Biologics for Severe Asthma: A Practical Overview

For patients with severe asthma that remains uncontrolled despite high-dose inhaled corticosteroids plus a second controller, biologics targeting specific inflammatory pathways have changed management.

Type 2 (T2) inflammation

Most severe asthma is driven by type 2 inflammation, characterized by elevated blood eosinophils, high fractional exhaled nitric oxide (FeNO), and often elevated total IgE. These biomarkers help select therapy.

The biologics

• Anti-IgE — omalizumab: allergic asthma with elevated IgE.
• Anti-IL-5 / anti-IL-5 receptor — mepolizumab, reslizumab, benralizumab: eosinophilic asthma (deplete eosinophils).
• Anti-IL-4Rα — dupilumab: blocks both IL-4 and IL-13 signaling; broad T2 effect, also for atopic dermatitis and chronic rhinosinusitis with nasal polyps.
• Anti-TSLP — tezepelumab: acts upstream and shows efficacy across both T2-high and T2-low asthma.

Choosing therapy

Selection depends on the patient’s phenotype and biomarkers (eosinophil count, FeNO, IgE) as well as comorbid disease such as nasal polyposis. Response should be assessed after a trial period, and therapy adjusted accordingly.

This content is for education and does not replace medical advice.