Biologics for Asthma: What to Know About New Asthma Treatments

Around 28 million people in the U.S. have asthma, making it one of the most common diseases in the country. It causes breathing problems that can be life-threatening.

Asthma can't be cured, but treatments can help manage it. In recent years, a new kind of asthma medication, known as biologic therapy, has come on the scene.

These new drugs are an important advance in asthma treatment, says John T. Watson, M.D., a pulmonary and critical care medicine doctor at Sentara Martha Jefferson Medical & Surgical Associates in Charlottesville. Dr. Watson describes what these medications do and who can benefit from them.

Understanding Asthma Treatment

Asthma causes inflammation, or swelling, in the airways, leading to wheezing, coughing and shortness of breath. As the airways continue to tighten or swell during an attack, the symptoms worsen. Triggers like pollen, dust, cigarette smoke and exercise can set off an asthma attack.

For many years, asthma treatment followed the same general pathway, Dr. Watson says:

1. Rescue inhaler: People usually start with a prescription medication called a rescue inhaler. "Rescue inhalers contain albuterol, a medication that opens the airways to make it easier to breathe," Dr. Watson explains. "You use rescue inhalers as needed when you're having an asthma attack."
2. Inhaled corticosteroids: If you have frequent asthma attacks, a rescue inhaler might not be enough. Your doctor might recommend a daily medication known as a corticosteroid. You take the medicine with an inhaler, and it reduces inflammation in the airways to help prevent asthma attacks. (But if an attack occurs, you can still use a rescue inhaler.)
3. Oral corticosteroids: People with severe asthma might need to take corticosteroids in pill form to help keep their symptoms under control. Prednisone is the most common medication used for this purpose.

"For decades, that's the way asthma has been treated in most patients," Dr. Watson says. But new biologic treatments are taking aim at asthma in a whole new way.

Biologic Drugs for Asthma

The new asthma treatments belong to a class of drugs known as biologics. These medications target your body's immune system.

The immune system uses inflammation to fight off things that make you sick, like bacteria or parasites. In asthma, however, the body's immune system is stuck in overdrive. It triggers inflammation in the airways, even though there's no infection there to fight.

Biologics block the chemical signals that kick-start that inflammatory process. Unlike corticosteroids, which reduce inflammation, biologics aim to stop the immune system from generating inflammation in the first place.

Different biologics act on different immune pathways, notes Dr. Watson. Most biologics for asthma target a type of immune cell called eosinophils. Not all people with asthma have high levels of eosinophils. But for patients who do, the asthma is often hard to control with inhalers alone. For those patients, biologics can go a long way toward managing symptoms.

Are the New Asthma Drugs Right for You?

Biologic treatments for asthma are usually given by injection, either at home or in a clinic. In people with high levels of eosinophils, biologic therapy can help keep the disease better controlled, Dr. Watson says.

Biologics are also a great choice for people who have to take oral corticosteroids for asthma, Dr. Watson says. Long-term use of oral corticosteroids can cause some serious side effects, including weight gain, increased diabetes risk and decreased bone density. "Given the risks, we try to avoid prescribing those medications for long-term use whenever possible," Dr. Watson says. Biologic drugs are generally much safer, with a low risk of serious side effects, he adds.

For a lot of people, asthma can be well controlled with traditional medications. But if you continue to have symptoms and frequent asthma attacks, biologics might help. "If you're considering biologics or need more help managing your asthma, talking to a pulmonologist is a good first step," Dr. Watson says.

John T. Watson, M.D., is board-certified in internal medicine, pulmonology medicine and critical care medicine at Sentara Martha Jefferson Medical & Surgical Associates in Charlottesville. Call 434-654-5260 to make an appointment.