Eosinophilic Asthma Treatment Guide: Inhaled Steroids, Biologics, and Lifestyle

Primary Pharmacologic Treatments

• Inhaled corticosteroids (ICS): Foundation therapy; reduce eosinophilic airway inflammation, improve control, prevent exacerbations. Examples: fluticasone, budesonide, mometasone.
• Leukotriene receptor antagonists (LTRAs): Block cysteinyl leukotrienes (montelukast, zafirlukast); add-on for incomplete ICS control.
• Systemic corticosteroids: Short courses (prednisone) for severe exacerbations; long-term use avoided due to toxicity.
• Biologic therapies (for severe, uncontrolled eosinophilic asthma): Target specific inflammatory pathways:
  • Anti-IL-5: mepolizumab, reslizumab, benralizumab
  • Anti-IL-4Rα: dupilumab
  • Anti-TSLP: tezepelumab
  Require specialist prescription and monitoring.

Adjunctive Management Strategies

• Trigger avoidance: dust mites, pet dander, pollen, mold, smoke, strong odors
• Regular aerobic exercise (with pre-exercise albuterol if needed)
• Mediterranean-style anti-inflammatory diet
• Adequate sleep and stress management
• Annual flu vaccine, updated COVID-19 vaccine, pneumococcal vaccines per guidelines
• Smoking cessation—critical

Eosinophilic asthma is a treatable phenotype. With phenotype-directed therapy (especially biologics for severe disease), most patients achieve excellent control and quality of life.