How is sputum eosinophilia used to assess asthma control and guide therapy?

Updated: Nov 20, 2020
  • Author: Michael J Morris, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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In assessing asthma control, the British Thoracic Society recommends using sputum eosinophilia determinations to guide therapy. An improvement in asthma control, a decrease in hospitalizations, and a decrease in exacerbations were noted in those patients in whom sputum-guided therapy was used. [57] A controlled prospective study has shown that adjusting inhaled corticosteroid (ICS) treatment to control sputum eosinophilia—as opposed to controlling symptoms, short-acting beta-agonist (SABA) use, nocturnal awakenings, and pulmonary function—significantly reduced both the rate of asthma exacerbations and the cumulative dose of inhaled corticosteroids. [58] In 2015, mepolizumab (anti-IL-5 antibody) was FDA approved for the treatment of severe asthmatics with an eosinophilic phenotype who have a baseline eosinophil count of 150 cells/μL or an eosinophil count of 300 cells/μL within the past 12 months.

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