Severe Asthma Treatment in Mohali — Biologic Therapy | Dr. Rahul Katyal

Understanding the Problem

What Does Severe or Uncontrolled Asthma Mean?

Not all asthma is the same. A small but important group of patients have asthma that stays out of control no matter how many inhalers they use — this is what specialists call severe asthma.

Most people with asthma achieve good control with a preventer (inhaled steroid) inhaler and a reliever inhaler. Severe asthma is different: it is asthma that remains uncontrolled despite high-dose inhaled corticosteroids combined with a second controller medicine, or that only stays controlled with repeated courses of oral steroids. Doctors distinguish this from "difficult-to-treat" asthma, where the real problem is poor inhaler technique, missed doses, ongoing triggers, or an untreated related condition.

The distinction matters because true severe asthma may respond to newer targeted treatments, whereas difficult-to-treat asthma usually improves once the basics are corrected. Sorting out which group you fall into is the first job of the specialist assessment.

Signs your asthma may be severe or uncontrolled

🔹 Frequent attacks despite regular preventer use

🔹 More than two oral steroid courses in a year

🔹 One or more emergency visits or admissions

🔹 Waking at night with breathlessness or wheeze

🔹 Using your reliever inhaler most days

🔹 Asthma limiting work, exercise, or daily life

The Science

Why Standard Inhalers Fail in Severe Cases

Inhaled steroids calm airway inflammation in general. But some severe asthma is driven by specific immune pathways that these inhalers simply do not switch off.

In many people with severe asthma, the airway inflammation is what doctors call "type 2" inflammation — driven by particular immune signals such as IgE antibodies and the interleukins IL-5 and IL-4/IL-13. Inhaled corticosteroids reduce inflammation broadly, but they do not specifically block these signalling pathways. So even at high doses, the underlying driver of the attacks keeps working and symptoms persist.

Escalating to higher and higher inhaler doses, or relying on repeated oral steroid courses, then exposes patients to side effects — weight gain, raised blood sugar, bone thinning, and cataracts — without solving the root problem. This is exactly the situation where a specialist looks beyond inhalers.

The breakthrough is that we can now identify these pathways with simple blood tests and then block them directly. That is what biologic therapy does.

Beyond Inhalers

Biologic Therapy — Targeting the Root of Severe Asthma

Biologics are targeted medicines (monoclonal antibodies) given as injections, usually once every few weeks. Instead of blanketing the whole immune system, each one blocks one specific inflammatory pathway that drives severe asthma. Because they act on the root driver rather than just the symptoms, they can reduce or even eliminate attacks and cut down or stop the need for oral steroids.

Below are the drug classes used in severe asthma, described by the pathway they target. The right class depends on your individual asthma phenotype, which the specialist assessment identifies.

Anti-IgE class

Blocks IgE, the antibody behind allergic asthma. Best suited to asthma driven by allergies to dust, pollen, or animal dander.

Anti-IL-5 class

Targets IL-5, which drives eosinophils — a type of white blood cell that fuels many severe asthma attacks. Suited to eosinophilic asthma.

Anti-IL-4/IL-13 class

Blocks the IL-4 and IL-13 signals central to type 2 inflammation, often helpful when asthma coexists with nasal polyps or eczema.

Note for the clinic team

[CONFIRM: which specific biologic drugs does Gini currently prescribe? — omalizumab, mepolizumab, dupilumab?] Until confirmed, this page describes biologic drug classes only and does not name specific brands as available at Gini.

Read the full guide to biologic therapy for asthma →

Eligibility

Who Qualifies for Biologic Therapy?

Biologics are not for everyone with asthma — they are reserved for genuine severe asthma with the right inflammatory signature.

💊

Uncontrolled despite maximal inhalers

Your asthma stays uncontrolled even on correctly used high-dose inhaled steroids plus a long-acting bronchodilator.

🔁

Frequent attacks or steroid courses

You have had repeated flare-ups, emergency visits, or several courses of oral steroids over the past year.

🧪

A treatable inflammatory phenotype

Blood tests (such as eosinophil count and IgE) point to type 2 inflammation that a biologic can target.

