Biologics for Moderate to Severe Asthma

Biologic medications can significantly reduce symptoms for many people with moderate to severe asthma. They target specific parts of the immune system that cause airway inflammation, stopping asthma symptoms before they can start.

Biologics allow you to gain better control of your asthma and reduce the risk of asthma attacks, leading to improved lung function and quality of life.

For many people who have difficulty managing their asthma with traditional medications, biologics are a new and innovative treatment option.

Biologic therapies for severe asthma vs. traditional asthma medications

Most people with asthma use medications to help treat and control their symptoms. Traditional asthma medications include inhalers and pills. Newer medications are biologics. These treatments are available either as injectables or by infusion (IV).

Traditional asthma medications are prescribed to mild, moderate and severe asthma patients. They are designed to treat and control asthma symptoms.

Asthma quick-relief inhalers, or bronchodilators, contain medication to help open up the airways so you can breathe more easily. You may be prescribed a quick-relief inhaler to use during an asthma attack. This is a short-acting beta2-agonist (SABA). You may also be given a controller inhaler to take once per day to help keep your asthma in check throughout the day. Your controller inhaler may contain a long-acting beta2-agonist (LABA), an inhaled corticosteroid, a long-acting muscarinic antagonist (LAMA), or any combination of them.

Traditional medications work well for many people with asthma. But sometimes they aren’t enough, especially for people with moderate to severe asthma.

Biologics are made from living cells, such as proteins or antibodies. They are special medications that can be prescribed to people with moderate to severe asthma. They work by targeting specific parts of the immune system that trigger airway inflammation. This can help stop asthma symptoms before they can start.

One type of biologic medicine blocks a protein antibody called immunoglobulin E (IgE). This is released during allergic reactions. It can lead to symptoms of allergic asthma. Other types of biologics block cells that release chemicals called eosinophils that cause inflammation. This condition is sometimes called severe eosinophilic asthma.

Biologic treatments are used to treat severe asthma in people who don’t get enough relief from traditional medications. They are an add-on medication, meaning they can be taken with other asthma treatments, including inhalers. They are given either as injections or infusions, usually at a doctor’s office. Some patients can take them at home.

How do biologics work for asthma?

Asthma happens when your airways become inflamed and narrow. For some people, their immune system overreacts, causing more inflammation than usual. Biologics help by blocking certain parts of the immune system that lead to this inflammation.

Some biologics block immunoglobulin E (IgE), a protein that plays a key role in allergic asthma. Other biologics block proteins such as interleukin-5 (IL-5). These are involved in the inflammatory process that leads to asthma symptoms. By inhibiting these molecules, biologics can reduce inflammation caused by the immune response and prevent asthma attacks.

The benefits of biologics for severe asthma

Biologics can help people with asthma control their symptoms, reduce the frequency of asthma attacks, and improve their overall quality of life. People with asthma who use biologics report fewer hospital visits, less reliance on quick-relief inhalers, and the ability to engage more fully in daily activities.

How much do biologics reduce asthma symptoms?

Biologics can significantly improve asthma symptoms, especially for people with moderate to severe asthma who don’t respond well to traditional treatments.

The benefits of biologics vary from person to person. In general, biologics can lead to…

• Fewer asthma attacks. Many people experience fewer asthma attacks after starting biologics. Some studies show biologics can reduce asthma attacks by up to 50% or more in patients with severe asthma.
• Better breathing. People often report easier breathing and improved lung function. This means less wheezing, coughing, and shortness of breath.
• Less need for corticosteroids: Biologics help some patients reduce or even stop using oral steroids, which can have severe side effects when used long-term.
• Improved quality of life: People on biologics often notice they can do more physical activities and feel less limited by their asthma.

Biologics as an add-on medication for severe asthma

In most cases, biologics are prescribed as an add-on to existing medications rather than replacing them. Your healthcare provider will work with you to adjust your treatment plan, ensuring that all medicines work together to provide the best control of your asthma symptoms.

Who qualifies for an asthma biologic?

Not everyone with asthma is prescribed biologic therapy. Your doctor will decide if biologics are right for you by looking at several factors:

1. Severity of asthma: Biologics are usually for people with moderate to severe asthma symptoms and lung inflammation. They are recommended when regular treatments like asthma inhalers and corticosteroids are not controlling symptoms well.
2. Type of asthma: The type of asthma you have is important when choosing a biologic. Biologics are often used for allergic asthma, where your body reacts to allergens like pollen or dust. And for eosinophilic asthma, where too many white blood cells cause inflammation in your airways.
3. History of asthma attacks: If you have frequent asthma attacks, even with the use of traditional asthma medications, you might need a biologic.
4. Frequent use of oral corticosteroids: Do you often take oral corticosteroids to control asthma? Biologics can help reduce your need for these steroids, lowering the risk of side effects.
5. Past treatments: Your doctor will check how well other treatments have worked for you. If your asthma is still not under control, a biologic might help.
6. Blood tests: Your doctor may do a blood test to check for certain things in your blood, like high levels of eosinophils or IgE. These tests help decide if a biologic is right for you.
7. Age: Some biologics are only for certain age groups, so your age might affect which treatments are available to you or your child.

