Severe asthma is a form of asthma that remains difficult to control despite appropriate high-dose inhaled treatment and management of contributing factors. For people with certain types of severe asthma, biologic therapies can target specific immune pathways responsible for airway inflammation. These treatments may reduce asthma attacks, improve symptom control, and decrease reliance on oral corticosteroids. Biomarker testing, careful evaluation, and regular follow-up with a respiratory specialist are important for selecting and monitoring biologic treatment.
Biologic medicines are targeted therapies designed to interfere with specific molecules or immune cells involved in asthma inflammation.
They are generally considered for people with severe asthma whose disease remains uncontrolled despite optimized standard treatment.
Potential goals include:
Several biologic therapies are available, with selection based on the underlying type of asthma and biomarkers.
Omalizumab targets immunoglobulin E (IgE), an antibody involved in allergic inflammation.
It may be considered for people with moderate to severe persistent allergic asthma who meet specific clinical and laboratory criteria.
Interleukin-5 (IL-5) plays an important role in the growth and activity of eosinophils, inflammatory cells involved in certain forms of asthma.
Biologics targeting this pathway include:
These treatments may be useful for people with eosinophilic asthma.
Benralizumab targets the IL-5 receptor on eosinophils and can substantially reduce eosinophil levels.
It is used for selected patients with severe eosinophilic asthma.
Dupilumab blocks signaling from interleukin-4 and interleukin-13, two inflammatory pathways involved in type 2 asthma.
It may be considered for certain people with severe eosinophilic or corticosteroid-dependent asthma.
Tezepelumab targets thymic stromal lymphopoietin (TSLP), an inflammatory signaling protein involved early in the asthma pathway.
It has a broader mechanism and may be considered for certain people with severe asthma, including some patients without elevated eosinophil levels.
Biologics are not necessary for everyone with asthma.
Healthcare providers may consider factors such as:
Eligibility requirements vary among individual biologic medications.
Most severe asthma biologics are administered through injections under the skin. Some treatments are given at intervals ranging from every few weeks to every several months, depending on the medication.
Administration may occur at a medical facility or, for certain treatments, at home after appropriate instruction.
For eligible patients, biologic therapy may:
The degree of benefit varies between individuals.
Side effects differ among medications but may include:
Serious reactions are uncommon but can occur. Medical teams provide appropriate monitoring and safety instructions.
Before starting a biologic, a respiratory specialist generally confirms that asthma is truly severe and remains uncontrolled despite optimized standard treatment.
Evaluation may include:
This helps determine whether a biologic is appropriate and which type may provide the greatest benefit.
Regular follow-up is important after starting a biologic.
Healthcare providers may monitor:
If the response is inadequate, the treatment plan may be reassessed.
Biologic therapy generally does not replace standard asthma medications immediately.
People receiving biologics often continue prescribed inhaled corticosteroids and other controller medications. If asthma control improves significantly, a healthcare provider may gradually adjust certain medications when appropriate.
Severe asthma biologics provide targeted treatment for people whose asthma remains uncontrolled despite optimized conventional therapy. Anti-IgE, anti-IL-5, anti-IL-5 receptor, anti-IL-4 receptor, and anti-TSLP therapies target different inflammatory pathways and can reduce exacerbations for appropriately selected patients.