Case review

Management of severe asthma: where are we now?

Kathryn M. Hulme, Helen K. Reddel


©pathdoc/ model used for illustrative purposes only
©pathdoc/ model used for illustrative purposes only


A 77-year-old man with severe asthma and a previous history of smoking is under consideration for biologic therapy. He has had persistent, disabling asthma symptoms despite good adherence to high-dose inhaled corticosteroid and long-acting beta-agonist therapy for more than 12 months. Does he qualify for biologic therapy and where should we start?

Key Points

  • Severe asthma represents about 4% of all patients with asthma.
  • Biologic add-on therapy can be beneficial to certain patients with uncontrolled severe asthma, but they should first have their treatment optimised and their comorbidities managed.
  • Three biologics are currently approved for severe asthma phenotypes in adults and adolescents in Australia: mepolizumab (anti-interleukin [IL]-5 antibody) and benralizumab (anti-IL-5 receptor antibody) for severe eosinophilic asthma; and omalizumab (anti-immunoglobulin E) for severe allergic asthma.
  • Recent PBS changes have removed some barriers to accessing these therapies.