Asthma Care and Biologic Therapies

Asthma is not one condition

Asthma makes it hard for air to move in and out of the lungs and can begin at any age. While there is no cure yet, the goal of asthma therapy is to control the disease and prevent it and its emergencies from progressing.

What matters clinically is which asthma you have, because the treatment is not the same for each. We identify and treat the primary cause of airway inflammation, as well as the symptoms, for all types.

• Allergic asthma
• Cough variant asthma
• Eosinophilic asthma
• Exercise-induced asthma
• Occupational asthma

When the cough is the asthma

Cough variant asthma is asthma whose main symptom is a cough rather than a wheeze. It is one reason a long-running cough ends up in an allergist’s office rather than being treated as an infection that will not clear.

A chronic cough is a serious medical condition with disruptive consequences — throat tickle, throat clearing, hoarseness, urinary incontinence, anxiety and depression — and Sher Allergy sees those patients in its Center for Cough clinic.

Measuring the airway rather than guessing at it

Two tests do most of the work, and both can be done in the office.

Spirometry, or pulmonary function testing, evaluates how well your lungs work: how much air they hold, how quickly you can move air in and out, and how well they add oxygen to the bloodstream. It adds valuable information for diagnosing asthma and other lung problems, can be used after a medication to assess its effect, and can measure progress during treatment. Your results are compared against values predicted as normal for a person of your age, size and sex. A pulmonary function test may be performed during your visit.

Nitric oxide testing, or FeNO, is a simple breath test that determines the amount of lung inflammation, identifying activity for asthma and eosinophilic bronchitis. It is the difference between knowing your airway is inflamed and assuming it is.

Where asthma is allergic, skin testing identifies which triggers are driving it. Testing and interpretation happen on the same day as the evaluation visit when possible.

Biologic therapy, and who it is for

Biologic therapies target the underlying pathways that drive allergic and inflammatory disease, with the potential for deeper control, fewer exacerbations, and in some conditions they may actually modify the disease itself.

They are not a first step. A single biologic can be approved for several different conditions, so the question is never simply whether a drug works — it is whether it fits your diagnosis, how severe it is and what you have already tried. Most are given by injection; for chronic hives there is now one that is taken by mouth.

The conditions treated with biologics here are asthma, nasal polyps, atopic dermatitis (eczema) and chronic hives. They work at the immune system level to prevent the inflammation that causes these conditions, and they offer the convenience of less frequent office visits for an injectable treatment, and fewer side effects than traditional medications for these conditions. Some biologics are able to be injected at home.

Qualifying generally depends on your diagnosis, your severity and what you have already tried, which is why the breathing tests come before this conversation rather than after it.

Biologics for nasal polyps

Nasal polyps and asthma often travel together, and the same biologic can treat both. Where chronic rhinosinusitis with nasal polyps is not controlled by a nasal steroid, these are the biologics approved as add-on maintenance treatment.

Treating the cause, not just the symptoms

Unlike medications that temporarily control symptoms, allergy immunotherapy gradually retrains the immune system, reducing sensitivity to allergens and potentially providing benefits that persist after treatment.

Allergy shots are the long game for allergic asthma. They are all-natural rather than medication, and they are a uniquely powerful allergy therapy: rather than masking symptoms, they work gradually on the allergic and asthmatic process itself, which can mean decreased symptoms and medication needs with no long-term side effects. They may also prevent progression to more severe allergic problems by desensitizing the immune system to a specific allergen.

The options that are not an injection

Not everything offered here is a shot. For food allergy, oral immunotherapy is taken by mouth rather than injected, and for chronic hives there is now an oral option as well.

Medical management still matters: there are safe and effective medications available to help alleviate and control asthmatic symptoms, and the doctor will recommend the safest and best medication therapy for your specific problems.

So does the air you are actually breathing. After identifying your specific allergic and irritant triggers, the team recommends an environmental control program to reduce your exposure to them. Some simple and cost-effective changes at home can be very helpful — which counts for a lot in a climate where humidity keeps dust mites and indoor mold in play all year.

What the first visit looks like

The aim is to get all the relevant tests done as quickly as possible, so that an accurate, personalized diagnosis is made and a personalized treatment plan can begin as soon as possible.

• We listen to your food allergy story and review your history in detail before testing anything
• A physical exam and that history decide which tests are worth doing
• Testing and preliminary results happen during the initial evaluation visit when possible
• Allergy skin tests are personally measured and read by a physician or physician assistant, with physician oversight and interpretation
• You leave with a diagnosis and treatment steps, not a general recommendation to avoid things
• An Allergist leads the care team and is on-site for every clinic visit
• An Allergist is available 24/7 every day in case of emergency
• Your allergist communicates with your other doctors

Common questions about asthma care