What are safer ways to manage my high eosinophil count?

Question

Hello doctor,

I am 61 years old and have been dealing with severe asthma since childhood. Now my pulmonologist says I also have COPD from smoking for 25 years before I quit. The combination of both conditions makes it so hard to breathe that I cannot even walk to my mailbox without stopping three times. My peak flow is only 180 when it should be around 350 for my age and height.

I am on Advair 500/50 twice daily, use an albuterol rescue inhaler about eight to 10 times a day, and started Dupixent injections two months ago. My oxygen saturation drops to 88 to 89 % with any activity, and my doctor prescribed a portable oxygen tank, but I hate using it because people stare at me.

The Prednisone bursts I have been taking every few weeks have caused my blood sugar to rise to 245, and now I am prediabetic. I have also gained 40 pounds from the steroids, which makes breathing even harder. I have had pneumonia twice this year and ended up in the hospital both times. My eosinophil count is 680, which they say is high and contributing to inflammation.

Is there any way to control severe asthma and COPD together without relying so much on Prednisone? The weight gain and diabetes risk are really scaring me.

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

What you have is what we call “asthma COPD (chronic obstructive pulmonary disease) overlap.” That means your lungs have both the allergic inflammation of asthma and the long-term structural damage from COPD due to smoking. It is a tough combination, but it is absolutely possible to get you breathing better and reduce your need for frequent prednisone with the right plan.

The first step is to double-check that your inhaler technique and devices are all correct. A spirometry test with a bronchodilator, a recent chest CT (computed tomography), and blood tests help confirm how much of your problem is due to inflammation versus permanent airway changes. Your eosinophil count of 680 shows that inflammation is still a major driver, and that is actually good news because it means you can respond well to certain inhaled medications and biologic therapies.

Right now, you are on Advair 500/50 twice daily and using your albuterol too often, which suggests your current inhaler is not providing enough control. The next step is to switch to a triple-therapy inhaler, one that combines an inhaled steroid, a long-acting beta-agonist, and a long-acting muscarinic blocker in a single device. Together, these improve breathing, reduce flare-ups, and drastically cut your need for rescue inhalers or oral steroids.

There are several options available, including combinations such as Budesonide Glycopyrrolate Formoterol or Fluticasone Umeclidinium Vilanterol. Your doctor can help choose the one that best fits your insurance coverage, device preference, and response.

You have already started Dupixent, which is an excellent step. Give it at least four to six months before deciding how well it is working. If you are still having frequent flare-ups after that, another biologic may be considered. The key is to use prednisone only when necessary.

For the blood sugar and weight issues, it is worth seeing your primary doctor to discuss adjustments in diet, exercise, and possibly newer diabetes or weight-control medications such as those in the GLP-1 (glucagon-like peptide) group. Make sure to maintain adequate calcium and vitamin D intake, and consider a bone density scan if you have been on Prednisone often.

I know it is frustrating, but when your oxygen saturation drops to 88 to 89 percent with walking, your body truly needs that extra support. Using oxygen is not a sign of weakness; it helps keep your heart and brain healthy and allows you to stay more active. Modern portable concentrators are small and much less noticeable. Most people find that once they accept using oxygen, they can walk farther and feel more independent, not less.

The other half of treatment is prevention. Pulmonary rehabilitation is one of the best tools we have; it improves stamina, confidence, and even mood. Vaccines are also essential: yearly flu shots, up-to-date COVID vaccines, the newer RSV (respiratory syncytial virus) vaccine, and pneumococcal vaccines.

I hope this helps.

Please follow up if you have any further concerns.

Thank you.