David Bernstein, MD

Seven approved biologics now target distinct points in the inflammatory cascade, giving clinicians genuine options, even for patients with low eosinophil levels.

Every dose is another opportunity to miss one. Real-world evidence indicates that longer biologic dosing intervals are associated with higher persistence and fewer treatment gaps.

Adherence depends on clear explanation, reliable inhaler technique, and affordable medication, and gaps in any one of these can quietly erode the benefit of an effective treatment plan.

Whether the goal is remission or simply fewer exacerbations depends heavily on the population served, and repeated steroid bursts quickly accumulate into lasting harm.

Current biologics halve exacerbations but achieve remission in a minority of patients, and adherence often falters before therapy begins or around the 6-month mark.

Biologics can offset their acquisition cost by preventing exacerbations and cumulative steroid toxicity, yet billing structures and prior authorization continue to delay patients who need treatment.

Asthma costs extend well beyond the emergency department, into lost schooling, reduced earning potential, and steroid harm, which sharpens the case for recognizing uncontrolled disease and escalating care promptly.

Most patients with asthma carry a type 2 inflammatory signature, and the sickest fifth of them account for the bulk of an $80 billion annual burden.