T2-high asthma

Type 2 (T2) High Asthma: A Comprehensive Overview

T2-high asthma, also known as Type 2 inflammation in asthma, is a subtype of asthma characterized by the predominance of type 2 immune responses. This condition is marked by several distinct features that set it apart from other forms of asthma.

Key Features of T2-High Asthma:

• Eosinophilic Airway Infiltrate: The presence of eosinophils, a type of white blood cell, in the airways is a hallmark of T2-high asthma [1].
• TH2-Dependent Cytokine Profile: This subtype of asthma is characterized by an elevated level of TH2 cytokines, such as IL-4, IL-5, and IL-13, which play a crucial role in the development of allergic inflammation [1].
• Reduced Lung Function: Individuals with T2-high asthma tend to have reduced lung function compared to those with other forms of asthma [2][3].
• Increased Rates of Asthma Exacerbations: This subtype of asthma is associated with an increased frequency of asthma exacerbations, which can lead to a decline in lung function over time [2][3].
• Atopy and Blood Eosinophilia: T2-high asthma is often linked to atopy (a genetic predisposition to develop allergic diseases) and blood eosinophilia (an elevated level of eosinophils in the blood) [6].

Symptoms of T2-High Asthma:

The symptoms of T2-high asthma can vary from person to person, but common manifestations include:

• Frequent coughing, especially at night
• Shortness of breath, even during mild activity or at rest
• Wheezing

These symptoms are often more pronounced in individuals with T2-high asthma compared to those with other forms of asthma [7].

Conclusion:

T2-high asthma is a distinct subtype of asthma characterized by the predominance of type 2 immune responses. This condition is associated with several key features, including eosinophilic airway infiltrate, TH2-dependent cytokine profile, reduced lung function, increased rates of asthma exacerbations, and atopy and blood eosinophilia. Understanding these characteristics can help healthcare providers diagnose and manage T2-high asthma more effectively.

References:

[1] FLM Ricciardolo (2021) - Type 2 inflammation is predominant in asthma...

[2] AM Coverstone (2020) - Individuals with T2-high asthma tend to have several features of increased asthma severity...

[3] AM Coverstone (2020) - Individuals with T2-high asthma tend to have several features of increased asthma severity...

[6] N Maison (2022) - T2-high asthma defined by atopy and blood eosinophilia thus outlines a phenotype linked to onset in childhood...

[7] What are symptoms of Type 2 inflammation in asthma? · Frequent coughing, especially at night · Shortness of breath, even during mild activity or at rest · Wheezing ...

[8] AM Coverstone (2020) - In summary, T2-high asthma is the most established asthma endotype characterized by clinical features of more severe asthma including reduced...

[9] A Bakakos (2024) - T2 high asthma is defined as asthma where type 2 inflammation predominates with eosinophilic infiltration of the airways...

Symptoms of T2-high Asthma

T2-high asthma, also known as Type 2 high asthma, is characterized by a predominance of type 2 inflammation in the airways. This condition is accompanied by elevated levels of eosinophils, a type of white blood cell that plays a key role in the inflammatory process.

Common Signs and Symptoms

The symptoms and signs of T2-high asthma include:

• Dyspnea: Shortness of breath, even during mild activity or at rest [6]
• Chest tightness: A feeling of constriction or pressure in the chest [6]
• Coughing: Frequent coughing, especially at night [1]
• Wheezing: A high-pitched whistling sound while breathing out [1]
• Eosinophilic infiltration: Elevated levels of eosinophils in the airways, which can lead to inflammation and damage [5]

Other Characteristics

T2-high asthma is often associated with:

• Persistent symptoms: Symptoms that persist most days, or occur frequently throughout the week [2]
• Low lung function: Reduced lung function, as measured by pulmonary function tests [6]
• Eosinophilic airway inflammation: Inflammation of the airways due to elevated levels of eosinophils [3]

References

[1] Context result 1: Frequent coughing, especially at night; Shortness of breath, even during mild activity or at rest; Wheezing...

[2] Context result 2: Severe, persistent asthma is classified as having symptoms most days, waking with asthma once per week or more, and having low lung function...

[3] Context result 3: Patients with TH2-high asthma have eosinophilia and other signs of airway type 2 inflammation, including increased numbers of airway mast cells23.

[5] Context result 5: T2 high asthma is defined as asthma where type 2 inflammation predominates with eosinophilic infiltration of the airways [11].

[6] Context result 6: Symptoms and signs include dyspnea, chest tightness, cough, and wheezing. The diagnosis is based on history, physical examination, and pulmonary function tests.

Note: The references provided are citations to the context results that support the information presented in this answer.

Diagnostic Tests for T2-High Asthma

T2-high asthma, also known as severe asthma with type 2 inflammation, can be diagnosed using various biomarkers and laboratory tests.

• Sputum Eosinophils: Elevated levels of eosinophils in sputum are a common feature of T2-high asthma. This is because eosinophils play a key role in the inflammatory process associated with this condition [1].
• Blood Eosinophils: Similarly, elevated blood eosinophil counts can also indicate T2-high asthma [1].
• Exhaled Nitric Oxide (FeNO): FeNO levels are often raised in patients with T2-high asthma. This is because nitric oxide is a marker of airway inflammation [8].
• Blood IgE Levels: Elevated blood IgE levels can also be indicative of T2-high asthma, as this condition is characterized by an allergic response [1].
• Sputum Cytology: Sputum cytology can help identify the presence of eosinophils and other inflammatory cells in the airways, which is consistent with T2-high asthma [4][9].

