Biologic Therapy in the Management of Asthma

Jennifer L. McCracken; Julia W. Tripple; William J. Calhoun


Curr Opin Allergy Clin Immunol. 2016;16(4):375-382. 

In This Article

Abstract and Introduction


Purpose of review Current asthma management relies on inhaled corticosteroids, but some asthma is not well controlled with inhaled steroids alone or in combination with long-acting bronchodilators or leukotriene pathway inhibitors. The field of biologic therapy has grown dramatically in the past two decades, with current availability of three molecules, with two distinct and highly selective approaches to interfering with the allergic and eosinophilic airway inflammation common to most asthma. This review summarizes current and future options for incorporating biologic therapy into the overall management of asthma.

Recent findings Two new biologic agents have been recently introduced in the United States market, supported by well controlled, randomized clinical trials. These trials have provided insight into the types of patients who are most likely to benefit from these novel agents.

Summary In asthma patients with frequent exacerbations, the addition of a biologic agent targeting the interleukin-5 pathway, or immunoglobulin E, can significantly reduce exacerbations and improve asthma control. The clinical predictors of utility of specific agents overlap with one another, highlighting the importance of clinical judgment in the overall management of this complex disorder.


Asthma is a heterogeneous, chronic disease of the airways characterized by reversible airflow obstruction, bronchial hyperresponsiveness, airway inflammation, and recurrent symptoms.[1] It is estimated that 300 million people worldwide have asthma, and the prevalence of disease has been increasing over the last 40 years.[2] The mainstay of asthma therapy is based on severity of disease and control of symptoms and relies on inhaled glucocorticoids (ICS) for patients with persistent disease or worse.[1] For the majority of patients, current treatment options offer good control of their disease, however 10–20% of patients do not achieve control with current gold standards of care.[3,4] This remaining population of severe refractory asthmatic patients is at increased risk of morbidity and mortality related to their disease and make up the majority of economic costs of asthma.[5–7]

Over the last decade, a shift towards evaluating specific phenotypes and endotypes of asthma has led to the creation of targeted therapies to fit patient specific disease.[4,8–11] Through a better understanding of the inflammatory modulators involved in asthma, a number of monoclonal antibodies have emerged with the aim of providing patient tailored asthma treatment.