Triknews.co-In 2003, the U.S. Food and Drug Administration (FDA) approved the first *biologic for the treatment of severe asthma* . That drug, *omalizumab* , is a monoclonal antibody therapy that works primarily by *reducing blood levels of IgE* , an immune system antibody that contributes to airway inflammation among people with severe asthma.

Although omalizumab was revolutionary, experts say the past few years have witnessed the arrival of *newer and better biologics that have all but eradicated the burden of severe asthma* for most patients. “These have been totally transformational,” says David Jackson, a respiratory medicine specialist at King’s College London. “Since 2017, a *new biologic has been added to our armory on almost an annual basis* , and the number of patients with uncontrolled asthma has gotten smaller and smaller.”

Whereas the first biologics blocked IgE, the latest drugs in this category target—with greater and greater precision—the specific immune pathways and cells that drive asthma-related inflammation and symptoms. “ *Cells called eosinophils are a hallmark of severe asthma, and these newer biologic therapies can dampen down their production and related pathways in a much more targeted way* ,” Jackson says. He uses a military analogy to highlight the effectiveness of the newest biologics. “These are like precision-guided laser bombs, as opposed to the old B52s dropping bombs from 50,000 ft. and just hoping for best.”

Some of the newest biologics take aim at two specific immune system proteins: *thymic stromal lymphopoietin (TSLP) and interleukin 33* . *These two activate cells in the airways, which leads to a release of all these [inflammation] players* ,” Brightling explains. Because *these two are farther “upstream* ” than some of the pathways targeted by older biologics, *mellowing their activity may produce broader benefits* , he says.

Biologics do come with downsides. For one thing, they’re expensive. They often *cost around $30,000 a year in the U.S* ., Jackson says. They are not always covered by insurance. Also, in the past their administration required regular office or clinic visits. *Biologics are traditionally delivered via injection anywhere from once every two months to once every two weeks.* However, the coronavirus pandemic has helped shift the use of these drugs away from the clinic and into the home. “There’s been a big push to self-administration,” Jackson says. “What we normally do now is to start in the clinic—so give the first one to three administrations here—then go to home administration when it’s clear the patient is doing well.”

Despite any lingering financial and logistical hurdles, the benefits provided by biologics are often profound. *The latest and greatest biologics work so well that many patients are effectively relieved of the burden of severe asthma attacks or symptoms* —something that would have seemed unbelievable just a decade ago.

Unfortunately, not everyone who would benefit from these drugs is getting them. “Awareness of this medicine is not what it should be,” Jackson says. “ *A lot of patients continue to have asthma attacks and their doctor hasn’t picked up on the fact that there are newer therapies* .” If every clinician who treats severe asthma was up to speed on these drugs—and if everyone who truly needs them had access to these medicines—it’s possible that *virtually every person with severe asthma could avoid the worst symptoms* , he says.

*However* ….

“I think one of the biggest challenges, especially with severe asthma, is that patients feel fine a lot of the time, and it’s difficult to remember to take a medication every single day if you’re feeling good,” says Dr. Ruchi Gupta, a professor of pediatrics, preventive medicine, and medicine (allergy and immunology) at Northwestern University’s Feinberg School of Medicine and Lurie Children’s Hospital. Other experts say that *pricey biologics might be needed far less if more patients with severe asthma reliably took their inhaled corticosteroids* .

https://time.com/6189983/managing-severe-asthma-advances/