Severe Asthma and Biologic Therapy

For some people, asthma remains difficult to control despite taking prescribed medications, avoiding known triggers, and following their treatment plans. Frequent coughing, wheezing, chest tightness, and shortness of breath can interfere with work, exercise, sleep, and everyday activities.

At Nova Pulmonary and Sleep, patients throughout Northern Virginia can receive specialized pulmonary evaluations for persistent respiratory symptoms and difficult-to-control asthma. For certain patients with severe asthma, biologic therapy may offer an additional treatment option.

Understanding how biologic medications work, who may benefit, and what to expect can help patients make informed decisions about their respiratory care.

What Is Severe Asthma?

Severe asthma is a form of asthma that remains uncontrolled despite optimized treatment with high-dose inhaled corticosteroids and additional controller medications, or that worsens when these treatments are reduced.

People with severe asthma may experience:

• Frequent wheezing, coughing, or chest tightness.
• Shortness of breath during routine activities.
• Nighttime symptoms that interrupt sleep.
• Repeated asthma attacks requiring urgent medical attention.
• Frequent use of rescue inhalers.
• Multiple courses of oral corticosteroids.

However, experiencing persistent symptoms does not automatically mean someone has severe asthma.

Before making this diagnosis, a pulmonologist typically evaluates inhaler technique, medication adherence, environmental triggers, and other conditions that may contribute to breathing difficulties.

What Is Biologic Therapy for Severe Asthma?

Biologic therapy uses medications designed to target specific immune-system components involved in asthma inflammation.

Unlike traditional asthma medications that broadly reduce airway inflammation, biologics interrupt specific inflammatory pathways associated with certain types of asthma.

These medications are generally administered by injection, though some require intravenous infusion.

Biologic treatments are typically considered when severe asthma remains uncontrolled despite appropriate standard therapy.

They are not rescue medications and should not replace prescribed inhalers without medical guidance.

How Does Biologic Therapy Work?

Asthma inflammation involves several immune cells and signaling proteins. In certain patients, specific inflammatory pathways contribute to persistent airway swelling and increased sensitivity.

Biologic medications target these pathways.

Different treatments may act on:

• Immunoglobulin E (IgE): An antibody involved in allergic reactions.
• Interleukin-5 (IL-5): A signaling protein involved in eosinophil production and survival.
• Interleukin-4 and interleukin-13: Proteins associated with type 2 airway inflammation.
• Thymic stromal lymphopoietin (TSLP): A protein involved in initiating inflammatory responses.

By blocking selected pathways, biologic therapy may reduce asthma exacerbations and improve symptom control.

A 2018 clinical trial published in the New England Journal of Medicine evaluated dupilumab in patients with uncontrolled moderate-to-severe asthma. The study found that treatment significantly reduced severe exacerbations and improved lung function compared with placebo, particularly among patients with elevated inflammatory markers.

These findings demonstrate how targeting specific immune pathways can benefit selected patients.

Who Is a Candidate for Biologic Therapy?

Not everyone with asthma requires biologic medication.

Physicians generally consider these treatments for patients with severe asthma who continue experiencing symptoms or exacerbations despite optimized inhaled therapy.

Potential candidates may include people who:

• Experience frequent asthma attacks despite controller medications.
• Require repeated oral corticosteroid treatment.
• Have elevated blood eosinophil levels.
• Have allergic asthma supported by appropriate testing.
• Demonstrate evidence of type 2 airway inflammation.
• Experience substantial limitations in daily activities.

Eligibility depends on the specific medication, asthma characteristics, clinical history, and applicable prescribing criteria.

A pulmonologist may recommend blood tests, allergy testing, spirometry, or fractional exhaled nitric oxide (FeNO) testing to help determine whether biologic therapy is appropriate.

What Biologic Medications Are Used for Severe Asthma?

Several biologic medications are available for selected patients with severe asthma.

Each medication has specific eligibility requirements, administration schedules, and safety considerations.

Treatment selection depends on the patient’s asthma type, exacerbation history, inflammatory markers, and other clinical factors.

What Are the Benefits of Biologic Therapy?

For appropriately selected patients, biologic therapy may provide several meaningful benefits.

These include fewer severe asthma attacks, improved lung function, reduced dependence on oral corticosteroids, and better symptom control.

A 2017 randomized clinical trial published in the New England Journal of Medicine examined benralizumab in patients with severe asthma who depended on oral corticosteroids.

The study found that patients receiving benralizumab achieved greater reductions in oral corticosteroid requirements than those receiving placebo while maintaining asthma control.

Reducing long-term corticosteroid exposure can be particularly important because these medications may contribute to osteoporosis, elevated blood sugar, weight gain, and other complications.

However, individual responses to biologic treatment vary.

What Are the Possible Side Effects?

Biologic medications are generally well tolerated, but side effects can occur.

Depending on the medication, possible reactions include injection-site discomfort, headaches, joint pain, and allergic reactions.

Rarely, serious hypersensitivity reactions, including anaphylaxis, may occur.

Some medications also have specific precautions related to infections or other medical conditions.

Patients should discuss their medical history, current medications, and potential risks with their healthcare provider before starting treatment.

How Long Does Biologic Therapy Take to Work?

Some patients notice improvement within several weeks, while others need several months of treatment before meaningful changes appear.

Physicians typically monitor asthma symptoms, exacerbation frequency, lung function, and medication requirements to evaluate effectiveness.

A 2014 clinical trial published in the New England Journal of Medicine found that mepolizumab significantly reduced exacerbations among patients with severe eosinophilic asthma.

This supports the importance of matching biologic treatment to the patient’s inflammatory characteristics.

Biologic therapy often requires ongoing treatment and regular follow-up appointments.

Can Biologic Therapy Replace Asthma Inhalers?

Biologic therapy usually complements existing asthma medications rather than replacing them.

Patients commonly continue using prescribed controller inhalers while receiving biologic treatment.

If asthma control improves, physicians may consider carefully adjusting certain medications.

However, patients should never discontinue inhaled corticosteroids or oral corticosteroids without medical supervision.

Explore Severe Asthma Treatment With Nova Pulmonary and Sleep

Living with severe asthma can be challenging, particularly when symptoms continue despite regular treatment.

Nova Pulmonary and Sleep provides specialized pulmonary care for adults throughout Northern Virginia, including Vienna, Leesburg, South Riding, Ashburn, Broadlands, Brambleton, Fairfax, Tysons Corner, Chantilly, and Purcellville.

A comprehensive respiratory evaluation can help identify factors contributing to uncontrolled asthma and determine whether advanced treatment options, including biologic therapy, deserve consideration.

Visit Nova Pulmonary and Sleep to learn more about pulmonary services and schedule a consultation with a lung specialist.