Severe Asthma Management: Your Complete Guide to Biologics

More than 28 million people in the United States — or about 1 in 12 Americans — live with asthma, a chronic inflammatory lung disease that makes breathing difficult. Most people with asthma can effectively manage their condition by:

• Avoiding or minimizing exacerbation triggers
• Taking daily long-term controller medications
• Treating symptoms with quick-relief medicine

In some cases, however, standard asthma management protocols aren’t effective enough. If you have severe asthma, our team at Fivestar Pulmonary Associates can help you get it under control with advanced biologics. 

When your asthma is uncontrolled 

When used properly and consistently, conventional inhaled asthma medicines — both long-acting bronchodilators and quick-relief corticosteroids — help most people achieve effective and reliable asthma control. 

For some people, however, these go-to asthma protocols don’t keep the condition in check. Poor asthma control may manifest as: 

• Having to use your rescue inhaler more than twice a week
• Waking up at night with shortness of breath and coughing
• Having to avoid exercise or other activities due to asthma
• Being hospitalized for asthma two or more times in a year 

At any sign of uncontrolled asthma, our team ensures you’re using your inhalers properly, assesses your lung function, and takes steps to adjust your treatment plan. If you continue to struggle despite switching to high-dose corticosteroids and/or taking a second controller medicine, you may have severe asthma. 

Severe asthma relief with biologics

An estimated 3-4% of people with asthma have a severe form of the disease that doesn’t respond adequately to conventional inhaled medication regimens. Fortunately, advances in asthma management have delivered a groundbreaking new solution called biologics. 

What they are

Biologics are monoclonal antibodies (moAbs), or lab-made proteins derived from living cells. Antibodies are immune cells that neutralize foreign invaders (antigens) in your body, binding to them, tagging them for destruction, and blocking them from harming healthy cells. 

Essentially, biologics are a highly targeted asthma therapy that interact directly with your immune system to interfere with the inflammatory cascade, reduce airway reactivity, and control severe asthma. 

How they work

Every antibody protein matches a specific antigen, much like a key fitting into a lock: The antibody can only recognize, bind with, and neutralize its corresponding antigen. Biologics are made to target specific antigen molecules in the two main types of severe asthma: 

Type 2 inflammation

Type 2 (T2) inflammation refers to asthma types — primarily eosinophilic and allergic asthma — that trigger the overproduction of certain cytokines, such as IL-4, IL-5, and IL-13, and drive the activation of inflammatory white blood cells called eosinophil cells. Biologic treatment targets these molecules to dial down airway inflammation.

Non-type 2 inflammation 

This type of asthma doesn’t cause high eosinophil levels; instead, it’s characterized by a flood of neutrophil immune cells that trigger an inflammatory response along upstream pathways, involving cytokine molecules like IL-8 and IL-17. 

Biologics for non-type 2 (non-T2) inflammation stop your airway from overreacting to triggers such as air pollution and respiratory infections. 

What to expect

If you’ve been diagnosed with severe asthma, our team conducts blood tests to check for biomarkers and identify the specific inflammatory pathway of your asthma type. Then, we match your biomarker phenotype to the right biologic treatment. 

There are different biologic treatments for allergic asthma, eosinophilic asthma, and broad, non-T2 asthma; your treatment is tailored to your exact needs. In some cases, patient age and co-existing conditions (i.e., nasal polyps) may guide biologics selection too. 

Most biologics are administered via injection in our office every two to eight weeks, depending on your specific treatment protocol. One biologic is administered via intravenous (IV) drip. 

Who can benefit

If you have severe asthma that isn’t well-controlled by standard inhaled treatments, you experience frequent exacerbations, or you rely on high-dose oral steroids, chances are you can benefit from biologics. With consistent treatment, you can expect: 

• A reduction in severe asthma flare-ups
• Improved lung function and breathing
• Fewer ER trips and hospitalizations
• Reduced reliance on rescue steroids
• Increased activity; fewer missed workdays 
• More restful sleep; better quality of life

Biologics are especially effective against T2 eosinophilic asthma — the type that’s responsible for four in five cases (80%) of severe asthma.

Specialist care for severe asthma

Interested in learning more about biologics? Fivestar Pulmonary Associates is here to help. Complete our online Asthma Control Test today, then schedule a visit with our experts at our nearest office in Allen, McKinney, and Plano, Texas.