Biologic therapies are a newer type of treatment that work by targeting specific parts of your immune system to reduce inflammation in your airways, offering hope for people with severe asthma or chronic obstructive pulmonary disease (COPD) who haven't responded to traditional medications. These lab-made antibodies, called monoclonal antibodies or mAbs, mimic the natural antibodies your body produces to fight harmful invaders, but they're designed to block the specific immune signals that cause airway inflammation .

How Do Biologic Therapies Actually Work?

Your immune system normally uses antibodies to detect things that shouldn't be in your body, triggering an immune response to attack them. In severe asthma and COPD, this system sometimes goes into overdrive. One key culprit is eosinophils, a type of white blood cell that helps your immune system function normally, but in excess can make airway inflammation worse .

Biologic therapies work by blocking the changes that cause this excessive inflammation. Some biologics target eosinophils directly, while others block the immune signals that trigger inflammation in your lungs. By reducing these inflammatory responses, biologics can help control asthma attacks and reduce COPD flare-ups, also called exacerbations .

Which Biologic Medications Are Available?

There are currently six different biologic medicines approved for severe asthma, each working slightly differently to reduce inflammation :

• Mepolizumab (Nucala): Given as an injection every four weeks to reduce eosinophils in the blood
• Reslizumab (Cinqaero): Administered through a drip every four weeks for patients with high eosinophil levels
• Benralizumab (Fasenra): Injected every four weeks for the first three treatments, then every eight weeks to target eosinophils
• Omalizumab (Xolair and Omlyclo): Injected every two to four weeks, particularly helpful for allergy-driven asthma
• Dupilumab (Dupixent): Injected every two weeks to reduce multiple inflammatory pathways
• Tezepelumab (Tezspire): Injected every four weeks, a newer option that works on a different immune mechanism

For COPD, there is currently one biologic treatment available: dupilumab (Dupixent) . Your specialist will help determine which biologic is right for your specific type of asthma or COPD based on your test results and medical history.

Who Is Eligible for Biologic Therapy?

Biologics aren't for everyone with asthma or COPD. There are strict criteria because these medications are typically reserved for people with more severe disease that hasn't responded to standard treatments. Your doctor will refer you to a specialist if you meet certain conditions .

For asthma, you may be eligible if you're having frequent attacks, taking high doses of oral steroids, or if other asthma treatments aren't helping you manage your condition. For COPD, eligibility requires uncontrolled disease with two or more flare-ups treated with steroids or antibiotics in the past year, or one flare-up requiring hospitalization, combined with high eosinophil levels in your blood .

How to Prepare for Biologic Therapy

Before starting biologic treatment, your specialist will conduct several tests and assessments to ensure it's the right choice for you :

• Blood Test: Measures the number of eosinophils in your blood to determine if you have the type of inflammation that biologics target
• FeNo Test: Measures fractional exhaled nitric oxide to assess how inflamed your airways are and confirm the type of inflammation
• Medication Review: Ensures you're using your existing asthma or COPD medicines correctly, including proper inhaler technique
• Health Assessment: Checks that any other health conditions you have are being managed properly before starting a new treatment

Your specialist will also make sure you're not missing any simpler solutions first. For example, they might help you quit smoking if needed or ensure you're using your inhalers correctly, since improper technique can make symptoms worse.

What to Expect Once You Start Treatment

Biologic therapies are add-on treatments, meaning you continue taking your regular asthma or COPD medications while also using the biologic. Never stop or reduce your usual medicines without talking to your specialist team first .

Most biologics come in prefilled syringes or pens that you store in your refrigerator. For your first two injections, a nurse will typically come to your home. If it's safe and appropriate for you, your nurse will teach you or a caregiver how to inject the medication yourself at home .

After starting treatment, your specialist will review how well the biologic is working. If you've been taking steroid tablets long-term, you'll see your specialist every four to eight weeks, and they may gradually help you reduce your steroid dose. If you haven't been on long-term steroids, you'll have appointments every three to six months. After six months, you and your specialist will have a full discussion about whether the treatment is working well enough to continue .

What If Biologics Aren't Right for You?

If biologic therapy doesn't meet your needs or you're not eligible, your specialist can discuss other treatment options. For asthma, alternatives may include bronchial thermoplasty or other specialist treatments. For COPD, options might include antibiotics for frequent infections or lung volume reduction surgery in select cases .

The key is working closely with your specialist team to find the treatment approach that best controls your symptoms and improves your quality of life. Biologic therapies represent an important advance for people with severe asthma and COPD, offering a new way to target the immune system's role in airway inflammation when standard treatments fall short.