Severe Asthma


Severe Asthma Treatment

Many patients with severe, persistent asthma remain symptomatic or refractory to treatment despite optimal therapy. These patients experience frequent, severe exacerbations, hospitalizations and/or poor lung function, and the care for their severe asthma requires significant healthcare utilization and expense.

Asthma management include the use of biologics when asthma control is difficult despite optimal management with high-dose inhaled corticosteroid/long-acting beta agonist and additional controller therapy. As with any difficult-to-control asthma, it is important to first confirm the severity, control exacerbating conditions and ensure proper medication use.

Patients that are referred to our Allergy and Asthma Clinic may qualify for administration of a biologic agent. Currently three biologic agents are available in our clinic for our use: omalizumab (Xolair), mepolizumab (Nucala) and Reslizumab (Cinqair).



Omalizumab is a antibody that binds to the high affinity IgE receptor on mast cells and basophils in the body. It is indicated in adults, adolescents and children with severe allergic asthma. Clinical studies have demonstrated that omalizumab reduced exacerbations, asthma symptoms, inhaled corticosteroid and rescue medication use, and improved quality of life. Since Omalizumab has a risk of anaphylaxis, patients must receive the medication where personnel and equipment/supplies to treat anaphylaxis are present.


Mepolizumab and reslizumab

Mepolizumab and reslizumab are monoclonal antibodies that inhibiting eosinophil cell function. Monthly, subcutaneous (SQ) injections of mepolizumab in patients with peripheral eosinophilia have shown to reduce the rate of asthma exacerbation by approximately 50 percent, reduce the risk of healthcare utilization by around 60 percent and improve asthma control. Reslizumab has a similar effectiveness as mepolizumab but differs in its route of administration (monthly intravenous infusions) and weight-based dosing.

The above biologics have altered the landscape of care. The majority of patients who fulfill criteria for treatment of mepolizumab and/or reslizumab also fulfill criteria for omalizumab, as they are all indicated in patients with severe asthma and those with allergies often have high peripheral blood eosinophil counts.