Association of Peripheral Blood Eosinophils and Neutrophils with Asthma Phenotype among School-Aged Children

Abstract BACKGROUND: Childhood asthma is a heterogeneous disease with several phenotypes that are distinguished by various inflammatory pathways. Blood eosinophils and neutrophils are frequently utilized to determine the underlying inflammatory profile and to direct phenotype-based management. This study aimed to determine the prevalence of distinct asthma phenotypes in school-aged children and study their association with peripheral blood eosinophils. METHODS: This cross-sectional study was conducted on school-aged children attending the Center of Pediatric Pulmonology at Karbala Teaching Hospital for Children. Patients were classified into four asthma phenotypes: allergic, eosinophilic, mixed allergic and eosinophilic (MAAE), and nonallergic noneosinophilic (NANE). Absolute eosinophil count and neutrophil counts were measured and statistically compared between the groups. RESULTS: The majority of patients (84%) had Th2-high asthma phenotype (allergic, eosinophilic, and MAAE). Peripheral blood eosinophil counts were higher in eosinophilic (554.29 ± 373.3) and MAAE (766.6 ± 423) phenotypes compared to allergic (113.85 ± 98.3) and NANE (89.23 ± 57.5), with patients in MAAE phenotype significantly have the highest value ( P < 0.001). Neutrophil counts did not differ significantly among the groups ( P = 0.44). CONCLUSION: From a strategic medical standpoint, incorporating eosinophil-based phenotyping into routine pediatric asthma management aligns with the precision medicine paradigm. This approach enables targeted therapeutic interventions that can optimize asthma control, decrease exacerbation rates, and ultimately improve the quality of life while reducing healthcare resource utilization. Such biomarker-guided strategies represent a critical advancement in personalized respiratory care for children.