✅

Basics already optimised

Inhaler technique, adherence, triggers, and related conditions have been reviewed and addressed first.

Final eligibility is always a clinical decision. Dr. Rahul Katyal confirms the asthma diagnosis, matches your phenotype to the right biologic class, and reviews suitability before any biologic is recommended.

What to Expect

What the Specialist Assessment Involves

A structured severe asthma work-up confirms the diagnosis and identifies whether targeted therapy will help.

1

Confirm the diagnosis

A detailed history and examination, plus lung function testing (spirometry / PFT), to be sure the problem really is asthma and to grade its severity.

2

Check technique, adherence and triggers

Reviewing how you use your inhaler, whether doses are being missed, and what triggers or related conditions (allergies, reflux, sinus disease) may be driving symptoms.

3

Identify the phenotype

Blood tests including eosinophil count and IgE (and, where indicated, further airway inflammation markers) to reveal which inflammatory pathway is active.

4

Match to the right treatment

If a biologic is appropriate, Dr. Katyal matches your phenotype to the correct drug class and explains the plan, monitoring, and what response to expect. If not, the plan is optimised in other ways.

Your Specialist

Meet Dr. Rahul Katyal

Dr. Rahul Katyal

MBBS, MD Pulmonary Medicine & Non-Invasive Cardiology

Director of Critical Care · Gini Advanced Care Hospital

✓ Special interest in severe and difficult-to-treat asthma and biologic therapy
✓ Postgraduate training in both Pulmonary Medicine and Non-Invasive Cardiology
✓ Director of the 30-bed ICU — so acute severe asthma can be managed on site
✓ Manages complex heart-lung overlap cases due to dual cardiology training

Dr. Rahul Katyal is Gini Hospital's lead pulmonologist and Director of Critical Care. He manages the full spectrum of respiratory conditions, with a particular focus on severe asthma that has not responded to standard inhaler therapy. As ICU Director, he is also the right specialist to see if your asthma has previously required emergency or intensive care — because the same team that assesses you for biologics is the team that manages acute attacks.

View Full Profile →

FAQ

Severe Asthma — Frequently Asked Questions

What counts as severe asthma? +

Severe asthma is asthma that remains uncontrolled despite high-dose inhaled corticosteroids combined with a second controller (usually a long-acting bronchodilator), or that needs oral steroids to stay controlled. Signs include frequent attacks, repeated emergency visits, waking at night with breathlessness, and reliever inhaler use several times a day. It is different from asthma that is uncontrolled simply because of poor inhaler technique or missed doses.

Why do my inhalers stop working in severe asthma? +

In many severe cases the underlying airway inflammation is driven by specific immune pathways (such as IgE or the type 2 pathways involving IL-5 and IL-4/IL-13). Standard inhaled steroids reduce inflammation broadly but do not switch off these specific pathways, so attacks continue. Biologic therapies are designed to block these exact pathways, which is why they can work when inhalers alone cannot.

Who qualifies for biologic therapy for asthma? +

Biologics are generally considered for patients with severe asthma that stays uncontrolled despite correct high-dose inhaler therapy, who have had frequent attacks or needed oral steroids, and whose blood tests point to a treatable inflammatory phenotype. Dr. Rahul Katyal confirms eligibility with a full assessment before any biologic is recommended.

What does the severe asthma assessment involve? +

The assessment confirms the diagnosis, checks inhaler technique and adherence, reviews triggers and other conditions, and includes lung function testing and blood tests such as eosinophil count and IgE. These results identify the asthma phenotype and guide whether a biologic targeting IgE, IL-5, or IL-4/IL-13 is appropriate.

Can severe asthma be treated in Mohali or do I need to travel to Chandigarh? +

Severe asthma assessment and biologic therapy are available at Gini Advanced Care Hospital in Sector 69, Mohali, under Dr. Rahul Katyal. Most patients from the Chandigarh Tri-City area do not need to travel further for this level of care, and a 30-bed ICU is on site for any acute deterioration.