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Biologics for Severe Asthma

How Do Biologics Treat 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. Yet, for around 5 to 10 percent of people with the condition, they may not be enough to manage symptoms.

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.

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 improved with inhaled corticosteroids, short-acting beta-agonists, and other standard treatments.

Biologics help to 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.

Biologics are administered either by a trained nurse in the clinic setting, or they can be self-administered at home after appropriate training.  Your doctor with help determine what is the best choice for you.

Biologic therapy Drugs

Six biologic drugs are FDA approved to treat asthma:

  • omalizumab (Xolair)

  • mepolizumab (Nucala)

  • reslizumab (Cinqair)

  • benralizumab (Fasenra)

  • dupilumab (Dupixent)

  • Tezepelumab-ekko (Tezspire)


The type of biologic your doctor will prescribe depends on the kind of asthma you have and what will work best for you.


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 healthcare provider will give this medication to you as an injection under the skin once or twice a month.

Xolair is approved to treat severe asthma in people ages 6 and over whose asthma isn’t well managed with inhaled corticosteroids.


Before getting this treatment, your healthcare provider will confirm you have environment allergies with a positive skin test or blood test.

This drug is usually only recommended for people with high IgE levels.


Studies show it can:

  • reduce the number of asthma attacks

  • prevent hospital visits

  • help people with asthma cut back on their daily steroid use

To learn more about Xolair, please click link here.

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 and over with severe eosinophilic asthma. Fasenra is approved for children and adults ages 12 and older, while Nucala is approved for those down to age 6.


Nucala and Fasenra are administered as an injection once every one or two months, whereas Cinqair is the only biologic administered intravenously (directly into a vein).

To learn more about Nucala, please click link here.

To learn more about Cinquair, please click link here.

To learn more about Fasenra, please click link here.

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 12 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.

To learn more about Dupixent, please click link here.

Tezepelumab-ekko (Tezspire)

Tezspire is a newer biologic that received FDA approval in December 2021 for children and adults ages 12 and older with severe asthma.

It acts at the top of the inflammatory cascade by targeting thymic stromal lymphopoietin (TSLP), an epithelial cytokine.

It is the first and only biologic that does not have a phenotype (eosinophilic or allergic) or biomarker limitation within its approved label.

The most common adverse reactions are pharyngitis, arthralgias, and back pain.

To learn more about Tezspire, please click link here.

Content provided by Amgen.

Side Effects

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

  • trouble swallowing

  • dizziness, fainting


Your doctor may also recommend that you carry an epinephrine (EpiPen®) auto-injector in case you have a risk for a severe allergic reaction.





Biologics don’t work for everyone — and they might not work alone. At first, your healthcare provider will add a biologic to your regular asthma treatment plan to see if it helps control your symptoms.

If biologics work for you, they may reduce the number of attacks you get. Over time, they may help you scale back your use of inhaled corticosteroids or other asthma treatments.

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