When a patient is diagnosed with severe eosinophilic asthma, indicating the presence of more than normal levels of eosinophils, doctors begin treatment with a goal of controlling and improving the symptoms. This can be done by reducing the eosinophils that are present in the airways. As the levels of eosinophils reduce, a person will be able to regain control of their breathing. In most cases, patients respond favorably to therapies that work for asthma and therapies used in the treatment of eosinophilia. Some patients can develop resistance to these therapies. There are many treatment options available to control asthma attacks and improve the patient’s quality of life. Whereas a few options focus on controlling the asthma attacks, some focus on preventing inflammation in the lungs. New research has brought in tremendous possibilities with the introduction of lab-made antibodies that are injected into the patients. These medicines are grouped as biologic therapies.

Corticosteroids
Corticosteroids are a group of medications that are used to reduce inflammation in the body and are very commonly used to treat asthma. They are used in inhalers by those affected by many types of asthma. However, they are not as effective for severe eosinophilic asthma and have to be supplemented with corticosteroid pills. These pills have side effects that include weight gain, mood changes, weakness, acne, and slow growth. Patients should discuss these medications with the doctor before taking them and plan accordingly.

Fast-acting inhalers
These inhalers are used when one needs quick relief during a severe eosinophilic asthma attack. Also known as bronchodilators, they reduce swelling and open the airways quickly. They can be taken in addition to the regular inhalers. Side effects of these inhalers include dry mouth and palpitations.

Leukotriene modifiers
Leukotriene is a chemical present in our immune system which when combined with eosinophils causes inflammation in the airways. These modifiers help reduce the effects of the chemicals and help to restore normal breathing. Patients can face side effects like anxiety when they take these medications. Consultation with a doctor is necessary beforehand.

Bronchial thermoplasty
For those who have severe eosinophilic asthma, and none of the above medication helps to relieve symptoms, this procedure is done multiple times over weeks. Bronchial thermoplasty is an invasive procedure done by experienced pulmonologists. They use a probe to send thermal heat that smoothens the muscles in the airways. This prevents the muscles from contracting during an asthma attack.

Biologics
Antibodies are proteins produced by the immune system. Also known as immunoglobulins, this Y-shaped protein’s job is to protect the body from intruders known as antigens. These antigens could be bacteria, virus or chemicals. Biologics are antibodies created by scientists to treat particular diseases. Their job is to block the chemicals that aid inflammation of the airways. These lab-made antibodies are administered through IVIG (intravenous immunoglobulin). Side effects are rare, but some may develop serious reactions like anaphylaxis. Some of the approved biologics that are used to treat eosinophilic asthma are:

• Benralizumab

• Dupilumab
• Mepolizumab
• Reslizumab

Even though oral steroids are effective, they all have side effects. Since asthma has no cure, patients need to use these oral and inhaler steroids for long periods of time. The side effects can take a big toll on their overall health and affect their quality of life. Glaucoma, osteoporosis, weight gain, and diabetes are side effects that can add to the health issues of the patients.

Benralizumab as an asthma medication
Benralizumab is an antibody that helps reduce the impact created by the protein Interleukin – 5. This is an approved medication for patients over 12 years affected by severe eosinophilic asthma. It can be used in combination with the other asthma medications that an affected patient is currently taking.

One of the earlier medications that were approved as part of targeted therapy trials—this medicine has been tested in one of the largest ever clinical trials. According to a clinical trial, the following pointers were recorded:

• Benralizumab reduced the recurrence of severe eosinophilic by about 51 %
• Reduced the usage of oral steroids by 75% among those who were using them every day
• In some cases, the patients were able to give up the oral steroids completely

• Benralizumab improved the lung function significantly

Dosage and side effects
The recommended dosage for benralizumab – the asthma medication is – shots of 30 mg every four weeks for the first three doses. Shots are repeated once every eight weeks. Talk to your doctor about other medicines that you take. Expectant mothers and breastfeeding women should talk to the doctor to understand the risk of consuming this medication.

Some side effects of benralizumab include:

• Allergic reactions, hypersensitivity including anaphylaxis
• Sourness in the injected area

• Breathing problems
• Fainting and dizziness
• Swelling of the mouth, tongue, and face
• Rash and hives

Before taking the medicine, the patient needs to have a discussion with their doctor about their current medications. Patients who have a helminth infection, women who are expecting a baby and are breastfeeding or planning to breastfeed should understand the risk and take the medication only after it is approved by a doctor.