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Why have I been given this information?
This leaflet will help you to better understand the role of the biologics and how they can improve your quality of life if you suffer from severe asthma. Please remember that you can always ask more questions if you have any to your nurse or doctor.
What are biologic treatments for severe asthma?
Biologic treatments for asthma are also called monoclonal antibodies.
They are lab-created and aim to stop eosinophils from causing inflammation of the airways, excess mucus production and asthma attacks.
What is an eosinophil?
Eosinophils are a type of white blood cell associated with inflammation.
People with severe asthma may have high eosinophil levels in their blood, which doctors and nurses can check in your blood test results.
The level of eosinophils is key information for your doctors to determine the type of asthma you have and to decide on the most effective treatments for you.
Am I eligible for biologic treatments for asthma?
Biologic treatments are available only for specific types of severe asthma that do not respond well to high doses of steroid inhalers.
We need to initially understand what type of asthma you have. There are two types of asthma which can be treated by biologics treatments. They are:
- eosinophilic asthma.
- allergic asthma.
How do I know what type of asthma I have?
If you have eosinophilic asthma you will have raised eosinophils in your blood. This type of asthma is generally linked to asthma that begins in adulthood.
If you have allergic asthma, it means that your symptoms are triggered by allergies. This type of asthma typically begins in childhood. To understand if you have allergic asthma, you can have two tests:
- a skin prick test for specific airborne allergens
- a blood test that, if positive, will show high levels of Immunoglobulin E (IgE). IgE are cells that help the immune system respond to allergens causing the reactions.
What are the available biologic treatment options for asthma and how are they administered?
After establishing what type of asthma you have, your doctors and nurses at University Hospitals Sussex hospital and the Royal Brompton Hospital (RBH) in London (a severe asthma specialist centre) will advise you on the best biologic treatment for you.
There are different biologic treatments available, depending on the symptoms that need to be treated.
Biologic treatments are available either as an injection or as an intravenous (IV) infusion, which are given through a needle into your arm.
What should I expect during my first appointment for biologic treatments?
You will need to come to the hospital for at least the first three doses of your biologic treatments and expect to stay for two hours each appointment.
When you arrive at the hospital you will meet the nursing staff in our day unit, and we will:
- ask about your asthma history. We will ask you different questions to make sure that all the information we have is accurate
- check your observations (blood pressure, oxygen levels, temperature and respirations rate)
- ask you to complete a questionnaire called asthma control test (ACT) and other questionnaires
- do a spirometry test, used to assess how well your lungs are working
- do blood tests
- ask you to sign a consent form for your information to be put onto the severe asthma registry
- give you your first dose of the biologic and monitored for an hour after administration.
We have a water fountain here but please do bring any hot drinks and entertainment with you.
Be aware
that biologic treatments must be given at specific times (every 2, 4 or 8 weeks) so it is very important you can attend all appointments, so your treatment is not interrupted or delayed. We will organise a date suitable for you well in advance.
What happens after my first doses of a biologic treatments on the day unit?
When you are comfortable, after receiving your first three doses in the day unit and being supervised by members of the asthma team, you can self-administer the injections at home.
Please do not worry if you do not feel comfortable to do so, come to the hospital for injections for as long as you need or continue coming here if you prefer.
If you are moving to homecare, the company will arrange with you to set up a delivery date and time once a month for you to receive your injection.
Be aware
regular reviews are required to make sure we can safely issue your biologic prescription to your homecare provider, and failure to attend appointments may result in your treatment being discontinued.
Frequently asked questions
Do I still need to take my regular medication?
Yes. Biologic therapy is an add on therapy. This means it is to be used alongside your inhalers and other asthma medications.
What about if I am on prednisolone?
If you take daily prednisolone, it is important to continue this until we have planned any changes. Please do not stop taking daily steroids without discussing with the asthma team.
This is because prednisolone replaces a natural hormone called cortisol in your body.
Sometimes your body stops producing cortisol by itself, if it is used to a daily intake of artificial cortisol (prednisolone tablets).
Suddenly stopping taking steroids can be very dangerous and send your body into a crisis. If the plan is to reduce your steroids, we will measure your cortisol regularly through a blood test and check that your body is responding well.
If you take prednisolone as a course (typically 30 to 40mg for 5 to 7 days) during an severe asthma attack, this will still be the case when having biologics.
We will aim to reduce the number of courses of steroids that you need. At every appointment then we will ask you how you feel and see if the biologic treatments are working well.
Will I always need biologic treatment?
Yes, if it works. You will try your chosen biologic treatment for at least 6 months and we will monitor your response to it.
If it is not working for you, we can switch to another type of biologic treatment or stop it, but you must not stop taking it before speaking to your asthma team.
What are the side effects?
Common side effects for all biologics are:
- redness or pain at the injection site
- light headache
- signs of worsening asthma (shortness of breath, cough, wheeze)
- muscle ache or joint ache
Please see the specific biologic booklet for side effects that we will give to you.
What can I do if I feel unwell?
If you are feeling unwell with your asthma you should following your asthma action plan and adjust your inhalers and start steroids if needed.
Being on a course of steroids will not necessarily stop you having your biologic treatments but please let us know before your appointment so we can rebook if necessary. We still recommend contacting your GP or phoning 111 or 999 if necessary.
What should I do if I am looking to become pregnant?
Please let us know if you are pregnant or looking to become pregnant. There is currently not much research available around biologic treatments and pregnancy so this is something which will need to be discussed between you and the asthma team.
Can I travel while having biologic treatment?
Yes. Please let us know so we can schedule your initial clinic appointments. If you are self-administering at home, make sure to plan your travel around your treatment schedule.
Useful contacts
If you need to cancel or change your booking or have any questions, please contact us:
Email: [email protected]
Phone number: 07385 947878
or the PALS service, if you would like further advice, support or to make a complaint:
Email: [email protected]
Phone number: 01273 664511
This information is intended for patients receiving care in Brighton & Hove or Haywards Heath.
The information here is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.