Biologics are genetically engineered medications designed to target and block substances that cause inflammation. In recent years, they’ve proven effective at treating severe asthma.
Asthma treatments have become pretty understandable by now. You take long-term control medications to avoid asthma attacks and quick-relief medications to treat symptoms when they start.
These treatments work well for most people with mild to moderate asthma.
A newer group of prescription drugs called biologics treats severe asthma.
Biologics work differently from other asthma medications. Instead of treating symptoms, they target the underlying molecular causes of asthma.
This article examines biologics for asthma in more detail, including how they work to treat asthma and potential side effects.
Biologic drugs are genetically engineered proteins. They’re designed to target specific substances in your immune system that cause inflammation.
Doctors prescribe biologics for certain people with severe asthma whose symptoms haven’t improved with inhaled corticosteroids, short-acting beta agonists, and other standard treatments.
Biologics help manage symptoms like shortness of breath, wheezing, and coughing when other medications have failed.
Taking a biologic may prevent you from getting asthma attacks. They can also make any attacks you do have less severe.
The Food and Drug Administration (FDA) has approved six biologic drugs to treat asthma:
Several others are currently in development.
The type of biologic your doctor will prescribe depends on the kind of asthma you have.
Omalizumab (Xolair)
Many people with asthma also have allergies to substances like:
- dust
- pollen
- pet dander
When you have an allergy, your immune system produces IgE, which is a special type of antibody (protein).
IgE locks onto the surface of immune cells, causing them to release chemicals that set off the allergic reaction. These chemicals trigger symptoms like:
- coughing
- shortness of breath
- wheezing
Xolair works by blocking allergic antibodies and lowering the activity of IgE receptors on immune cells, preventing them from releasing their chemicals.
Your doctor will inject this medication under the skin once or twice a month.
Xolair is approved to treat severe asthma in people ages 6 years and over when inhaled corticosteroids are not able to manage their asthma.
Before getting this treatment, your doctor will confirm you have environmental allergies with a positive skin test or blood test.
This drug is usually only recommended for people with high IgE levels.
- reduce the number of asthma attacks
- prevent hospital visits
- help people with asthma cut back on their daily steroid use
Mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra)
Mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra) treat a severe form of asthma called eosinophilic asthma.
Eosinophils are a type of white blood cell. Your immune system uses them to fight off:
- viruses
- bacteria
- other germs
They work by triggering inflammation in your body.
Eosinophils are helpful in preventing disease.
However, when there are too many of them, they can cause too much inflammation and swelling. If that swelling is in the airways of your lungs, it can be hard to breathe.
Anti-eosinophilic antibodies target interleukin-5 (IL-5). This immune system protein activates the production of eosinophils.
Cinqair is approved for adults ages 18 years and over with severe eosinophilic asthma. Fasenra is approved for children and adults ages 12 years and older, while Nucala is approved for those down to age 6 years.
You receive these drugs intravenously (directly into a vein) or as an injection once every 1 or 2 months.
Dupilumab (Dupixent)
Dupixent blocks two proteins that drive allergic inflammation in asthma:
- interleukin-4 (IL-4)
- interleukin-13 (IL-13)
It’s approved for people ages 6 years and over.
Dupixent is the only drug that treats moderate and severe eosinophilic asthma. It also helps people who need to take corticosteroids to manage their asthma.
Tezepelumab-ekko (Tezspire)
Tezspire can help treat severe asthma in adults and children ages 12 years and older. Tezspire is an add-on treatment alongside other asthma medications, such as rescue inhalers, to treat your condition.
The medication is a liquid solution given as an injection under your skin. You‘ll receive doses at your doctor’s office or other healthcare facility.
Tezspire belongs to a group of drugs called monoclonal antibodies. It helps relieve severe asthma by targeting and
Biologic drugs are generally safe, but they can cause a few side effects, such as:
- irritation at the injection site
- cold-like symptoms
- headaches
- sinus infection
- fatigue
- conjunctivitis
Rarely, these drugs can cause a severe allergic reaction called anaphylaxis. Your doctor will monitor you for signs of anaphylaxis, which include:
- hives, rash
- itching
- swelling of the face, mouth, or tongue
- shortness of breath
- low blood pressure
- wheezing
- difficulty swallowing
- dizziness, fainting
Biologics help people with severe asthma manage their symptoms and reduce the frequency of asthma attacks. It can also allow some people to stop or reduce their use of oral steroids for asthma. This is beneficial as long-term use of oral corticosteroids can cause many side effects.
Please note: Don’t stop taking your prescribed steroid medication for asthma without speaking with your doctor. If you’ve been advised to reduce your steroid medications after starting biologics, it’s important to do this gradually with your doctor’s guidance.
According to the Asthma and Allergy Foundation of America, biologics work differently for everyone and might not take effect right away. It may be several weeks before you begin to notice improvements in your asthma symptoms.
Do keep taking your biologic and other asthma medications until your doctor tells you otherwise.
The American Lung Association recommends the following treatments for severe asthma:
- inhaled corticosteroids
- long-term control medications, such as long-acting beta2 agonists montelukast or theophylline
- oral corticosteroids as an additional treatment for those still experiencing symptoms and flare-ups
- biologics (monoclonal antibodies that target inflammation)
- macrolide antibiotics also may be an option if necessary to help the body fight infection
Biologics don’t work for everyone — and they might not work alone. At first, your doctor will add a biologic to your regular asthma treatment plan to see if it helps manage your symptoms.
If biologics work for you, they may reduce the number of asthma attacks you experience. Over time, they may help you scale back your use of inhaled corticosteroids or other asthma treatments.
