The term 'biologic medication' refers to an antibody (protein) with a specific function, just like all other antibodies made by our immune systems. When designing a biologic medication for asthma, researchers seek to figure out a particular factor in causing the breathing problems suffered by people with asthma, and then build an antibody to block it.
The really important thing about these biologic medications is that they do only that one thing they're designed to do. By carefully choosing that 'one thing,' we can drastically reduce side effects. In contrast, steroids like prednisone are known to interfere with over 800 different processes in the body. This is why they both work very well and cause many side effects when used for long periods of time.
Up until now, we had five biologics for asthma. The first, Xolair, blocks allergic antibodies, or IgE. It is effective and approved for allergic asthma, chronic hives, and nasal polyps. Eosinophils are a type of white blood cell involved in asthmatic inflammation, among other things. We have three biologics that block eosinophils' growth factor: Nucala, Fasenra, and Cinqair. Reducing eosinophils is helpful in asthma, nasal polyps, and two less common but severe diseases known as EGPA and HES. A third strategy is to block the receptor used by two important inflammatory chemicals involved in asthmatic inflammation, known as IL-4 and IL-13. The biologic that does this, Dupixent, is helpful in asthma, nasal polyps, and atopic dermatitis.
Our newest biologic against asthma, Tezspire, was approved by the FDA in December 2021. It works completely differently than the other five; its 'one thing' is to block thymic stromal lymphopoietin (to which we can thankfully refer as TSLP!). The really exciting thing about Tezspire is that while the other five work best for asthma in allergic people, TSLP is involved in asthmatic inflammation in both allergic and nonallergic people. So we now have a biologic medication for people with severe asthma primarily worsened by nonallergic triggers such as smoke, fumes, pollution, and viral infections.
People for whom biologic asthma medications are appropriate include those who are taking their asthma controller medications such as steroid-containing inhalers, oral steroids like prednisone, or others on a consistent, daily basis yet are still frustrated by poor control of their asthma. Poor control means one or more significant asthma attacks per year that result in an emergency department visit, hospitalization, or treatment with increased steroid like prednisone for a week or more. If you or someone you know fit this description, please reach out for help! All new patients are seen by one of our allergists in a virtual visit from the comfort of your home, office, or other quiet, private location; no need to take a half-day off of work to come to the doctor's office. During this visit, the allergist will review your history, asthma control, current medication use, and all other necessary information to determine if and what testing is needed, which will then be scheduled in-person in our offices. Starting with that, we'll help get you on a path to better asthma control!