Beyond Inhalers: Biologic therapy for Asthma and COPD
Asthma
Let's talk about using those special medicines called "biologics" for asthma. Those for COPD are mentioned further below.
Imagine your regular asthma inhalers (like a reliever for quick help, and a controller you take daily) are like general tools for keeping your airways open and reducing everyday inflammation. They work well for many people.
However, for some people with severe asthma, these standard tools might not be enough. Their asthma is driven by very specific types of inflammation deep within their body's immune system, and it's hard to control, leading to frequent asthma attacks, lots of symptoms, and maybe even trips to the hospital.
This is where biologics come in.
Think of biologics as highly specialized, smart missiles for your asthma. Here's the breakdown:
What are they?
Instead of being made from chemicals like many traditional drugs, biologics are complex medicines made from living sources, like cells or proteins.
They are designed to be very precise.
What do they do in asthma?
Your immune system has many different signals and cells that can cause inflammation in your airways, making asthma symptoms worse.
Biologics are designed to find and target very specific "culprits" – particular cells (like eosinophils) or signaling proteins (like IgE, IL-4, IL-5, IL-13, TSLP) that are overactive and driving that hard-to-control inflammation in severe asthma.
By blocking these specific culprits, they can calm down the particular type of inflammation that's causing the trouble, without broadly suppressing the entire immune system like strong oral steroids (e.g., prednisone) might.
Who are they usually for? Biologics are typically considered for people with severe asthma when:
Their asthma isn't well-controlled even when they're using high doses of their standard controller inhalers (often including an inhaled corticosteroid and a long-acting bronchodilator).
They still have frequent asthma attacks.
They might often need to take oral steroid pills (like prednisone) to manage bad flare-ups, which can have a lot of side effects long-term.
Doctors will often do tests (like blood tests to check for certain inflammatory markers like eosinophils or IgE levels) to see if a person has the specific type of inflammation that a particular biologic is designed to target. This helps choose the right "smart missile" for the right person.
What are the potential benefits? For the right person, biologics can lead to:
Fewer asthma attacks: Sometimes dramatically reducing them.
Improved lung function: Making it easier to breathe.
Reduced daily symptoms: Less coughing, wheezing, and shortness of breath.
Less need for oral steroids: This is a big one, as it helps avoid the side effects of long-term steroid use.
Better overall quality of life.
How are they given?
Biologics are usually given as an injection under the skin (subcutaneous) or sometimes directly into a vein (intravenous).
You might get these injections every few weeks or months, either at your doctor's office, a clinic, or sometimes you (or a caregiver) can be trained to give them at home.
In a Nutshell for Patients:
If you have severe asthma that's really tough to manage with your usual inhalers and you're still having a lot of problems or relying on steroid pills, biologics are a newer class of advanced medications. They are very targeted treatments that aim to interrupt the specific inflammatory process driving your severe asthma. By calming down that specific inflammation, they can help reduce your asthma attacks, improve your breathing, and lessen your need for strong steroid pills.
It's a specialized treatment, so your doctor (usually a lung specialist or an allergist/immunologist) would need to do a thorough evaluation to see if your type of severe asthma might benefit from a biologic and, if so, which one would be the best fit for you.
Biologics currently approved for the treatment of asthma:
Omalizumab (Xolair): Targets IgE antibodies, which play a role in allergic asthma.
Mepolizumab (Nucala): Targets interleukin-5 (IL-5), a cytokine that stimulates eosinophils, which are white blood cells involved in asthma inflammation.
Reslizumab (Cinqair): Similar to mepolizumab, targets IL-5 and reduces eosinophil levels.
Benralizumab (Fasenra): Targets the IL-5 receptor on eosinophils, preventing them from activating and contributing to inflammation.
Dupilumab (Dupixent): Targets interleukin-4 (IL-4) and interleukin-13 (IL-13), cytokines that drive type 2 inflammation, which is a common feature of asthma.
Tezepelumab (Tezspire): Targets thymic stromal lymphopoietin (TSLP), a cytokine that plays a role in the development and maintenance of asthma inflammation.
COPD
Okay, let's break down the latest thinking on using special medicines called "biologics" for COPD, in simple terms.
Think of your usual COPD medications, like inhalers, as general tools to help manage your breathing. Biologics are more like specialized tools. They are a newer type of medication made from living sources (like proteins) that target very specific parts of the immune system that cause inflammation and make COPD worse for some people.
Here's the main idea from the latest guidelines, especially from the important Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025 report:
A New Option for a Specific Group: For a long time, biologics were mostly used for severe asthma. But now, there's a biologic called dupilumab (brand name Dupixent) that is recommended as an add-on treatment for a specific group of people with COPD. This is big news because it's the first biologic to get this kind of recommendation for COPD.
Who Might Benefit from Dupilumab? This isn't for everyone with COPD. Doctors might consider it if you:
Still have frequent flare-ups (exacerbations) even though you're already using the standard "triple therapy" inhalers (which usually combine three different long-acting medicines).
Have signs of a specific type of inflammation in your body, indicated by a high count of a certain type of white blood cell called eosinophils (doctors will check this with a blood test; the guidelines often mention a count of 300 cells per microliter or higher).
Often also have symptoms of chronic bronchitis (like a long-term cough that produces mucus).
What's the Goal? For these specific patients, adding dupilumab aims to:
Reduce the number of flare-ups.
It may also help improve lung function and quality of life.
How Does It Work (Simply)? Dupilumab works by blocking two specific proteins (IL-4 and IL-13) that are key drivers of "Type 2 inflammation," which is thought to play a role in COPD for patients with those higher eosinophil counts. By calming this specific type of inflammation, it can help reduce flare-ups.
Important Considerations:
It's an "add-on": Dupilumab doesn't replace your regular COPD inhalers; it's used in addition to them.
Not a cure: It helps manage the condition better for the right patients.
Given by injection: Unlike inhalers, biologics like dupilumab are typically given as an injection under the skin, usually every two weeks.
Other biologics: Scientists have studied other biologics for COPD, and some have shown promise in certain subgroups, but dupilumab is the one with the clearest recommendation in the latest major guidelines for this specific type of COPD patient. Research is ongoing for other biologics as well.
In a Nutshell for Patients:
If your COPD is still causing you a lot of trouble with flare-ups despite using your maximum inhaler therapy, and if your doctor finds you have a certain type of inflammation (high eosinophils in your blood) and possibly chronic bronchitis symptoms, there's a newer type of add-on medication called dupilumab. It's a biologic given by injection that could help reduce your flare-ups and potentially improve your breathing and quality of life.
This is a specialized treatment, so it's something you would need to discuss in detail with your lung doctor (pulmonologist) to see if it's a suitable option for your specific situation. They will consider all your health factors and the latest detailed guidelines.
