541.00024-2015

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Management of the patient with eosinophilic asthma: a new era begins
Jantina C. de Groot, Anneke ten Brinke, Elisabeth H.D. Bel
ERJ Open Research May 2015, 1 (1) 00024-2015; DOI: 10.1183/23120541.00024-2015
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  • Article
    • Abstract
    • Abstract
    • Introduction
    • Asthma phenotypes and the role of the eosinophil
    • Molecular pathways of eosinophilic inflammation
    • Clinical profile of the patient with eosinophilic asthma
    • Management of the patient with eosinophilic asthma
    • New treatment options for the patient with eosinophilic asthma
    • Conclusions
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    • References
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  • Info & Metrics
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