Management Case Study - Managing Type 2 Inflammation in Mild Asthma with FeNO

Patient profile

Gender/Age: Female, 30’s
History: Childhood-onset asthma, allergic rhinitis, no maintenance or anti-inflammatory reliever therapy

Symptoms

One asthma exacerbation per year, usually triggered by upper respiratory tract infections
No symptoms between episodes
Does not use albuterol

Management Approach:

The patient has Type 2 inflammation, placing her in the high risk catergory due to elevated FeNO and eosinophil levels. Despite mild symptoms and few exacerbations, the inflammation indicated that more proactive treatment was needed to prevent long-term complications.

Eosinophil count: 300 cells/µL IgE Testing: Positive for dust mite and grass pollen; total IgE 230 kU/L

FeNO Test: 70 ppb, indicating significant airway inflammation

Treatment Plan:

Inhaled Corticosteroid (ICS): The patient was likely to respond well to ICS based on her high FeNO and eosinophil count.
Shared Decision-Making: The patient was educated about the risks of untreated Type 2 inflammation and the benefits of using an anti-inflammatory reliever (such as ICS-formoterol) as needed.
Monitoring: Close follow-up was recommended to ensure that the ICS therapy was effective in preventing future exacerbations.

Outcome:

The patient was more comfortable accepting the change to ICS therapy after understanding the reason for the treatment, particularly in light of the FeNO results.
Ongoing monitoring was planned to assess the effectiveness of the therapy and adjust as needed.

Clinical Takeaway:

FeNO testing revealed underlying inflammation in a patient with mild symptoms, highlighting the importance of treating Type 2 inflammation even in seemingly well-controlled asthma. Educating the patient about the risks and benefits of ICS therapy helped them accept the change, improving long-term asthma management.