If your asthma still flares up even though you take your medicine every day, you may have heard the words “severe asthma” and “biologics.” This guide explains what those terms mean, what the American Lung Association says about them, and where pulmonary rehab fits next to the care your specialist directs. Bloom does not prescribe or choose biologics. Rehab is a different kind of help, and it works alongside your medical treatment.
What is severe asthma, and how is it different from uncontrolled asthma?
The American Lung Association says people with severe asthma “use the highest dose of inhaled corticosteroids plus a second controller and/or oral corticosteroids.” Its article on uncontrolled versus severe asthma explains the difference. Uncontrolled asthma tends to improve with treatment changes. With severe asthma, symptoms continue despite maximized, optimal therapy.
Before a doctor concludes that asthma is severe, the same article lists several steps:
- A review of how well your current medicines are working.
- A breathing test called spirometry to check your lung function.
- A look at how you use your inhaler, so errors can be corrected.
- A review of triggers and other factors, such as smoking, allergen exposure, reflux, obesity, and depression or anxiety.
- Time on a treatment plan. If symptoms persist after 3 to 6 months of treatment that includes a high-dose inhaled corticosteroid, severe asthma may be considered.
- A referral to a pulmonologist or allergist for further testing.
If your asthma has not been well controlled, our guide on how to treat asthma covers the basics of a treatment plan.
What are biologics for asthma?
According to the American Lung Association, biologics are medicines (monoclonal antibodies) for moderate to severe asthma that “help block the response to airway triggers.” Here is what the page says about how they are used:
- They are given by injection in a doctor’s office, by IV infusion in a clinic or hospital, or by self-injection at home.
- People taking biologics receive treatment every 2 to 8 weeks, depending on the particular biologic.
- Biologics are approved for people 18 and older, and several are available for children as young as 6.
- Starting the conversation takes a referral from your primary asthma provider. Which biologic fits depends on biomarker testing.
The association describes a biologic as something “worth discussing with your specialist to see if one of these may be right for you.” Whether a biologic fits you is a medical decision for your doctor, and nothing on this page should be read as a recommendation for or against any medicine.
Where does pulmonary rehab fit?
Medicines treat the inflammation in your airways. Rehab works on a different problem: how your body and breathing handle activity. Many people with hard-to-control asthma start avoiding stairs, walks and exercise because they are afraid of symptoms, which can leave them less fit and more breathless. Our article on pulmonary rehab for severe asthma describes who tends to be a candidate and what a program involves.
What does the research say about rehab for adults with asthma?
A Cochrane review of pulmonary rehabilitation for adults with asthma pooled 10 randomized trials with 894 adults, comparing supervised exercise and education with usual care. Its main findings:
- Six minute walking distance improved by about 80 metres right after the program. The review rates this as moderate certainty evidence and says rehab “probably causes a large increase in physical fitness.”
- Quality of life on the St George’s Respiratory Questionnaire improved a lot right after the program (moderate certainty). A second quality of life questionnaire showed little to no effect.
- Asthma Control Questionnaire scores improved slightly, with low certainty. At 9 to 12 months there was little to no difference from usual care.
The authors concluded that rehab is probably associated with clinically meaningful improvements in exercise capacity and quality of life at the end of the program, that its effect on asthma control appears minimal, and that larger, better designed studies are needed. In plain terms: rehab may help you do more with less breathlessness, but it is not a substitute for asthma medicine, and gains seen right after a program may fade without continued activity.
How Bloom can help
Bloom Medical Group offers virtual pulmonary rehab for adults with moderate to severe asthma, COPD, interstitial lung disease and long COVID. Every rehab session is one on one, live by video, with an individualized treatment plan, and we meet every patient where they are. Education sessions about your condition may include other patients. Sessions are run by licensed respiratory therapists and clinical exercise physiologists and are billed to insurance. Rehab is not a prescription service. Medicine decisions, including biologics, stay with your doctor. You can read more about how a respiratory therapist can help when asthma is not well controlled and what the evidence says about breathing exercises for asthma.
Questions to bring to your asthma specialist
- Is my asthma uncontrolled, or is it severe? What makes you think so?
- Have you checked my inhaler technique and my triggers?
- Would biomarker testing help decide whether a biologic is an option for me?
- If I start a biologic, how will we measure whether it is working?
- Is it safe for me to start a supervised exercise program, and what should I watch for?
It also helps to keep a simple log of daytime symptoms, nights you wake up, how often you use quick-relief medicine, and any urgent visits. If you are having trouble breathing right now, read our guide on how to calm asthma and when to use your rescue inhaler or call 911.
Frequently asked questions
The American Lung Association says uncontrolled asthma tends to improve with treatment changes, while severe asthma continues to cause daily symptoms despite maximized, optimal therapy. Your doctor decides which applies to you.
Biologics are monoclonal antibody medicines for moderate to severe asthma that, according to the American Lung Association, help block the response to airway triggers. They are given by injection or infusion, and some can be self-injected at home. Ask your specialist whether one may be right for you.
The American Lung Association says people taking biologics receive treatment every 2 to 8 weeks, depending on the particular biologic.
No. Rehab works alongside your prescribed treatment, not instead of it. Bloom does not prescribe or change medicines. Those decisions stay with your doctor.
A Cochrane review of 10 trials with 894 adults found that rehab probably improves exercise capacity and quality of life right after a program. Its effect on asthma control appeared minimal, and the authors called for larger studies.
Yes, for adults with moderate to severe asthma. Every rehab session is one on one and live by video, with an individualized treatment plan, run by licensed respiratory therapists and clinical exercise physiologists and billed to insurance.
Not sure whether rehab fits you?
Not sure whether rehab fits you? Take our free 2 minute lung health assessment. When you are ready, call 1-866-972-8228 or fill out the see if you qualify form.
This article is for education only and is not medical advice. Talk with your doctor about what is right for you.
Sources
- American Lung Association. Severe Asthma
- American Lung Association. Uncontrolled Asthma vs. Severe Asthma: How to Get the Right Diagnosis
- Cochrane. What are the benefits of supervised programmes of exercise and education (known as pulmonary rehabilitation) compared with usual care for adults with asthma?
