Eosinophilic bronchitis has also been linked to other conditions such as COPD, atopic cough, and allergic rhinitis. Pathophysiology
The number of eosinophils in the sputum samples of non-asthmatic eosinophilic bronchitis patients are similar to those of patients with asthma. In the sputum samples of those with NAEB, histamine and prostaglandin D2 is increased. This suggests that the superficial airways have significant mast cell activation and this may lead to the differing symptom presentation compared to asthma. Inflammation caused by eosinophils is associated with an increased cough reflex. In another study, however, some follow-up patients who were asymptomatic also had increased eosinophils in their sputum, indicating that the inflammation is not always associated with an increased cough reflex.The cause of the inflammation can be associated with environmental triggers or common allergens such as dust, chloramine, latex, or welding fumes. Diagnosis
Diagnosis of eosinophilic bronchitis is not common as it requires the examination of the patients sputum for a definitive diagnosis, which can be difficult in those who present with a dry cough. In order to induce the sputum, the patient has to inhale increasing concentrations of hypertonic saline solution. If this is unavailable, a bronchoalveolar lavage can be done, and the bronchial wash fluid can be examined for eosinophils. The diagnosis is usually considered later by ruling out other life-threatening conditions or more common diagnoses such as asthma and GERD, and by seeing an improvement in symptoms with inhaled corticosteroid treatment. Chest X-rays and lung function tests are usually normal. CT scans may show some diffuse airway wall thickening.
MenQuadFi
MenQuadFi, manufactured by Sanofi Pasteur, was approved by the US Food and Drug Administration (FDA) on April 23, 2020, for use in individuals 2 years of age and older. Menomune
Meningococcal polysaccharide vaccine (MPSV-4), Menomune, has been available since the 1970s. It may be used if MCV-4 is not available, and is the only meningococcal vaccine licensed for people older than 55. Information about who should receive the meningococcal vaccine is available from the CDC. Nimenrix
Nimenrix (developed by GlaxoSmithKline and later acquired by Pfizer), is a quadrivalent conjugate vaccine against serogroups A, C, W-135, and Y. In April 2012 Nimenrix was approved as the first quadrivalent vaccine against invasive meningococcal disease to be administered as a single dose in those over the age of one year, by the European Medicines Agency. In 2016, they approved the vaccine in infants six weeks of age and older, and it has been approved in other countries including Canada and Australia, among others. It is not licensed in the United States. Mencevax
Mencevax (GlaxoSmithKline) and NmVac4-A/C/Y/W-135 (JN-International Medical Corporation) are used worldwide, but have not been licensed in the United States. Limitations
The duration of immunity mediated by Menomune (MPSV-4) is three years or less in children aged under five because it does not generate memory T cells. Attempting to overcome this problem by repeated immunization results in a diminished, not increased, antibody response, so boosters are not recommended with this vaccine.