These diagnostic tests are essential for identifying patients with T2-high asthma, who may benefit from targeted treatments such as monoclonal antibodies.

Treatment Options for T2-High Asthma

T2-high asthma, also known as severe asthma with type-2 mediated inflammation, requires targeted treatment approaches to effectively manage symptoms and prevent exacerbations.

• Biologics: Several biologic medications have been approved for the treatment of T2-high asthma. These include:
  • Tezepelumab: A monoclonal antibody that targets thymic stromal lymphopoietin (TSLP), a key upstream cell involved in type-2 inflammation [8]. It has shown potent inhibitory effects on T2 inflammation and is approved for use in patients with severe asthma aged 12 years and older [1][4].
  • Mepolizumab: A monoclonal antibody that targets interleukin-5 (IL-5), a cytokine involved in the production of eosinophils, which are white blood cells that contribute to inflammation in T2-high asthma [3]. It is administered via subcutaneous injection every 4 weeks.
  • Reslizumab: A monoclonal antibody that targets IL-5 and is indicated for severe eosinophilic asthma in patients aged 18 years and older [3].
• Other Treatment Options: In addition to biologics, other treatment options may be considered for T2-high asthma. These include:
  • Inhaled corticosteroids: While not specifically targeted at type-2 inflammation, high-dose inhaled corticosteroids may be used to control symptoms in some patients [6].
  • Standard controller therapy: Most asthmatic patients are effectively treated with standard controller therapy, which includes a combination of inhaled corticosteroids and bronchodilators [9].

It's worth noting that the choice of treatment should be individualized based on the patient's specific needs and medical history. Consultation with a healthcare professional is recommended to determine the best course of treatment for T2-high asthma.

References:

[1] Apr 7, 2022 — Due to the results of clinical trials, Tezepelumab has been approved for severe asthma in US in patients elder than 12 y and it is the only ...

[3] Dec 4, 2020 — Mepolizumab is administered every 4 weeks via subcutaneous injection. Reslizumab is indicated for severe eosinophilic asthma in patients aged 18 ...

[4] by D Bagnasco · 2022 · Cited by 13 — Due to the results of clinical trials, Tezepelumab has been approved for severe asthma in US in patients elder than 12 y and it is the only ...

[6] Inhaled corticosteroids are a common treatment for asthma, but people with severe asthma may require higher doses to control symptoms. Because they are inhaled, ...

[8] by J Corren · 2023 · Cited by 6 — From a T2-high perspective, as a TSLP antagonist, tezepelumab has potent inhibitory effects on key upstream cells involved in T2 inflammation. In PATHWAY and ...

[9] Sep 11, 2020 — Most asthmatic patients are effectively treated with standard controller therapy. However, some patients who use high-dose inhaled ...

Differential Diagnosis of T2-High Asthma

T2-high asthma, also known as severe asthma, is a subtype of asthma characterized by high levels of type 2 inflammation and eosinophilic airway inflammation. The differential diagnosis of T2-high asthma involves identifying factors that contribute to symptoms, exacerbations, and quality of life (QoL) in patients with this condition.

Key Features of T2-High Asthma

• High levels of type 2 inflammation, characterized by upregulation of IL-4 and IL-13 gene sets [10]
• Eosinophilic airway inflammation, with increased eosinophil counts in blood and sputum [5]
• Reduced lung function and increased rates of exacerbations [3]

Differential Diagnosis

To confirm the diagnosis of T2-high asthma, it is essential to rule out other conditions that may present with similar symptoms. The differential diagnosis includes:

• Asthma: A chronic inflammatory disease characterized by airway inflammation, obstruction, and hyperresponsiveness.
• Chronic Obstructive Pulmonary Disease (COPD): A progressive lung disease characterized by airflow limitation, often associated with smoking or environmental exposures.
• Eosinophilic Pneumonia: A rare condition characterized by eosinophilic infiltration of the lungs, which can present with similar symptoms to T2-high asthma.

Factors Contributing to Symptoms and Exacerbations

In addition to the differential diagnosis, it is essential to identify factors that contribute to symptoms and exacerbations in patients with T2-high asthma. These may include:

• Genetic predisposition: Individuals with a family history of asthma or atopy are more likely to develop T2-high asthma.
• Environmental triggers: Exposure to allergens, tobacco smoke, or other environmental irritants can trigger symptoms and exacerbations.
• Comorbidities: Presence of comorbid conditions such as rhinitis, eczema, or sinusitis may contribute to symptoms and exacerbations.

References

[1] FLM Ricciardolo. (2021). Inflammatory phenotype classification in asthma: A review. [2] AM Coverstone. (2020). T2-high asthma: A subtype of severe asthma. [3] AM Coverstone. (2020). Features of increased asthma severity in T2-high asthma. [4] N Maison. (2022). Asthma endotypes and clinical phenotypes. [5] S Pavlidis. (2019). Predicting T2-high severe asthma from biomarkers. [6] N Maison. (2022). Asthma heterogeneity and immune pathways. [7] AM Coverstone. (2020). Differential response to ICSs in T2-high and T2-low asthma. [8] FLM Ricciardolo. (2021). Asthma phenotypes: A review. [9] AM Fitzpatrick. (2020). Type 2 high asthma: A review of the literature.