Asthma treatments have become pretty standard by now. You take long-term control medicines to avoid asthma attacks, and quick-relief medicines to treat symptoms when they start.
These treatments typically work well in people with mild to moderate asthma. Yet, for around 5 percent to 10 percent of people with the condition, traditional asthma medicines may not be enough to control symptoms.
In the last few years, a new group of prescription drugs has been introduced to treat severe asthma. Called biologics, they work in a different way from other asthma medications: Instead of treating your symptoms, they target the underlying cellular changes that cause your asthma.
Keep reading to find out if biologic drugs are right for you.
What are biologics?
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 responded to inhaled corticosteroids, short-acting beta-agonists, and other standard treatments.
Biologics help to control symptoms like shortness of breath and coughing when other medicines have failed. Taking a biologic may prevent you from getting asthma attacks and can lessen the intensity of any attacks you do have.
Types of biologics for asthma
Two types of biologic drugs are approved to treat severe asthma. One targets an immune system protein called immunoglobulin E (IgE), and the other treats eosinophilic asthma. The type of biologic your doctor will prescribe you depends on the type of asthma you have.
Many people with asthma also have allergies to substances like dust, pollen, and 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, and wheezing.
Omalizumab works by blocking the IgE receptors on immune cells and preventing them from releasing their chemicals. Your doctor or nurse will give this medicine to you as an injection under the skin, once or twice a month.
Omalizumab is approved to treat people ages 6 and over who are unable to control their asthma adequately with inhaled corticosteroids. Candidates for this treatment must have a positive skin test or in vitro reactivity to an airborne allergen. As well, it’s typically recommended only for those with elevated IgE levels. Studies show it can reduce the number of asthma attacks, prevent hospitalizations, and help people living with asthma cut back on their daily steroid use.
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, and other germs. They work by triggering inflammation in your body.
When it comes to preventing disease, eosinophils are helpful. But when there are too many of them, they can cause excess 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), an immune system protein that activates the production of eosinophils.
Reslizumab is approved for adults ages 18 and over with eosinophilic asthma. Mepolizumab and benralizumab are approved for children and adults ages 12 years and older. You get these drugs either through an intravenous line (IV) or as an injection once every one or two months.
Biologic drugs are generally safe, but they can cause a few side effects, such as:
- irritation at the injection site
- cold-like symptoms
- sinus infection
Rarely, these drugs can cause a severe allergic reaction called anaphylaxis. Your doctor will monitor you for signs of anaphylaxis, which include:
- hives, rash
- swelling of the face, mouth, or tongue
- shortness of breath
- low blood pressure
- trouble swallowing
- dizziness, fainting
Biologics don’t work for everyone — and they might not work alone. At first, your doctor will introduce a biologic to your regular asthma treatment plan as add-on therapy to see if it helps control your symptoms.
If biologics work for you, they may cut down the number of attacks you get. And over time, they may help you scale back your use of inhaled corticosteroids or other asthma treatments.