Biologic therapies for severe asthma and chronic obstructive pulmonary disease (COPD)

Biologics are a type of treatment that target your immune system and reduce inflammation in your airways. They can help to control severe asthma or reduce chronic obstructive pulmonary disease (COPD) flare-ups (exacerbations).

Inflammation in your lungs can cause asthma symptoms and attacks or COPD flare-ups (exacerbations). Biologics work by blocking the changes that cause inflammation in your lungs. Inflammation in your lungs can be caused by allergies or eosinophils.  

Antibodies (proteins in our blood) detect things that should not be in our bodies so our immune system can attack them. This can include allergies and eosinophils.

Biologics contain something called monoclonal antibodies or mAbs. These are like the antibodies that exist naturally in our body, but they’re made in a lab.    

What’s an eosinophil?

Eosinophils are a type of white blood cell that help your immune system work properly.  But if you have severe asthma or COPD, you might have too many eosinophils in your blood. This can make inflammation in your airways worse.    

Biologics are a specialist, targeted treatment. 

There’s strict criteria for who can access them as they’re only right for some people with severe asthma and COPD. 

In general, biologics might help if:   

• you’re having a lot of asthma attacks or COPD flare-ups
• you’re taking a lot of oral steroids to treat your asthma or COPD
• other asthma or COPD treatments are not helping you manage your condition
• a lung specialist thinks that biologics could help your type of asthma or COPD. 

If you have asthma

You’ll need to be referred to severe asthma specialists to work out if biologics are right for you. We have more advice about how to get a referral to specialist care. 

To work out if biologics are right for you, your specialists might:  

• do a blood test to work out the number of eosinophils in your blood
• do a FeNo (fractional exhaled nitric oxide) test to see how inflamed your airways are
• check that you’re managing any other health conditions you have
• make sure you’re using your existing asthma medicines and treatments properly, for example they might check you’re using the right inhaler technique or that you have help to stop smoking if you need it.  

Which asthma biologic could I get?

There are six different biologic medicines for severe asthma: 

• mepolizumab (brand name Nucala)  
• reslizumab (brand name Cinqaero)  
• benralizumab (brand name Fasenra)  
• omalizumab (brand names Xolair and Omlyclo)  
• dupilumab (brand name Dupixent)   
• tezepelumab (brand name Tezspire).

If you’re eligible for biologics, your specialists will help you decide which one is right for your asthma.  

What happens if I’m not eligible for asthma biologics?  

If asthma biologics are not right for you, you and your specialist can talk to you about other treatments that could work for you.  For example, bronchial thermoplasty or other specialist treatments.

If you have COPD

If you have COPD, your healthcare professional should refer you to a specialist if you’re still having flare-ups (exacerbations) or are very breathless even though you’re managing your COPD well. 

If you have COPD, the best ways to treat and manage it are:   

• getting any vaccines you can, like flu
• getting help to stop smoking if you need it
• going to pulmonary rehabilitation and doing regular activity
• using any treatments and medicines you’re prescribed properly, for example using your inhalers as prescribed with the correct inhaler technique
• having a COPD self-management plan
• managing any other health conditions you have. 

What happens in specialist care?

Your specialist will work out if biologics or other specialist treatments might be right for you.  

To work out if biologics are right for you, your specialist will do tests to work out the number of eosinophils in your blood. For example, a blood test. 

They will also check if you’re already using the best treatments for your COPD.   

Which COPD biologic could I get?

There is one biologic treatment for COPD called dupilumab. The brand name for dupilumab is Dupixent.

To get dupilumab, you must:   

• have uncontrolled COPD. This means that in the last year you’ve had two or more flare-ups that were treated with steroids or antibiotics OR one or more flare-up that was treated in hospital
• have high amounts of eosinophils in your blood
• be using a steroid inhaler, long acting bronchodilator inhaler and long-acting muscarinic inhaler to treat your COPD OR be using a long acting bronchodilator and long-acting muscarinic inhaler to treat your COPD if steroid inhalers are not right for you. 

If dupilumab is right for you, your specialists will prescribe it.

What happens if I’m not eligible for COPD biologics?  

