Fast Five Quiz: Challenges of Severe Asthma

Zab Mosenifar, MD


February 25, 2021

Several monoclonal antibody therapies, including reslizumab, benralizumab, and dupilumab, are recommended as add-on therapy for severe or moderate to severe asthma with eosinophilic phenotype.

Eosinophilic asthma is characterized by marked elevations of eosinophils in blood, lung tissue, and sputum. Eosinophils can cause inflammation and swelling, leading to severe asthma symptoms. Patients with eosinophilic asthma have airflow obstruction extending along the entire respiratory tract, from the sinuses to the small or distal airways. Although many patients can control their symptoms with conventional treatments such as inhaled steroids or a long-acting bronchodilator, more advanced therapies are available for those who do not respond to these treatments.

While beta2 agonists, mast cell stabilizers, and leukotriene modifiers can be useful in asthma treatment, they are not specifically considered in patients with moderate-to-severe or severe eosinophilic phenotype asthma. These classes of drugs work in the following ways:

  • Beta2 agonists relieve reversible bronchospasm by relaxing the smooth muscles of the bronchi. These agents act as bronchodilators and are used to treat bronchospasm in acute asthmatic episodes and to prevent bronchospasm associated with exercise-induced asthma or nocturnal asthma.

  • Mast cell stabilizers block early and late asthmatic responses, interfere with chloride channels, stabilize the mast cell membrane, and inhibit the activation and release of mediators from eosinophils and epithelial cells. They inhibit acute responses to cold air, exercise, and sulfur dioxide.

  • Leukotrienes cause bronchospasm, increased vascular permeability, mucosal edema, and inflammatory cell infiltration. Their effects are reduced with leukotriene receptor antagonists.

Learn more about asthma medication.


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