Severe Asthma

Macrolide antibiotics are used to help the body fight infection. These medicines control the number of white blood cells (or neutrophils) found in your airways. One study showed positive results using macrolide antibiotics in people with high counts of neutrophils in blood or sputum samples. Doctors don’t suggest these medications be used long term though because side effects, such as antibiotic resistance, can be very serious.

Oral corticosteroids are medicines that help to control inflammation. While experts recommend these medicines only for short-term use, doctors may prescribe them long-term for people with more frequent asthma flare-ups. Severe asthma patients use these medications in combination with quick-relief medicine, high-dose inhaled corticosteroids and long-acting bronchodilators. Side effects from using oral corticosteroids can pose a risk to the function of other bodily organs, but the benefits may at times outweigh the risk. The hope is that by using these powerful drugs for a short period of time, patients can gain better control and will eventually not need them at all. This treatment option is approved for adults and children, although long-term use in children is not recommended due to the higher risk side effects. If symptoms are still not controlled with long-term use of an oral corticosteroid, another treatment option should be considered and may include targeted therapies such as biologics.

Biologic medicines for moderate-to-severe asthma help block the response to airway triggers that cause inflammation, specifically targeting the cells that are part of the body’s immune system. Biological products include a wide range of medicines that are delivered either by an injection in your doctor’s office, IV infusion in a clinic or hospital or self-injection at home. People taking biologics receive treatment every 2-8 weeks depending on the particular biologic. Biologics are approved for people 18 years or older, and several are available for children as young as 6 years old. Pharmaceutical companies have been researching and developing these new biologic medicines with more on the way. Like most medicines, people taking biologics can experience side effects. However, this treatment option is worth discussing with your specialist to see if one of these may be right for you.

Bronchial Thermoplasty (BT) is a procedure that involves using radio frequency energy to apply mild heat to the smooth muscle tissue in the airway. The heat reduces the amount of smooth muscle tissue, causing less airway constriction and reducing flareups. BT is an option but is generally limited to those patients whose severe asthma does not respond well to inhaled corticosteroids and/or long-acting bronchodilator medications and also rely on oral-corticosteroids more than twice a year to manage asthma attacks or take an oral corticosteroid for daily maintenance. This treatment option is only available to adults and not recommended for patients that have other health conditions besides severe asthma.

Smoking, obesity, GERD and exposure to environmental triggers are linked to Non-Type-2 inflammation. This type of inflammation is mostly associated with the presence of neutrophils and few to no eosinophils in the airways. Neutrophils are white blood cells that the body produces to fight infection. Quitting smoking, changing diet, exercising, and reducing exposure to environmental triggers are strategies that may help to improve this (Non-Type 2) type of asthma.