Do you have asthma? You may be using your inhaler as prescribed and taking other medications, but your asthma symptoms are not getting better. If you are experiencing frequent wheezing, chest tightness, and coughing, you may have moderate to severe asthma. This new, advanced treatment method, called 'Biologic Therapy', is used for such difficult-to-control asthma conditions.
Simply put, what is Biologic Therapy?
This is a modern, targeted treatment for severe asthma. While regular inhalers temporarily widen the airways and make breathing easier, biologic therapy goes deeper.
Imagine, the main reason why we develop asthma is inflammation in the airways caused by some other activity of the body's immune system. So what these biologic drugs do is target specific antibodies, cells or molecules in the body that contribute to that inflammation and stop their activity. Due to this, asthma is controlled at a basic level.
This treatment is given in two main ways. One is as an injection under the skin (subcutaneous injection) and the other is as an intravenous (IV infusion) infusion.
The important thing is that this is not a stand-alone treatment. It should be used in conjunction with your existing inhaler and other asthma medications.
Who is this treatment suitable for?
Biologic therapy is not a treatment for all asthma patients. Your doctor will consider several factors before recommending this treatment for you. The table below will give you a good idea.
| Situations where you may be referred for Biologic Therapy | |
|---|---|
| Not controlled by prescribed medication | If your asthma symptoms are not controlled despite using your prescribed inhaler and other medications correctly. |
| Blood test results | If you have elevated levels of Eosinophils (a white blood cell that causes inflammation in the lungs) or IgE (an antibody related to allergies) in your blood. |
| Causes that aggravate the disease | If you know what triggers your asthma is and avoid them, but symptoms persist. |
| Frequent symptoms | If you wake up in the middle of the night with a cough, or if you use your rescue inhaler more than twice a week. |
| Frequent exacerbations | If you have to take corticosteroid pills more than twice a year or have to go to the ETU (Emergency Treatment Unit). |
| Hospitalization | If you have to stay in the hospital and receive treatment due to asthma. |
What types of biologic drugs are available for asthma?
There are several types of biologic medications that have been approved so far. Each of them works in a slightly different way. Your doctor will choose the most suitable medication for you based on your asthma type and blood test results.
| Name of the drug | Function and delivery method | Common side effects |
|---|---|---|
| Omalizumab (Xolair®) | Treats asthma caused by allergies. It is injected under the skin every 2-4 weeks. | Muscle pain, joint pain, extreme fatigue, swelling/pain at the injection site. |
| Mepolizumab (Nucala®) | Treats eosinophilic asthma. It is injected under the skin every 4 weeks. | Headache, back pain, weakness, fatigue, swelling/pain at the injection site. |
| Reslizumab (Cinqair®) | Treats eosinophilic asthma. It is given intravenously (IV) every 4 weeks. | Sore throat, muscle pain. |
| Benralizumab (Fasenra®) | Treats eosinophilic asthma. The first 3 doses are given every 4 weeks, then every 8 weeks. | Headache, sore throat. |
| Dupilumab (Dupixent®) | Treats eosinophilic asthma and other conditions caused by inflammation. Injected every 2 weeks. | Sore throat, swelling/pain at the injection site, increased white blood cell count. |
| Tezepelumab (Tezspire®) | A new drug for severe asthma. It reduces inflammation. It is injected every 4 weeks. | Sore throat, back pain, joint pain. |
How long does this treatment take?
This is usually a long-term treatment. It can take at least 4-6 months to know for sure if this medication is working for you. So it's important to be patient with your treatment.
Do I need to continue using my inhaler?
Yes, absolutely. This is the most important thing. Even after starting biologic therapy, never stop taking your inhalers and other medications prescribed by your doctor. Over time, if your asthma becomes well-controlled, your doctor may decide to reduce your inhaler dose. But this should only be done under medical advice.
What are the benefits and risks of this treatment?
Like any treatment, this one has benefits as well as minor risks.
Main advantages:
- It reduces inflammation in the respiratory tract and effectively controls asthma symptoms.
- Frequent colds and coughs will decrease.
- You will be able to exercise and complete daily tasks without having to work as hard as before.
- The number of times you wake up at night decreases.
- The need to go to the ETU (Emergency Treatment Unit) less often will decrease.
- The quality of life is getting much better.
Possible risks:
- Severe allergic reactions: Very rarely, some people may experience a severe allergic reaction (anaphylaxis). This is why the first few doses are given in a hospital or clinic under medical supervision.
- Risk of parasitic infections: Medications that reduce eosinophils may slightly reduce the body's ability to fight parasites, especially helminths. So your doctor will take that into account before starting this treatment.
Important: Do not stop taking this medication suddenly for any reason without your doctor's advice. Doing so may make your asthma symptoms worse.
When to talk to your doctor
In the following cases, be sure to consult your doctor and inform him/her.
- If asthma symptoms do not improve or worsen after several months of treatment.
- If new allergic symptoms (e.g. skin rash, itching) appear.
- If you have any questions or concerns regarding the treatment.
This treatment can be obtained on the recommendation of a specialist doctor, from a specialized unit of a hospital (infusion center) or from a specialist doctor's clinic. This treatment can be a bit expensive. But you can talk to your doctor about it and find out more details.
Take-Home Message
- Biologic Therapy is an advanced treatment method used for severe asthma conditions that are difficult to control with regular medications.
- This is not a cure for asthma, but it helps to control the disease very well.
- While receiving this treatment, it is essential to continue using your inhaler and all other medications prescribed by your doctor.
- Whether this treatment is suitable for you or not will be determined after considering your symptoms and specific blood test reports.
- Since it can take several months for the results of treatment to show, it is very important to be patient and follow medical instructions during treatment.
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