Vicki Burke’s email tag includes a quote from Mother Theresa. It reads: “If you can’t feed a hundred people, then feed just one.”

Burke can feed 100, easy. In fact, five days a week, she leads a team that cooks for 650. She runs the cafeteria at Holy Family High School in Broomfield. She could go by “executive chef” or “food service manager,” but Burke, 57, just likes to be called “the Lunch Lady.” Her kids, as she calls the Holy Family student body, generally refer to her simply as “Mama.”

She’s been an actual mama, and she’s now a grandmother of seven. Whatever you call her, she’s feeling a whole lot better these days, thanks to UCHealth’s Comprehensive Lung and Breathing Program.

Burke had never had breathing issues. Then about four years ago, the wheezing started. Her doctor diagnosed her with adult-onset asthma (which, as long as we’re being flexible with names, you can also call late-onset asthma).

She ended up at an allergist, taking shots for sensitivity to trees. But long after the leaves had fallen and well before the spring burst of pollen, she was still wheezing. She was prescribed an inhaler, and during cold-and-flu season, the steroid prednisone. Then her nose and sinuses got into the act, to the point that she couldn’t smell and could scarcely taste. That’s not good for anyone, and worse yet if you’re a Lunch Lady. She would have to ask her staff questions like, “Does this have enough salt?”

It got to where she was going through three or four boxes of tissues a day. The kids at Holy Family noticed. “Mama, you’re not feeling well,” they told her. A surgery to remove sinus polyps restored her sense of smell, but the polyps came back after a while, robbing it again. A second surgery repeated the process. The polyps returned, and it got to the point that her nose and lungs produced so much mucous she couldn’t sleep, The wheezing wasn’t getting better, and her face was “starting to look like a basketball because of all of the prednisone,” Burke said.

More than a hunch

She learned of a UCHealth sinus specialist, otolaryngologist Dr. Todd Kingdom, who might be able to help. In December 2017, Burke sat down with him and described what she had gone through. He listened, and then said, “I think I know what it is.”

A blood test confirmed it. It wasn’t just a sinus problem per se, but something more complicated called eosinophilic asthma, an inflammatory disorder. The sinus problems stemmed from it. White blood cells called eosinophils, which usually increase with allergies, trigger inflammation in the lungs—and also the sinuses. That, in turn, can lead to the sorts of polyps that Burke had twice had surgically removed.

“In the United States, 80 percent of those with nasal polyps will have an increased concentration of eosinophils in the sinus tissue,” Kingdom said. “And an 80-percent chance of asthma.”

Kingdom could surgically remove the polyps to ease Burke’s sinus symptoms. But he knew that, unless he addressed the underlying cause – the eosinophilic asthma – they’d probably just come back like they did last time.

Burke had come to the right place in a couple of ways. First, while severe adult-onset eosinophilic asthma is uncommon, academic medical center specialists such as Kingdom frequently see difficult cases referred from outside physicians, so he sees enough eosinophilic asthma and related sinus disease that it’s on his radar. Second, Kingdom’s work as part of UCHealth’s Comprehensive Lung and Breathing Program places him among a stable of specialists who collaborate on cases like Burke’s. In this case, he brought in Dr. Fernando Holguin, a UCHealth lung specialist who leads the Severe Asthma Clinic and research program for the Comprehensive Lung and Breathing Program.

Dial it back

The blood test showed Burke’s eosinophil production to be in hyperdrive. In such cases, Holguin said, traditional asthma treatments often don’t work. He prescribed one, then a second biologic – medications that work by adjusting how the immune system operates. The first, zileuton (Zyflo), is a pill; the second, reslizumab (Cinqair), is a once-a-month infusion. The drugs act on different links of the immune-system chain, with the common goal of tamping down on eosinophils and other cells causing inflammation. New eosinophilic asthma patients hoping for relief come to the Severe Asthma Clinic on a weekly basis, Holguin said; these therapies have helped many of them.

They’re helping Burke. She’s off steroids and allergy shots and can taste the salt again. The Comprehensive Lung and Breathing Program has made “a huge difference in quality of life,” she said.

Burke says she may need the medications the rest of her life, and now that the underlying cause is on a short leash, another sinus surgery to remove polyps may be in the cards, this time with a much better chance of a successful outcome. But she’s grateful, she said, and amazed at how much better she feels.

“They gave me back more than I could ever repay UCHealth,” she said. “Everybody depends on me – I’m the Lunch Lady.”