Asthma assessment and biologic therapy

What is asthma assessment and biologic therapy?

This is a two-part pathway for people whose asthma stays severe despite regular treatment. First, a specialist severe asthma team carries out a careful assessment to confirm the diagnosis, check that inhalers are being used correctly, look for other conditions that mimic or worsen asthma, and work out what type of inflammation is driving it.

If asthma remains severe and the right tests point to it, the team may consider a biologic. Biologics are targeted medicines (monoclonal antibodies) given by injection or, in one case, a drip. Rather than easing symptoms moment to moment like a reliever inhaler, they dampen the specific immune pathways that drive asthma attacks, aiming to reduce attacks and cut down the need for steroid tablets.

Biologics are not a cure and do not work for everyone. They are for a particular group of people with severe asthma, are prescribed under strict NICE criteria, and are reviewed to check they are helping. You usually keep using your inhalers alongside them.

This guide explains what to expect; it is not personal medical advice. Your respiratory physician will explain which biologic, if any, suits you.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Steroid tablets compared with biologic therapy

A key aim of biologics is to reduce or stop long-term steroid tablets, which carry significant side effects. Your team weighs this up with you.

Preparing for your treatment

• Expect a referral to a specialist severe asthma centre, where the assessment usually takes more than one appointment.
• Bring a full list of your medicines and inhalers, and be ready to show or describe your inhaler technique.
• Be honest about how often you actually use your preventer inhaler, as poor technique or missed doses are common and treatable reasons asthma seems severe.
• You will usually have blood tests (including eosinophil count and sometimes IgE) and breathing tests such as spirometry and a FeNO test.
• Note down how many asthma attacks you have had, any A&E visits or hospital stays, and your steroid tablet use over the past year.
• Tell the team about other conditions (such as nasal polyps, reflux, anxiety or smoking) that can affect asthma.
• Ask whether you could be pregnant or are planning pregnancy, as this affects treatment decisions.

What happens

At the assessment, the specialist team reviews your history, confirms the asthma diagnosis, and checks for other conditions that can mimic or worsen it. They check your inhaler technique and how regularly you take your preventer, because getting these right sometimes improves control without a biologic. Blood tests, breathing tests and a FeNO test help show what type of inflammation you have.

If you meet the criteria for a biologic, the team explains the options, how the medicine is given, and how response will be checked. The first few doses are usually given in hospital and you are watched for about two hours afterwards in case of an allergic reaction. Many people are later taught to inject at home.

The medicine is given regularly — every few weeks depending on which biologic — alongside your usual inhalers. Your symptoms, attacks and steroid use are tracked over time to see whether it is working.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The most important risk to know about is a severe allergic reaction (anaphylaxis), which is uncommon but is why the first doses are given where staff can watch you and treat a reaction. Biologics are generally well tolerated, but they need ongoing monitoring, and they do not work for everyone. Ask your respiratory physician about the specific risks of the biologic suggested for you, how response will be judged, and what to do if you have a reaction or your asthma flares.

Published figures to discuss

How well a biologic works and how often side effects occur vary a lot between people and between the different biologics, and depend on how carefully patients are selected. Because the medicines, doses and the people they suit differ, exact percentages are not given here. The most important quantified safety point is that severe allergic reactions are uncommon but possible, which is why early doses are monitored. Eligibility and response are defined by NICE criteria rather than by a single success rate.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from the treatment itself, but the early doses involve staying to be watched, and the response is judged over months rather than straight away.

• Mild soreness or redness at the injection site
• A mild headache or aching after a dose
• No sudden change at first — benefit often builds over weeks to months
• Continuing to need your usual inhalers alongside the biologic
• Regular review appointments while on treatment

Aftercare

• Stay for the full watching period after early doses in case of a reaction.
• Keep using your preventer and reliever inhalers and your asthma action plan unless told otherwise.
• Learn the signs of an allergic reaction and what to do, and carry any emergency advice given.
• If injecting at home, follow the instructions on technique, sites, storage and disposal of needles.
• Keep a note of your symptoms, attacks, reliever use and any steroid courses to bring to reviews.
• Do not stop the biologic or your inhalers suddenly without speaking to your specialist.
• Keep your review appointments and save the team's contact number for questions or problems.

