Managing Severe & Complex Asthma with Biologics

Asthma is a relatively common condition, but various treatments exist to help patients manage symptoms. Asthma is highly individualized, with the severity and complexity of cases ranging dramatically among patients. For some, asthma symptoms may mostly go unnoticed. For others, airway inflammation can prove severe enough to be life threatening. Managing complex or severe asthma with biologics is a modern approach that can lead to life-changing improvements in condition severity.

Advanced biologics for asthma are among the most significant breakthroughs in asthma management, and we offer this treatment at Dr. Shukla’s practice in NYC. If your asthma condition gets to the point where your inhaler and current medications do not help at all, you may be a front-row candidate for biologic therapy.

What Constitutes Severe or Complex Asthma?

Severe Asthma

Severe asthma is a unique medical category defined by organizations like the Global Initiative for Asthma (GINA) and the American Thoracic Society (ATS). It generally has one or more of the following attributes:

Requires High-intensity Treatment: Patient symptoms are uncontrolled or unresponsive to treatments like inhaled corticosteroids (ICS) plus a second controller (e.g., long-acting beta agonist).
Symptoms Become Uncontrolled with Reduced Treatment: If scaling back medications immediately worsens asthma, it qualifies as severe.
Persistent Symptoms and Exacerbations: Asthma symptoms flare in the presence of triggers. But when controlled, these exacerbations should be infrequent. Persistent airway symptoms or frequent exacerbations can constitute severe asthma.
Impact on Daily Life: Severe asthma often involves symptoms that restrict activities and limit quality of life.

Complex Asthma

Complex asthma is less rigidly defined. We use the term to describe asthma with multiple factors that complicate control. These can include:

Overlapping Conditions: Common examples include allergies, sinus disease, obesity, sleep apnea, or mental health conditions.
Mixed Phenotypes: Occurs when patients show features of both allergic (eosinophilic) and nonallergic asthma.
Medication Difficulties: Contraindications to common medications, medication side effects, or medication nonadherence.

What Are Asthma Biologics?

Asthma biologics are laboratory-made monoclonal antibodies that target specific immune pathways. Biologics work by targeting specific cells or molecules to disrupt airway inflammation. Asthma symptoms present when the airways are exposed to certain molecules, and the body then mounts an inflammatory response. The result is airway constriction or swelling. Biologics act as a stoppage point in this process. Biologics attach to the inflammatory molecules and prevent them from setting off the usual reaction.

What Makes Biologics So Effective?

Different sets of molecules can cause different types of immune reactions. The efficacy of biologics lies in how the treatment can be adapted to your specific symptoms and situation. For example, say your symptoms occur when exposed to a specific type of molecule. Your provider will prescribe a biologic specifically designed to block that molecule from triggering a reaction. This approach of personalized medicine provides stronger outcomes while reducing the risk of side effects.

A Steroid-Sparing Treatment

Corticosteroids often play a central role in managing asthma symptoms. However, these medications are not ideal for long-term use. Research shows that prolonged or excessive steroid therapy increases patient risk for osteoporosis, diabetes, certain infections, and other health risks.

Biologics offer a steroid-sparing effect by specifically targeting the inflammatory pathways that drive autoimmune and inflammatory diseases. In many cases, successful treatment means a notable reduction or even full discontinuation of long-term corticosteroid use.

What Biologics Are Available?

As of 2025, the FDA has approved the use of six different biologics for asthma. At the office of Dr. Mayank Shukla, we offer the following medications to those in need of this kind of treatment:

Mepolizumab (Nucala): Targets interleukin-5 (IL-5), for patients ≥ 6 years old.
Benralizumab (Fasenra): Targets IL-5 receptor alpha, for patients ≥ 6 years old.
Omalizumab (Xolair): Targets IgE antibodies, for patients ≥ 6 years old.
Dupilumab (Dupixent): Targets IL-4 receptor alpha, for patients ≥ 6 years old.
Reslizumab (Cinqair): Targets IL-5, for patients ≥ 18 years old.
Tezepelumab (Tezspire): Targets thymic stromal lymphopoietin (TSLP), for patients ≥ 12 years old.

Both adults and children can be recipients of biologic therapy treatment. Currently, biologics are only available for patients starting at 6 years of age, though some are only approved for patients ≥ 12 years or ≥ 18 years. During the initial appointment, Dr. Shukla will perform a series of screening tests to ensure that the right type of biologic medicine is being prescribed.

Biologic Management for Comorbid Conditions

Biologics can play a core role in treating complex morbidity alongside asthma. When managing any single condition, physicians should take the patient’s entire medical picture into account. Treating asthma without addressing comorbidities is bound to deliver less benefits both short and long term.

Some of the comorbid conditions we treat involve using biologics such as: