Which patients with asthma should be considered for biologic therapy, and what are the criteria for referral?

Patients who should be considered for biologic therapy are those with severe asthma or an incomplete response to optimised treatment, as they may need further investigation, phenotyping, and consideration of additional treatments such as biologic therapy targeting immune pathways ¹. Specialist biologic treatments may also be considered if asthma control remains inadequate following a trial of other treatments ¹.

The criteria for referral to a specialist in asthma care, which may lead to consideration of biologic therapy, include:

• Asthma that is not controlled despite treatment with moderate-dose Maintenance and Reliever Therapy (MART), and trials of both a Leukotriene Receptor Antagonist (LTRA) and a Long-Acting Muscarinic Receptor Antagonist (LAMA) ¹,².
• If, despite good adherence to moderate-dose MART, the fractional exhaled nitric oxide (FeNO) level or blood eosinophil count is raised ¹,². A raised FeNO or blood eosinophil count despite good adherence to inhaled corticosteroids (ICS) indicates a high risk of adverse outcomes ¹.
• Asthma that is not controlled on treatment containing a high dose of ICS ².