• Specialist severe asthma referral and assessment booked
• List of medicines, inhalers and recent attacks prepared
• Blood and breathing tests arranged
• Understanding of how the biologic is given and watched
• Training planned for home injection if suitable
• Asthma action plan up to date
• Specialist team contact number saved

⚠ Get urgent help if…

• Signs of a severe allergic reaction after a dose — swelling of the face, lips or throat, difficulty breathing, a widespread rash or feeling faint — call 999
• An asthma attack that is not relieved by your reliever inhaler
• Increasing breathlessness, wheeze or chest tightness
• Needing your reliever far more often than usual
• A high fever or signs of a significant infection
• Any new or severe symptom you are worried about after a dose

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good response usually means fewer asthma attacks, less need for steroid tablets, and better day-to-day control and breathing. Because biologics work by changing inflammation over time, the benefit is judged over weeks to months, not on a single dose.

A biologic does not cure asthma and does not work for everyone. If there is not a clear enough improvement by the formal review (usually around 12 months), the team may stop it or switch to a different one. Even when it works well, you usually keep taking your inhalers. Your respiratory physician will explain what counts as an adequate response in your case.

Biologics are a long-term treatment that works while you keep taking it, rather than a one-off fix. If it helps, it is usually continued and reviewed each year. Asthma and its triggers can change over time, so your treatment and which biologic you are on may be adjusted. Stopping treatment is a decision to make with your specialist, not on your own.

Related tests, treatments or support

Biologics are used alongside your usual asthma inhalers and action plan, not instead of them. The assessment also looks at treating linked conditions, such as nasal polyps, reflux or smoking, and at vaccinations. Some biologics are also used for related conditions, which your team will explain if relevant to you.

Follow-up & long-term care

You will have regular specialist follow-up while on a biologic, with your symptoms, attacks and steroid use tracked. A formal review at about 12 months decides whether the treatment has helped enough to continue, and it is then reviewed each year. You should know who to contact between appointments and what to do in an asthma attack or after a reaction.

• Keep using your preventer inhaler and follow your asthma action plan alongside the biologic.
• Attend regular reviews so attacks, symptoms and steroid use can be tracked.
• Keep up with recommended vaccinations as advised by your team.
• Maintain good inhaler technique and adherence, which underpin the biologic's benefit.
• Tell your team if you are planning pregnancy, become pregnant, or your circumstances change.

Repeat, follow-on and what comes next

• If there is not a clear enough improvement by the review at about 12 months, the biologic is usually stopped.
• Switching to a different biologic is common if the first does not work well enough.
• Response is reassessed each year, and treatment may be adjusted as asthma changes.
• Even a biologic that works well is usually continued alongside inhalers rather than replacing them.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Early doses given where an allergic reaction can be watched for and treated.
• Clear written advice on the signs of a reaction and exactly what to do.
• A named specialist team contact and an up-to-date asthma action plan.
• Regular review of attacks, symptoms and steroid use, with a formal review at about 12 months.
• Safe arrangements and training if you self-inject at home, including storage and needle disposal.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The specialist assessment, including several appointments and tests
• The specific biologic chosen, as costs differ between medicines
• How often the medicine is given and for how long
• Whether doses are given in hospital or self-injected at home after training
• Blood tests and breathing tests for the initial assessment and ongoing monitoring
• Regular review appointments, including the formal review at about 12 months

• The cost of the specialist assessment and all initial tests
• The cost of the biologic itself and how often it is given
• Whether early doses given and monitored in hospital are included
• The cost of training and supplies if you inject at home
• Ongoing monitoring blood tests, breathing tests and review appointments
• What happens, and what it costs, if the biologic does not work and you stop or switch

On the NHS? Biologics for severe asthma are available on the NHS for people who meet NICE eligibility criteria after a specialist assessment; private access is mainly used for speed or choice rather than because the NHS does not offer them.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• Has my asthma diagnosis been confirmed, and have other causes and my inhaler technique been checked first?
• Do I meet the NICE criteria for a biologic, and which one is most suitable for my type of asthma?
• What is the expected benefit, how will you judge whether it is working, and when is the review?
• What are the side effects and the risk of an allergic reaction, and what should I do if I have one?
• What happens if it does not work well enough — would I switch to a different biologic or stop?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for asthma assessment and biologic therapy

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: Asthma + Lung UK — Biologic therapies for severe asthma and COPD NICE — Benralizumab for treating severe eosinophilic asthma (TA565) NHS Accelerated Access Collaborative — Asthma biologics British Thoracic Society / SIGN — Asthma guideline Biological therapy for severe asthma — review (PMC)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.