If COPD biologics are not right for you, you and your specialist can talk to you about other treatments that could work for you. For example, antibiotics or lung volume reduction. 

How you take biologics and how often you take biologics depend on the specific medicine you’re prescribed: 

Taking biologics for asthma

You’ll need to visit a specialist severe asthma centre to start your treatment.  

Your nearest specialist clinic may not be in your local area, so it’s a good idea to think about travel time and costs before:

• the NHS has advice about getting help with travel costs
• we have advice about asking for time off work for medical appointments.

Injections at home

If it’s safe and right for you, your specialist will teach you or your carer how to inject biologics by yourself at home. They come in prefilled syringes or pens that need to be stored in your fridge.

The NHS has more advice about injecting asthma biologics at home, including how to get, store and dispose of biologics. 

Taking biologics for COPD

How you take biologics might be different depending on where you live. Usually, a nurse will come to your house and give you your first two injections.

If it’s safe and right for you, you’ll be able to carry on injecting biologics by yourself at home. Your nurse will teach you or your carer how to use biologics at home. They come in prefilled syringes or pens that need to be stored in your fridge.

Reviewing asthma biologics

Your specialists will review your treatment regularly after you start biologics to make sure it’s working.  

If you’ve been using steroid tablets long-term to manage your asthma, you should see your specialists every four to eight weeks. If it’s right for you, they might suggest that you gradually stop taking steroid tablets. They will support you to do this safely.

If you have not been using steroid tablets long-term to manage your asthma, you should see your specialists every three to six months.

We have more advice about preparing for specialist appointments.

Your six month review

After six months, you and your specialists will talk about your treatment and assess how well your biologics are working.  

Your review might include answering a set of questions about your asthma symptoms to see if they’re are improving, this is called the Asthma Control Test. Your specialists might also do tests to see how well your biologics are working, for example spirometry and blood tests.  

If biologics are working for you and your asthma symptoms are improving you can keep using biologics long-term.  

If biologics are not working for you, you might need to stop or change your treatment. You and your specialists can talk about other treatments that could work for you, for example if you can try a different biologic.

Reviewing COPD biologics

You can ask your specialist for a review at any time if you want to talk about your treatment. Your specialist should book a review after six months to see how biologics are working for you.

After a year, you and your specialist will assess how well your biologics are working.

Your specialist will look at the number of flare-ups (exacerbations) you’ve had while using biologics to work out if they’re right for you:

• if biologics have reduced how many flare-ups you’re having, then you can keep using them long-term
• if biologics have not reduced the amount of flare-ups you’re having, then you will stop using them. You and your specialist can talk about other treatments that could work for you, for example antibiotics or lung volume reduction.

How can biologics help severe asthma?

Biologic treatments can:  

• make your severe asthma symptoms easier to manage
• lower the amount of steroid tablets you need to use, which also reduces your risk of side effects from steroid tablets
• reduce asthma attacks.

How can biologics help COPD?

Biologics treatments can reduce the number of flare-ups (exacerbations) that you have, which can help to keep you out of hospital and improve your quality of life.

Like all medicines, biologics can have risks and side effects, but this does not mean that you’ll get them.  

Different biologics have slightly different side effects. Your specialist can explain all of the benefits and side effects of your specific treatment before prescribing you biologics. 

The patient information leaflet for the biologics that you’re being treated with also lists all the possible risks and side effects. Read your leaflet carefully and speak to your specialist if you have any questions. If you do not have the patient information leaflet, you can find a copy on the electronic medicines compendium website.  

If you get any side effects from your biologics, tell your specialist. You can also report it to the Yellow Card Scheme. 

Severe allergic reactions

Biologics can cause severe allergic reactions (anaphylaxis) in some people. This usually happens within two hours of taking biologics.  

The risk depends on the type of biologics you’re using, but in most biologics it’s uncommon. It’s more likely if you have a history of severe allergic reactions. 

You should be able to keep using biologics for severe asthma and COPD while you’re pregnant, breastfeeding, or if you’re thinking of getting pregnant, but always speak to your specialist.

They can let you know if it’s safe for you to keep using your biologics and explain the benefits and risks so you can decide on the best treatment plan for you.   

We have more advice about asthma and pregnancy.