Biologics for asthma in children

Most children with asthma can manage their symptoms with traditional treatments like quick-relief and controller inhalers. However, for some kids with moderate to severe asthma, these treatments aren’t enough. That’s where biologics come in.

Biologics are typically recommended for children with moderate to severe asthma who don’t get enough help from traditional treatments. If your child has frequent asthma attacks or needs a lot of medicine, biologics might be an option to improve symptoms. Biologics have been proven to be safe treatments for children. They should be prescribed with some caution, however. Children’s immune systems are still developing. They may respond differently to biologics than adults.

Some biologics are approved for children as young as 6 years old. Others are approved for children ages 12 and up. Parents should talk with their child’s doctor about benefits and risks of biologics for childhood asthma.

List of biologics for asthma symptoms

Here are FDA-approved biologics for the treatment of moderate to severe asthma. Each works in a slightly different way and is targeted at specific types of asthma:

• Omalizumab (Xolair®): Omalizumab is used for people with moderate to severe allergic asthma. It works by blocking IgE, which helps prevent allergic reactions that can trigger asthma symptoms. This medicine is given as a subcutaneous injection (under the skin) and is approved for adults and children ages 6 years and older.
• Mepolizumab (Nucala®): Mepolizumab treats eosinophilic asthma, which is marked by high levels of white blood cells called eosinophils. It blocks IL-5, reducing eosinophil levels and as a result asthma symptoms. This medicine is given as a subcutaneous injection and is approved for adults and children ages 6 years and older.
• Reslizumab (Cinqair®): Reslizumab is also for eosinophilic asthma. It blocks IL-5 to lower eosinophil levels. Unlike all the other biologics used to treat asthma, it’s given through an IV infusion directly into a vein. Reslizumab is approved only for adults ages 18 years and older.
• Benralizumab (Fasenra®): Benralizumab is also used for eosinophilic asthma. It targets IL-5 to block eosinophils from triggering asthma symptoms. This medicine is given as a subcutaneous injection and is approved for adults and children ages 6 years and older.
• Dupilumab (Dupixent®): Dupilumab is for both eosinophilic and allergic asthma. It blocks two proteins, IL-4 and IL-13, which are involved in asthma inflammation. This medicine is given as a subcutaneous injection and is approved for adults and children ages 6 years and older.
• Tezepelumab (Tezspire®): Tezepelumab is suitable for a wide range of asthma types. It is an option for patients who do not fit into the profile of the other biologics. Tezepelumab works by blocking a molecule called TSLP, thereby reducing inflammation. This medicine is given as a subcutaneous injection and is approved for adults and children ages 12 years and older.

Choosing the right biologic for your severe asthma

How do doctors choose the right biologic for your asthma? It will likely depend on several factors. You and your doctor may consider your specific type of asthma, the severity of your asthma, your age, medical history, and how you respond to current treatments. You should also consider insurance coverage as biologics can be expensive medications.

It’s important to have an open discussion with your doctor about symptoms, treatment goals, and any concerns you may have about biologic treatment.

Biologic side effects

Side effects of biologic medications can range from mild to severe. In general, common side effects are injection site reactions, mild fever, joint pain, headache and fatigue. Depending on the medication, other side effects may include sore throat, dizziness, skin rash, itchy skin, ear discomfort and stomach pain or discomfort. These side effects are usually manageable.

When taking a biologic, it’s important to have regular check-ins with your doctor to discuss any side effects.

Some people may have an allergic reaction soon after taking a biologic. Tell your healthcare provider or get emergency help right away if it’s a severe allergic reaction. This is anaphylaxis, a potentially life-threatening condition. Symptoms of anaphylaxis may include hives on the skin, swelling of your face, mouth and/or tongue, breathing problems, nausea, abdominal cramps, vomiting, low blood pressure, fainting, or feeling lightheaded.

If you take a biologic at home, you will need a prescription for epinephrine. Epinephrine is the first-line treatment for anaphylaxis. Take it at the first sign of symptoms.

Drawbacks to biologic therapy for severe asthma

Biologic therapy is an innovative way to treat moderate to severe asthma. But it is not without challenges for some patients.

Biologics to treat asthma require regular injections or infusions. These are usually done in a doctor’s office or medical clinic. It can be inconvenient for some people to schedule regular visits to a doctor’s office or clinic. The good news is, biologics can now be self-administered at home.

Another challenge is the cost of biologics. These are expensive medications and may not always be covered by insurance, limiting access for some patients. The good news is, drug companies are offering biologics at minimal cost to people with private health insurance. Medicare and Medicaid may also cover biologics.

What to do if you think a biologic might be right for your severe asthma?

If you think a biologic could help treat your severe asthma, start by talking to your doctor. Discuss your symptoms and how well your current medications are working. Your doctor might do tests, like a blood test, to see if a biologic is a good fit.

Since biologics can be costly, check with your insurance about coverage and ask about financial help if needed. Working with your doctor, you can decide if a biologic is the right choice to help improve your asthma and quality of life.