Peter O’Rourke developed asthma in his mid-40s and at first, he was able to control it with just a rescue inhaler. When his symptoms began to worsen, he would supplement his inhaler with a course of a high-dose steroid called prednisone, taken as a tablet. Steroids are very effective at reducing the inflammation that makes breathing difficult for people with asthma, but there’s a catch.
“The prednisone messes you up,” said O’Rourke, who is not only a Brigham and Women’s Hospital patient, but also a clinical manager there. “It’s hard to sleep and you’re always super hungry. You feel good a lot of the time but it’s a false sense of energy because what steroids are really doing is making you hyper.” Long term, steroids can also thin the bones and raise blood pressure.
Biologic medications: Game-changers for asthma treatment
His Brigham pulmonologist, Christopher Fanta, MD, then prescribed a biologic drug that changed O’Rourke’s life. Unlike traditional medications, which are created through chemical processes, biologics come from living sources.
“These drugs are game-changers for asthma because they often can replace oral steroids, which some patients refer to as ‘the devil’s drug,’ because they have so many miserable side effects,” explained Dr. Fanta.
Worsening symptoms led to a new treatment approach
When his asthma was well controlled, O’Rourke was able to enjoy his favorite activities: spin classes, racquetball and hikes in the woods with his wife and their golden retriever. But eventually, those activities left him short of breath, despite taking puffs from his inhaler. “I would feel a tightness in my chest, a pressure, like when you hold your breath under water for a while and come up, gasping for air,” he said.
Eventually things got really bad. “I would go for walks and have to stop and catch my breath,” recounted O’Rourke. Then in 2017 he was hospitalized for several days, requiring supplemental oxygen, steroids and treatment by a respiratory therapist.
“They did a lung X-ray and CT scan and my lungs looked horrible. I couldn’t breathe. It was just terrible.” That is when Dr. Fanta broached the idea of using a biologic to treat what was now becoming his difficult-to-control asthma.
“He’s very conscientious, calming and a wonderful person to have as your physician,” said O’Rourke. “When he asked me if I wanted to try it, I was confident that his suggestion was a good one. He leaves you feeling like everything will work out O.K. and it did.”
“I breathe easier, I meet with Dr. Fanta much less, my numbers on my breathing tests are perfect. It has just been wonderful. My breathing has gone back to what it was like before I was diagnosed. You can’t ask for more than that.”Peter O’Rourke
Asthma treatment with fewer side effects
Four of the five biologics prescribed for asthma are delivered through shots administered in a doctor’s office or by the patient at home — every 2 weeks or monthly, depending on the drug. The beauty of using biologics to treat asthma is that they target the specific biological mechanisms at the root of asthma.
“They’re like smart bombs,” explained Dr. Fanta. “In general, they interact only with the molecules implicated in asthma and rarely have undesired effects elsewhere, unlike oral steroids, which interact in many places in the body.”
Biologics for patients with severe, hard-to-control asthma
The best candidates for biologics are people with severe asthma who have been conscientious about using their inhalers, yet still have flare-ups. They’ve reduced their exposure to the triggers in the environment that worsen their asthma, like cat hair and cigarette smoke. And like O’Rourke, they may also have had to undergo multiple courses of oral steroids.
Dr. Fanta warns, however, that even some people who fit this description may not be helped by biologics if the biological mechanism at the root of their asthma is not one that these drugs target. Consulting with an asthma specialist is the only way to determine whether biologics would be suitable, he added. Typically, the doctor will order a blood test to help make the decision.
O’Rourke receives a monthly shot, which feels like a quick pinch. And he experiences no side effects, not even pain or swelling at the injection site. After several months of shots, he was able to get rid of his rescue inhaler and has not had to do another course of oral steroids. He does also take one daily puff of a low-dose inhaled steroid, which does not have the same troubling side effects of its oral counterparts.
O’Rourke said that the new treatment approach has transformed his life and he has returned to all of the activities he gave up when his asthma was at its worse. “I breathe easier, I meet with Dr. Fanta much less, my numbers on my breathing tests are perfect. It has just been wonderful. My breathing has gone back to what it was like before I was diagnosed. You can’t ask for more than that.”