Late onset asthma / eosinophilic bronchitis

Whilst it is common for those born with OA/TOF to be diagnosed with asthma incorrectly, in some the exposure of the airway to frequent micro-aspiration can trigger airway eosinophilia, leading to late-onset asthma and eosinophilic bronchitis. It is thought that those with an atopic diathesis (history of eczema/asthma/urticarial/hay fever) are predisposed to develop inflammation through the T helper 2 pathway when exposed to chronic inflammation through reflux. Airway reflux is also a known exacerbatory factor in existing asthma. (28–30)

Investigations and treatment

• Diagnosis and treatment of asthma and eosinophilic airway disease follows standard National Institute for Clinical Excellence (NICE) and local protocols.
• If the development of eosinophilic airway disease in patients with OA/TOF is suspected, an eosinophil count of 0.3 or higher is highly suggestive in the presence of other symptoms. (11)
• Management of airway reflux and asthma/eosinophilic airway disease is important to optimise airway symptoms. (11,28)