Is Your Asthma Severe? Here’s a New Treatment (When Steroids Fail)

Biologics target eosinophilic asthma
Is Your Asthma Severe? Here's a New Treatment (When Steroids Fail)

Many people with asthma control their symptoms with regular use of medications for inflamed airways.

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But what if you have severe asthma that doesn’t respond to these drugs, including corticosteroid inhalers or anti-inflammatory pills, such as montelukast?

You may consider biologics, a newer, different type of drug for treating eosinophilic asthma.

Why some asthma is harder to treat

If you have asthma, inflammation in your breathing tubes may cause coughing and excess mucus in your airways. And, you know the typical symptoms — wheezing and shortness of breath.

Underlying problems like allergies can worsen some types of asthma. In these cases, avoiding allergens and being on asthma medications (inhaled steroids) can help reduce the inflammation. In severe asthma, a biologic specific for neutralizing allergic triggers, Omalizumab, may be needed.

Omalizumab has been available for 10 years, is an injection, and neutralizes some of the effects of allergies on severe asthma. In contrast, mepolizumab and reslizumab concentrate on targeting eosinophils, whether or not allergies are involved.

Eosinophilic non-allergic asthma is different. The eosinophil, a type of white blood cell, causes this type of asthma even without the involvement of allergies.

These blood cells are useful in the right amounts; they help your body fight off disease. But when there are too many in your airways, they can lead to severe asthma.

This type of asthma can even begin in adulthood. A doctor can identify eosinophilic asthma by testing your blood or mucus for eosinophils. Steroids by mouth may help, but people often need high doses, which can cause severe side effects.

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How can biologics help?

Biologics don’t work like steroids do. Rather, they specifically target the source of the problem.

Biologics work with your immune system to reduce the number of eosinophils in your body, says asthma treatment specialist Sumita Khatri, MD.

“We have been waiting for this opportunity to offer more targeted therapies for our patients with eosinophilic asthma,” she says. “Until now, all we had was high-dose oral or injectable steroids.”

The new biologics the Food and Drug Administration (FDA) has approved to treat eosinophilic asthma so far are:

  • Mepolizumab
  • Reslizumab

Your doctor will give these drugs either through an IV or subcutaneously (an injection under the skin) once or twice a month, depending on which one they prescribe.

Are there risks or side effects?

Dr. Khatri warns that doctors must prescribe biologics with caution for people who have had allergic reactions to other injectable medications.

You’re particularly at risk if you have had a reaction to biologics when used to treat other conditions.

One of the most serious risks is anaphylaxis (a severe allergic reaction). Your doctor likely will want to monitor you for at least two hours after administering the drug as a precaution.

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Other side effects may include irritation at the injection site, headaches and fatigue.

Biologics don’t work for everyone

“It’s important to note, too, that your asthma may or may not improve,” says Dr. Khatri.

Not everyone responds to biologics. Researchers are still looking for ways to identify people who will do best with these medications. So you shouldn’t assume that one of these drugs will replace your other medications.

“At first, we add on the biologics, and then, over time, there is a possibility the other medications may also be changed or pared back,” she says.

Dr. Khatri says it’s critical that you keep your asthma medications consistent and maintain your inhaler regimen.

“Make changes in your asthma regimen only in partnership with your asthma physician or practitioner. This means keeping up with office visits, contact by phone, and also having periodic testing of your lung function.”

Biologics aren’t the answer for everyone. But if you have severe asthma, they offer new hope. They can reduce asthma attacks and allow some people to breathe better. Ask your doctor whether they might help you.

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